Document Detail

Automated responsiveness test and bispectral index monitoring during propofol and propofol/N2O sedation.
MedLine Citation:
PMID:  12904186     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Sedation practice, especially when non-anaesthesia personnel are involved, requires efficient anaesthetic depth monitoring. Therefore, we used prediction probability (PK) to evaluate the performance of the bispectral index (BIS) of the EEG and automated responsiveness test (ART) to predict sedation depth and loss of subject's responsiveness during propofol sedation, with and without N2O. METHODS: Twenty volunteers were studied during propofol administration with (N2O) and without (Air) N2O. The protocol consisted of sequential 15-min cycles. After a control period, propofol was infused to a target effect-site concentration of 0.25 microg/ml (N2O) or 1.5 microg/ml (Air), which was subsequently increased by 0.25 or 0.5 microg/ml, respectively, until loss of responsiveness was detected by loss of response to command [observer's assessment of alertness/sedation (OAA/S) score <or= 2]. RESULTS: Deeply sedated patients did not respond to ART indicating that the sensitivity was 1.0 with or without N2O. The specificity of ART was 0.24 with Air and 0.98 with N2O. The BIS was better than ART in predicting OAA/S score (PK = 0.84 vs. 0.77) and loss of responsiveness (PK = 0.87 vs. 0.69) during the Air trial. Nitrous oxide decreased the performance of BIS in predicting OAA/S score (PK = 0.76), but increased the performance of ART to predict loss of responsiveness (PK = 0.85). CONCLUSION: BIS and ART comparably predict sedation and loss of responsiveness. However, ART, because of its resistance to false-normal responses, might prove to be more useful on an individual patient basis - especially in the presence of agents that impair BIS sensitivity.
A G Doufas; M Bakhshandeh; G S Haugh; A R Bjorksten; R Greif; D I Sessler
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  47     ISSN:  0001-5172     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  2003 Sep 
Date Detail:
Created Date:  2003-08-07     Completed Date:  2004-01-22     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  951-7     Citation Subset:  IM    
The Outcomes Research Institute and Department of Anesthesiology and Pharmacology, University of Louisville, Louisville, KY 40202, USA.
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MeSH Terms
Electroencephalography / drug effects*
Hypnotics and Sedatives / pharmacology*
Monitoring, Physiologic
Nitrous Oxide / pharmacology*
Propofol / blood,  pharmacology*
Grant Support
Reg. No./Substance:
0/Hypnotics and Sedatives; 10024-97-2/Nitrous Oxide; 2078-54-8/Propofol

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