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TECHNOLOGY, COMPUTING, AND SIMULATION

A-Line, Bispectral Index, and Estimated Effect-Site Concentrations: A Prediction of Clinical End-Points of Anesthesia

Department of Anesthesiology and Intensive Care Medicine, University of Saarland, Homburg/Saar, Germany in co-operation with the Outcomes Research^TM Institute, University of Louisville, Louisville, Kentucky

Address correspondence and reprint requests to Sascha Kreuer, MD, Department of Anesthesiology and Intensive Care Medicine, University of Saarland 66421 Homburg/Saar, Germany. Address e-mail to sascha.kreuer{at}uniklinik-saarland.de.

Autoregressive modeling with exogenous input of middle-latency auditory evoked potentials (A-Line AEP index, AAI) has been developed for monitoring depth of anesthesia. We investigated the prediction of recovery and dose-response relationship of desflurane and AAI or bispectral index (BIS) values. Twenty adult men scheduled for radical prostatectomy were recruited. To minimize opioid effects, analgesia was provided by a concurrent epidural in addition to the general anesthetic. Electrodes for AAI and BIS monitoring and a headphone for auditory stimuli were applied. Propofol and remifentanil were used for anesthetic induction. Maintenance of anesthesia was with desflurane only. For comparison to AAI and BIS monitor parameters, pharmacokinetic models for desflurane and propofol distribution and effect-site concentrations were used to predict clinical end-points (Prediction probability P_K). Patients opened their eyes at an AAI value of 47 ± 20 and a BIS value of 77 ± 14 (mean ± sd), and the prediction probability for eye opening was P_K = 0.81 for AAI, P_K = 0.89 for BIS, and P_K = 0.91 for desflurane effect-site concentration. The opening of eyes was best predicted by the calculated desflurane effect-site concentration. The relationship between predicted desflurane effect-site concentration versus AAI and BIS was calculated by nonlinear regression analysis (r = 0.75 for AAI and r = 0.80 for BIS). The correlation between BIS and clinical end-points of anesthesia or the desflurane effect-compartment concentration is better than for the AAI.

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