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NEUROSURGICAL ANESTHESIOLOGY AND NEUROSCIENCE

A Comparison in Adolescents of Composite Auditory Evoked Potential Index and Bispectral Index During Propofol-Remifentanil Anesthesia for Scoliosis Surgery with Intraoperative Wake-Up Test

Heleen J. Blussé van Oud-Alblas, MD^*, Jeroen W. B. Peters, PhD^*, Tom G. de Leeuw, MD^*, Kris T. A. Vermeylen, MD^*, Luuk W. L. de Klerk, MD, PhD, Dick Tibboel, MD, PhD, Jan Klein, MD, PhD^*, and Frank Weber, MD^*

From the Departments of *Anesthesiology, Orthopedics, and Pediatric Surgery, Erasmus Medical Center–Sophia Children’s Hospital, Rotterdam, The Netherlands.

Address correspondence and reprint requests to Heleen Blussé van Oud-Alblas, Department of Anesthesiology, Erasmus Medical Center, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands. Address e-mail to h.blussevanoudalblas{at}erasmusmc.nl.

Abstract

BACKGROUND: The electroencephalogram-derived Bispectral Index (BIS), and the composite A-line ARX index (cAAI), derived from the electroencephalogram and auditory evoked potentials, have been promoted as anesthesia depth monitors. Using an intraoperative wake-up test, we compared the performance of both indices in distinguishing different hypnotic states, as evaluated by the University of Michigan Sedation Scale, in children and adolescents during propofol-remifentanil anesthesia for scoliosis surgery. Postoperative explicit recall was also evaluated.

METHODS: Twenty patients (aged 10–20 yr) were enrolled. Prediction probabilities were calculated for induction, wake-up test, and emergence. BIS and cAAI were compared at the start of the wake-up test, at purposeful movement to command, and after the patient was reanesthetized. During the wake-up test, patients were instructed to remember a color, and were then interviewed for explicit recall.

RESULTS: Prediction probabilities of BIS and cAAI for induction were 0.82 and 0.63 (P < 0.001), for the wake-up test, 0.78 and 0.79 (P < 0.001), and 0.74 and 0.78 for emergence (P < 0.001). During the wake-up test, a significant increase in mean BIS and cAAI (P < 0.05) was demonstrated at purposeful movement, followed by a significant decline after reintroduction of anesthesia.

CONCLUSIONS: During induction, BIS performed better than cAAI. Although cAAI was statistically a better discriminator for the level of consciousness during the wake-up test and emergence, these differences do not appear to be clinically meaningful. Both indices increased during the wake-up test, indicating a higher level of consciousness. No explicit recall was demonstrated.