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GENERAL ARTICLES

The Performance of Electroencephalogram Bispectral Index and Auditory Evoked Potential Index to Predict Loss of Consciousness During Propofol Infusion

Stefan Schraag, MD^*, Ulrich Bothner, MD, Roger Gajraj, MD, Gavin N. C. Kenny, MD, BSc, FRCA^§, and Michael Georgieff, MD, PhD^*

*Department of Anesthesiology, University of Ulm, Ulm, Germany; Department of Medical Informatics, University of Utah, Salt Lake City, Utah; Department of Anaesthesia, The General Infirmary, Leeds, UK; and §Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK

Address correspondence and reprint requests to Stefan Schraag, MD, Department of Anesthesiology, University of Ulm, Stein- hövelstraße 9, D-89075 Ulm, Germany. Address e-mail to stefanschraag{at}compuserve.com

The bispectral index (BIS) of the electroencephalogram and middle latency auditory evoked potentials are likely candidates to measure the level of unconsciousness and, thus, may improve the early recovery profile. We prospectively investigated the predictive performance of both measures to distinguish between the conscious and unconscious state. Twelve patients undergoing lower limb orthopedic surgery during regional anesthesia additionally received propofol by target-controlled infusion for sedation. The electroencephalogram BIS and the auditory evoked potential index (AEPi), a mathematical derivative of the morphology of the auditory evoked potential waveform, were recorded simultaneously in all patients during repeated transitions from consciousness to unconsciousness. Logistic regression procedures, receiver operating characteristic analysis, and sensitivity and specificity were used to compare predictive ability of both indices. In the logistic regression models, both the BIS and AEPi were significant predictors of unconsciousness (P < 0.0001). The area under the receiver operating characteristic curve for discrete descending index threshold values was apparently, but not significantly (P > 0.05), larger for the AEPi (0.968) than for the BIS (0.922), indicating a trend of better discriminatory performance. We conclude that both the BIS and AEPi are reliable means for monitoring the level of unconsciousness during propofol infusion. However, AEPi proved to offer more discriminatory power in the individual patient.

Implications: Both the bispectral index of the electroencephalogram and the auditory evoked potentials index are good predictors of the level of sedation and unconsciousness during propofol infusion. However, the auditory evoked potentials index offers better discriminatory power in describing the transition from the conscious to the unconscious state in the individual patient.

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