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LETTER TO THE EDITOR

The Auditory Evoked Potential Monitor: First Data from Infants Outside the Operation Room

ErasmusMC-Sophia Children’s Hospital; Pediatric Surgery; Rotterdam, the Netherlands; s.prins9{at}chello.nl

To the Editor:

Increased awareness of anxiety and pain in children in intensive care units has increased the use of sedatives and analgesics. We can monitor these drugs with behavioral assessment tools or with electroencephalogram-derived techniques, such as the bispectral index and auditory evoked potential (AEP) monitor (1,2). The A-line ARX index (AAI), derived from the AEP monitor, has been reported to measure the hypnotic component of anesthetic drugs (3).

We performed a pilot study in eight children (median age 40 days, range 1–795 days) to determine how well the AEP monitor assessed levels of sedation. We encountered six severe limitations. First, for almost 80% of testing time patients received 75 dB click stimuli, exceeding the unit’s environmental noise (54 ± 4 dB). Second, we frequently noted artifacts and signal disturbances, only 48.6% of the AAI values were artifact free. Third, children easily pulled off connection cables. Fourth, it was difficult to apply the electrodes and earphone. Fifth, electrode impedance testing was time-consuming and irritating to the children, who then attempted to disconnect the electrodes. Finally, removal of the electrodes revealed erythematous skin indentations in all children. Fortunately, lesions disappeared after 15 min without leaving scars.

We terminated our pilot study after collecting data on just eight patients because of these limitations. Although the AEP monitor yields objective data and requires no verbal interaction or physical stimuli, we feel it is not ready for use in pediatric intensive care.

REFERENCES

1. Billard V. Brain injury under general anesthesia: is monitoring of the EEG helpful? Can J Anaesth 2001;48:1055–60.[Web of Science][Medline]
2. Absalom AR, Sutcliffe N, Kenny GN. Effects of the auditory stimuli of an auditory evoked potential system on levels of consciousness, and on the bispectral index. Br J Anaesth 2001;87:778–80.[Abstract/Free Full Text]
3. Anderson RE, Barr G, Jakobsson JG. Correlation between AAI-index and the BIS-index during propofol hypnosis: a clinical study. J Clin Monit Comput 2002;17:325–9.[Medline]

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