ORIGINAL ARTICLE
Year : 2013  |  Volume : 6  |  Issue : 3  |  Page : 243-248

The effect of cerebral monitoring on depth of anesthesia using auditory-evoked potential


Department of Anesthesia and ICU, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Correspondence Address:
Wafaa Z. El-Morsy
MD, Department of Anesthesia and ICU, Faculty of Medicine, Al-Azhar University, 11471 Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


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Background Monitoring depth of anesthesia may improve anesthetic dosing and postanesthetic recovery. The auditory-evoked potential (AEP) monitors provide an electroencephalogram-derived index, A-lme autoregression index (AAI), that has been reported to correlate with central nervous system depressant effects of anesthetic drugs. Patients and methods Forty consenting female patients undergoing elective gynecological laparoscopic surgery procedures were assigned randomly to either a control group (standard clinical practice) or an AEP-monitored group. Although the AEP monitor was connected to all patients of both groups, in the control group, the inspired sevoflurane concentration was varied on the basis of standard clinical parameters (target = baseline hemodynamic parameters! 1 5%). In the AEP-monitored group, the inspired sevoflurane concentration was titrated to maintain AAI (target = 20±5). Heart rate, arterial blood pressure, inspiratory and expiratory gas concentration, and AAI were recorded in all patients of both groups, but AAI was made available only to the anesthesiologist assigned to AAl-momtored patients. The recovery times to achieve a white fast-track score greater than 1 2, an Aldrete score of 1 0, and the actual duration of postanesthesia care unit stay were determined. Results The AAl-momtored group showed a reduction in the consumption of sevoflurane by 27% (18±5 vs. 13±4ml/h, P= 0.001) compared with the standard clinical parameters group (control) and also a highly significant reduction of end-tidal concentration of sevoflurane by 24% (2.5±0.3 vs. 1.9 ±0.5, P=0.000), but there was no significant difference between the two groups in the total doses of propofol, fentanyl, and cisatracunum. The average intraoperative AAI value in the AEP-monitored group was significantly higher than the control group (23.64 ±0.50 vs. 18.27 ±1.27, P= 0.000). The AAl-momtored group more rapidly achieved an Aldrete score of more than 9 (mm) (32 ±8 vs. 40 ±7 mm, P= 0.028) and achieved fast-track eligibility of more than 1 2 (mm) (28 ± 1 0 vs. 45 ± 1 2 mm, P= 0.002) compared with the control group. The duration of stay in the recovery room (72 ± 28 vs. 1 02 ± 48 mm, P=0.02) was also significantly reduced in the AAl-momtored group. Conclusion The use of AEP monitoring as an adjunct to standard clinical monitors improved titration of anesthetic drugs therapy, facilitating early recovery.


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