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Failure of Two Commercial Indexes and Spectral Parameters to Reflect the Pharmacodynamic Effect of Desflurane on EEG

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Abstract

Objective

We compared two PK/PD models, one with and one without a plateau effect. Bispectral (BIS, Aspect Medical Systems, Natick, MA, version XP) and Narcotrend™ (NCT, MonitorTechnik, Bad Bramstedt, Germany, Version 4.0) indices were used as an electroencephalographic measure of desflurane drug effect.

Methods

With IRB approval and informed consent we investigated 20 adult patients scheduled for radical prostatectomy. At least 45 minutes after induction of general anaesthesia, end-tidal concentrations of desflurane was varied between 3 and 10 vol%. To evaluate the relationship between concentrations and EEG indices, two different pharmacodynamic models were applied: A conventional model based on a single sigmoidal curve, and a novel model based on two sigmoidal curves for BIS and NCT values with and without burst suppression. The parameters of the models␣were estimated by NONMEM V (GloboMax, Hanover, USA) by minimizing log likelihood. Statistical significance between the two models was calculated by the likelihood ratio test.

Results

The maximum end-tidal desflurane concentration during the two concentrations ramps was 10.0 ± 1.4 vol%. The mean BIS and NCT values decreased significantly but slightly with increasing end-tidal desflurane concentrations between 4 and 8 vol%. Therefore a two sigmoidal curves PK/PD model including a plateau describes the effects of desflurane on BIS and Narcotrend better than a single sigmoidal curve model. The difference between the log likelihood values of the new PK/PD model with two connected sigmoidal curves and the classical E max model with one sigmoidal curve is 634 (P < 0.001) for the BIS monitor and 4089 (P < 0.001) for the NCT.

Conclusions

BIS and Narcotrend are not useful to differentiate pharmacodynamic changes in the EEG between 4 and 9 vol% desflurane.

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Acknowledgement

This study was solely supported by departmental funding.

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Authors and Affiliations

  1. Department of Anaesthesiology and Intensive Care Medicine, University of Saarland, 66421, Homburg/Saar, Saarland, Germany

    Sascha Kreuer MD, Stephan Ziegeler MD & Darius Kubulus MD

  2. Department of Anaesthesiology, UMC St. Radboud, Nijmegen, The Netherlands

    Jörgen Bruhn MD

  3. Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Bonn, NRW, Germany

    Richard Ellerkmann MD

  4. Department of Anaesthesiology and Intensive Care Medicine, St.-Marien-Hospital, Luenen, NRW, Germany

    Wolfram Wilhelm MD, DEAA

Authors
  1. Sascha Kreuer MD
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  2. Jörgen Bruhn MD
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  3. Richard Ellerkmann MD
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  4. Stephan Ziegeler MD
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  5. Darius Kubulus MD
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  6. Wolfram Wilhelm MD, DEAA
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Corresponding author

Correspondence to Sascha Kreuer MD.

Additional information

This study was presented in part at the American Society of Anesthesiologists meeting October 20, 2005 Atlanta.

Kreuer S, Bruhn J, Ellerkmann R, Ziegeler S, Kubulus D, Wilhelm W. Failure of two commercial indexes and spectral parameters to reflect the pharmacodynamic effect of desflurane on EEG.

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Kreuer, S., Bruhn, J., Ellerkmann, R. et al. Failure of Two Commercial Indexes and Spectral Parameters to Reflect the Pharmacodynamic Effect of Desflurane on EEG. J Clin Monit Comput 22, 149–158 (2008). https://doi.org/10.1007/s10877-008-9116-1

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  • DOI: https://doi.org/10.1007/s10877-008-9116-1

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