Abstract
Purpose
To compare changes in the A-line ARX index (AAI) by the Alaris AEP monitor™ with those of the bispectral index (BIS) during propofol-fentanyl-nitrous oxide anesthesia.
Methods
Eighty female patients undergoing partial mastectomy were randomly allocated to AAI or BIS (40 per group). Anesthesia was induced with propofol 2 mg·kg−1 and fentanyl 3 μg·kg−1 during the inhalation of oxygen. A laryngeal mask airway (LMA) #3 was inserted. Anesthesia was maintained with propofol 4 mg·kg−1·hr−1, fentanyl 1 μg·kg−1 given at the start of surgery, and nitrous oxide 4 L·min−1 in oxygen 2 L·min−1. Blood pressure, heart rate, and AAI or BIS were monitored, including recovery time of the index after disturbance by electrocautery.
Results
The AAI but not the BIS increased significantly with LMA insertion and skin incision, while blood pressure and heart rate did not change. The BIS decreased from 87 ± 7 to 30–60 while the AAI decreased from 75 ± 8 to 10–25 during anesthesia. The increase of the AAI was larger than that of the BIS at recovery from anesthesia. The variation of the index was smaller in the AAI than in the BIS. Recovery time of the index after electrocautery was significantly longer in the BIS group (21 ±9 sec) than that in the AAI group (5 ± 3 sec).
Conclusions
During propofol-fentanyl-nitrous oxide anesthesia, the AAI responded to LMA insertion or surgical incision, but not the BIS, and the AAI had smaller variations. The AAI recovered faster from the disturbance by electrocautery than the BIS. Thus, the AAI may be a more sensitive and useful detector of arousal than the BIS.
Résumé
Objectif
Comparer les changements de l’index «A-line ARX» (AAI) par le Alaris AEP monitor™ avec ceux de l’index bispectral (BIS) pendant l’anesthésie avec propofol-fentanyl-protoxyde d’azote.
Méthode
Quatre-vingt femmes devant subir une mastectomie partielle ont été réparties également en deux groupes (AAI ou BIS). L’anesthésie a été induite avec 2 mg·kg−1 de propofol et 3 μg·kg−1 de fentanyl pendant l’inhalation d’oxygène. Un masque laryngé (ML) n∮ 3 a été inséré. L’anesthésie a été maintenue avec 4 mg·kg−1·h−1 de propofol, 1 μg·kg−1 de fentanyl au début de l’opération et 4 L·min−1 de protoxyde d’azote dans 2 L·min−1 d’oxygène. La tension artérielle, la fréquence cardiaque, et l’AAI ou le BIS ont été enregistrés, y compris le temps de récupération de l’index après la perturbation causée par l’électrocautérisation.
Résultats
L’AAI, mais non le BIS, s’est élevé de façon significative avec l’insertion du ML et l’incision cutanée, tandis que la tension artérielle et la fréquence cardiaque n’ont pas changé. Le BIS est passé de 87 ± 7 à 30–60 pendant que l’AAI a baissé de75± 8à 10–25 pendant l’anesthésie. La hausse de l’AAI a été plus importante que celle du BIS lors du réveil. La variation de l’index a été plus petite dans l’AAI que dans le BIS. Le temps de récupération de l’index après l’électrocautérisation a été significativement plus long avec le BIS (21 ± 9 sec) qu’avec l’AAI (5 ± 3 sec).
Conclusion
Pendant l’anesthésie avec propofol-fentanyl-protoxyde d’azote, l’AAI a été sensible à l’insertion du ML ou à l’incision chirurgicale, mais non le BIS, et l’AAI n’a eu que de faibles variations. L’AAI a été récupéré plus rapidement que le BIS après la perturbation causée par l’électrocautérisation. L’AAI peut donc être un détecteur plus efficace et sensible du réveil que le BIS.
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Nishiyama, T., Hanaoka, K. The A-line ARX index may be a more sensitive detector of arousal than the bispectral index during propofol-fentanyl-nitrous oxide anesthesia: A preliminary investigation. Can J Anesth 51, 539–544 (2004). https://doi.org/10.1007/BF03018394
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DOI: https://doi.org/10.1007/BF03018394