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Evaluation of the auditory evoked potentials derived aep EX ™ as a measure of hypnotic depth in pediatric patients receiving sevoflurane–remifentanil anesthesia
Author(s) -
Cheung Yuen M.,
Scoones Gail P.,
Stolker Robert J.,
Weber Frank
Publication year - 2014
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.12434
Subject(s) - medicine , bispectral index , anesthesia , sevoflurane , receiver operating characteristic , remifentanil , desflurane , sedation , propofol
Summary Background The aep EX is a measure of depth of hypnosis (DoH), derived from processed mid‐latency auditory evoked potentials. Objectives To evaluate the aep EX as a measure of DoH in children receiving sevoflurane–remifentanil anesthesia. Methods aep EX and bispectral index ( BIS ) were recorded simultaneously in 75 children, (1–3, 3–6, and 6–18 years), receiving sevoflurane at endtidal concentrations ( ET sevo ) between 1.5 and 0.5 MAC . The ET sevo at which the aep EX and BIS had a value of 50 ( EC 50 aep EX and EC 50 BIS ) was calculated by nonlinear regression analysis. The accuracy of aep EX and BIS to predict the DoH was assessed by prediction probability (P k ) and receiver operating characteristics ( ROC ) analysis. Results Seventy‐four children were included for analysis. The EC 50 aep EX (2.68%) and EC 50 BIS (2.10%) were comparable; the same accounts for the EC 50 aep EX of the different age groups and the EC 50 aep EX and EC 50 BIS of corresponding age groups. The EC 50 BIS in children aged 1–3 years was lower than in the older age groups ( P < 0.05). P k values of the aep EX (0.32, CI 95% 0.08–0.56) and BIS (0.47, CI 95% 0.19–0.75) were comparable. The area under the ROC curve was 0.72 ( CI 95%: 0.62–0.82) and 0.67 ( CI 95%: 0.56–0.77) for the aep EX and BIS , respectively ( P = 0.54). Optimal cutoff values were >60 (aep EX ) and >68 ( BIS ), with corresponding specificities 91%, CI 95%: 80–97% (aep EX ) and 66%, CI 95%: 52–77% ( BIS ). Conclusions In this study with children receiving sevoflurane anesthesia, the aep EX outperformed the BIS in distinguishing unconsciousness from consciousness. Both indices performed equally bad in differentiating different levels of DoH.