Five commercial 'depth of anaesthesia' monitors provide discordant clinical recommendations in response to identical emergence-like EEG signals.

Hight, Darren; Kreuzer, Matthias; Ugen, Gesar; Schuller, Peter; Stüber, Frank; Sleigh, Jamie; Kaiser, Heiko A (2023). Five commercial 'depth of anaesthesia' monitors provide discordant clinical recommendations in response to identical emergence-like EEG signals. British journal of anaesthesia, 130(5), pp. 536-545. Oxford University Press 10.1016/j.bja.2022.12.026

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BACKGROUND

'Depth of anaesthesia' monitors claim to measure hypnotic depth during general anaesthesia from the EEG, and clinicians could reasonably expect agreement between monitors if presented with the same EEG signal. We took 52 EEG signals showing intraoperative patterns of diminished anaesthesia, similar to those that occur during emergence (after surgery) and subjected them to analysis by five commercially available monitors.

METHODS

We compared five monitors (BIS, Entropy-SE, Narcotrend, qCON, and Sedline) to see if index values remained within, or moved out of, each monitors' recommended index range for general anaesthesia for at least 2 min during a period of supposed lighter anaesthesia, as observed by changes in the EEG spectrogram obtained in a previous study.

RESULTS

Of the 52 cases, 27 (52%) had at least one monitor warning of potentially inadequate hypnosis (index above range) and 16 of the 52 cases (31%) had at least one monitor signifying excessive hypnotic depth (index below clinical range). Of the 52 cases, only 16 (31%) showed concordance between all five monitors. Nineteen cases (36%) had one monitor discordant compared with the remaining four, and 17 cases (33%) had two monitors in disagreement with the remaining three.

CONCLUSIONS

Many clinical providers still rely on index values and manufacturer's recommended ranges for titration decision making. That two-thirds of cases showed discordant recommendations given identical EEG data, and that one-third signified excessive hypnotic depth where the EEG would suggest a lighter hypnotic state, emphasizes the importance of personalised EEG interpretation as an essential clinical skill.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy > Partial clinic Insel 04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Anästhesiologie 04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Anästhesiologie
UniBE Contributor:	Hight, Darren Fletcher, Ugen, Gesar Vincent, Stüber, Frank, Kaiser, Heiko Andreas
Subjects:	600 Technology > 610 Medicine & health
ISSN:	0007-0912
Publisher:	Oxford University Press
Language:	English
Submitter:	Pubmed Import
Date Deposited:	10 Mar 2023 10:10
Last Modified:	14 Apr 2023 00:15
Publisher DOI:	10.1016/j.bja.2022.12.026
PubMed ID:	36894408
Uncontrolled Keywords:	BIS Narcotrend Sedline Spectral Entropy depth of anaesthesia monitor electroencephalography general anaesthesia qCON
URI:	https://boris.unibe.ch/id/eprint/179850