Electroencephalographic density spectral array monitoring during propofol sedation in teenagers, using the narcotrend electroencephalographic monitor.

BACKGROUND: Recently published articles address concerns about the safe use of currently available index-based depth of hypnosis monitors. Electroencephalographic Density Spectral Array monitoring facilitates the interpretation of unprocessed electroencephalogram data, providing the anesthesiologist with real-time drug-specific information on hypnotic depth. The primary aim of this study was to investigate the clinical applicability of Density Spectral Array with a commercially available monitor as the Narcotrend EEG monitor in teenagers under procedural sedation using propofol. METHODS: We performed a secondary analysis of EEG data. Unprocessed electroencephalogram data from 37 patients, aged 12-18 years, scheduled for gastrointestinal endoscopy under propofol sedation, were used for analysis. The relationship between non-steady state propofol concentrations and Density Spectral Array, represented by the four electroencephalographic frequency bands ß, α, θ and δ was investigated. RESULTS: Increasing propofol concentration caused augmentation in the amplitude of frontal δ oscillations and a decrease in the amplitude of frontal ß oscillations. The expression of α oscillations showed a biphasic pattern related to increasing the propofol concentration. Spearman correlation analysis showed a significant correlation between propofol concentration and relative EEG power in ß (r -0.84, P<0.0001), θ (r 0.50, P=0.004) and δ (r 0.63, P<0.0001). CONCLUSIONS: We were able to show that DSA displayed in real time, on a commercially available DoA monitor (the Narcotrend EEG monitor), can provide the anesthesiologist with understandable information regarding the dose-dependent EEG effects of propofol in teenagers.

The heart rate variability-derived Newborn Infant Parasympathetic Evaluation (NIPE™) Index in pediatric surgical patients from 0 to 2 years under sevoflurane anesthesia-A prospective observational pilot study.

BACKGROUND: The heart rate variability-derived Newborn Infant Parasympathetic Evaluation (NIPE™) Index is a continuous noninvasive tool to assess pain and discomfort in infants <2 years. Initial studies focused on pain monitoring in the neonatal intensive care unit environment. AIMS: The aim of this study was to investigate the performance of the NIPE in infants under sevoflurane anesthesia. The primary objective of this study was to compare the NIPE and heart rate as tools to help recognize the need for additional opioid drugs. Secondary objectives were the course of the NIPE and heart rate around specific standardized noxious procedural mile-stones. METHODS: NIPE and heart rate values recorded during a 120 seconds interval before the anesthetist's decision to administer additional opioid due to the perceived insufficient antinociception and during a 120 seconds interval after drug administration were analyzed by means of a repeated measures ANOVA. The same analyses were performed for datasets around per protocol administration of morphine for postoperative analgesia, performance of a caudal block and surgical incision. RESULTS: In patients with a NIPE value <50, an additional opioid drug administration resulted in a rise of NIPE values, reaching a maximum increase of 5.1 (95% CI: 0.22-9.99) units 120 seconds after drug administration (P = 0.041). There was no evidence of a change in heart rate during these two 120 seconds periods. Per protocol administration of morphine, caudal block, and surgical incision did not result in changes of the NIPE, which was around 65 units on these occasions, and heart rate. CONCLUSION: In infants anesthetized with sevoflurane, NIPE values <50 might be indicative of insufficient antinociception. The results of this observational pilot study might suggest that the NIPE could be a better measure of the nociception/antinociception balance than heart rate.