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A comparison between bispectral index analysis and auditory-evoked potentials for monitoring the time to peak effect to calculate the plasma effect site equilibration rate constant of propofol

Published online by Cambridge University Press:  01 October 2007

M.-Z. Zhang ,
Q. Yu ,
Y.-L. Huang ,
S.-J. Wang  and
X.-R. Wang
M.-Z. Zhang*
Affiliation:
Shanghai Jiao Tong University School of Medicine, Renji Hospital, Department of Anaesthesiology, Shanghai, China
Q. Yu
Affiliation:
Shanghai Jiao Tong University School of Medicine, Renji Hospital, Department of Anaesthesiology, Shanghai, China
Y.-L. Huang
Affiliation:
Shanghai Jiao Tong University School of Medicine, Renji Hospital, Department of Anaesthesiology, Shanghai, China
S.-J. Wang
Affiliation:
Shanghai Jiao Tong University School of Medicine, Renji Hospital, Department of Anaesthesiology, Shanghai, China
X.-R. Wang
Affiliation:
Shanghai Jiao Tong University School of Medicine, Renji Hospital, Department of Anaesthesiology, Shanghai, China
*
Correspondence to: Ma-Zhong Zhang, Department of Anaesthesiology, Shanghai Renji Hospital, 145 # Shandong (C) Road, Shanghai, 200001, China. E-mail: doctorzmz@tom.com; Tel: +86 21 13601604170; Fax: +8621 50903239
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Summary

Background and objectives

To the best of our knowledge, the value of the plasma effect site equilibration rate constant (ke0) of propofol has not been reported in Chinese patients. The aim of this prospective, randomized study was to examine the characteristics of the time to peak effect (TPEAK) of propofol, a pharmacokinetic-independent descriptor of blood–brain equilibration, and ke0 derived from TPEAK with A-line auditory-evoked potential monitor and Aspect A-2000 bispectral index monitor in Chinese patients.

Methods

Two-hundred ASA I patients received a submaximal bolus dose of propofol (1.5 mg kg−1). TPEAK was randomly measured by means of the A-line auditory-evoked potential monitor (Group AAI (auditory-evoked potential index), n = 100) or the Aspect A-2000 bispectral index monitor (Group BIS, n = 100). Using TPEAK and four previously validated pharmacokinetic parameter sets of propofol, the ke0 was estimated according to a method proposed recently.

Results

The mean TPEAK was 145 ± 35 s (50–224 s) and 74±24 s (38–143 s) in Groups AAI and BIS, respectively (P < 0.01 between groups). There were no correlations between the patient’s age and TPEAKs (r = 0.147 and 0.031 for Groups AAI and BIS). The median ke0 in Group AAI was 0.64 min−1 with the model of Marsh, 0.17 min−1 with the Schnider model, 0.78 min−1 with the Tackley model and 0.93 min−1 with the Shafer model. The median ke0 in Group BIS was 1.87 min−1 with the model of Marsh, 0.83 min−1 with the Schnider model, 2.14 min−1 with the Tackley model and 2.48 min−1 with the Shafer model (P < 0.01 between groups and models).

Conclusions

The TPEAK of propofol measured by the A-line auditory-evoked potential monitor is different from that measured by the Aspect A-2000 bispectral index monitor. The TPEAKs of propofol from auditory-evoked potential index and bispectral index, and the values of ke0 calculated based on TPEAKs are different from previous reports and appear to be not affected by age. Further studies need to be taken to validate clinically the ke0 values of propofol.

Keywords

ANAESTHETICS, intravenousPROPOFOLMONITORING PHYSIOLOGIC, bispectral index, auditory evoked potentialsPHARMACOLOGYPHARMACOKINETICS
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 10 , October 2007 , pp. 876 - 881
Copyright
Copyright © European Society of Anaesthesiology 2007

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