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Performance of AEP Monitor/2-derived composite index as an indicator for depth of sedation with midazolam and alfentanil during gastrointestinal endoscopy

Published online by Cambridge University Press:  01 March 2007

Y.-Y. Huang ,
Y.-C. Chu ,
K.-Y. Chang ,
Y.-C. Wang ,
K.-H. Chan  and
M.-Y. Tsou
Y.-Y. Huang
Affiliation:
National Yang-Ming University, Taipei Veterans General Hospital & School of Medicine, Department of Anaesthesiology, Taipei, Taiwan, ROC Institute of Clinical Medicine, Taipei, Taiwan, ROC
Y.-C. Chu
Affiliation:
National Yang-Ming University, Taipei Veterans General Hospital & School of Medicine, Department of Anaesthesiology, Taipei, Taiwan, ROC
K.-Y. Chang
Affiliation:
National Yang-Ming University, Taipei Veterans General Hospital & School of Medicine, Department of Anaesthesiology, Taipei, Taiwan, ROC
Y.-C. Wang
Affiliation:
Division of Healthcare and Service, Department of Medicine, Taipei, Taiwan, ROC
K.-H. Chan
Affiliation:
National Yang-Ming University, Taipei Veterans General Hospital & School of Medicine, Department of Anaesthesiology, Taipei, Taiwan, ROC
M.-Y. Tsou
Affiliation:
National Yang-Ming University, Taipei Veterans General Hospital & School of Medicine, Department of Anaesthesiology, Taipei, Taiwan, ROC
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Summary

Background and objective

The A-Line® auditory evoked potential index (AAI) (AEP Monitor/2, Danmeter A/S, Odense, Denmark) is a newly developed composite parameter representing the degree of hypnosis. We conducted a prospective, observational study to explore the performance and validity of the AAI during conventional sedation for gastrointestinal (GI) endoscopy.

Methods

Thirty adults of either sex, age <65, scheduled for combined oesophagogastroduodenoscopy (OGD) and colonoscopy under sedation with intravenous (i.v.) midazolam and alfentanil were enrolled. The sedative end-point was set at the Observer’s Assessment of Alertness/Sedation (OAA/S) score less than 4. An AEP Monitor/2 was used in all patients. AAI, sedation scores, heart rate (HR), blood pressure (BP) and SPO2 were recorded every 2 min up to the end of the procedure. Receiver operator characteristic analysis was used to test validity and to select optimal sedation.

Results

There was a significantly positive correlation between AAI and OAA/S scores (ρ = 0.886; P < 0.001). The AAI also showed significant differences between subsequent levels of sedation scores (P < 0.001). AAI greater than 54 indicated fully awake or minimal sedation and values between 54 and 42 were suggestive of moderate sedation. Values between 42 and 34 were associated with moderate to deep sedation and readings below 34 were associated with deep sedation. The relative risk of SPO2 < 95% for OAA/S = 2 compared with 3 was 15.98 (95% confidence interval (CI): 3.94–64.81).

Conclusions

AAI is an effective tool for monitoring sedation during GI endoscopy induced by i.v. midazolam and alfentanil.

Keywords

AUDITORY EVOKED POTENTIALSCONSCIOUS SEDATION; MONITORINGGASTROINTESTINAL ENDOSCOPYMIDAZOLAMALFENTANIL
Type
Research Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 3 , March 2007 , pp. 252 - 257
Copyright
Copyright © European Society of Anaesthesiology 2006

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