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Is the ARX index a more sensitive indicator of anesthetic depth than the bispectral index during sevoflurane/nitrous oxide anesthesia?

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During general anesthesia, hypnotic components have been monitored with electroencephalogram. The bispectral index is derived from a cortical electroencephalogram, but the A-line ARX index is the electroencephalographic response to auditory stimuli. The purpose of this study was to compare the changes of the A-line ARX index and the bispectral index during sevoflurane – nitrous oxide anesthesia. Methods: 

One hundred females aged 30–60 years, and scheduled for partial mastectomy, were divided into two groups. Anesthesia was induced with sevoflurane 5% and nitrous oxide in oxygen for 3 min. A laryngeal mask airway was inserted, and anesthesia was maintained with sevoflurane 1–2% and nitrous oxide in oxygen. During surgery, the sevoflurane end-tidal concentration was kept at 0.5%, 1%, or 2% for 5 min before each measurement. Blood pressure, heart rate, and the A-line ARX index (n = 50), and the bispectral index (n = 50) were measured. Results: 

Blood pressure and heart rate increased following laryngeal mask airway insertion and blood pressure decreased at 2% sevoflurane in both groups similarly. The A-line ARX index, but not the bispectral index, increased significantly by laryngeal mask airway insertion and skin incision. The A-line ARX index decreased at 2% sevoflurane compared with 0.5%, while the bispectral index remained unchanged. Conclusion: 

During sevoflurane-nitrous oxide anesthesia, the A-line ARX index might be a more sensitive indicator of anesthetic depth than the bispectral index.

Keywords: Auditory evoked potential; Inhalation anesthetic; bispectral index; nitrous oxide; sevoflurane

Document Type: Research Article


Affiliations: 1: Department of Anesthesiology, The University of Tokyo, Tokyo, Japan, 2: Department of Anesthesia, Yamanashi University Medical School, Yamanashi, Japan

Publication date: September 1, 2004


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