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British Journal of Anaesthesia, 2003, Vol. 91, No. 3 336-340
© 2003 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigations

Comparison of Alaris AEP index and bispectral index during propofol-remifentanil anaesthesia{dagger}

S. Kreuer1, J. Bruhn2, R. Larsen1, M. Hoepstein1 and W. Wilhelm*,1

1 Department of Anaesthesiology and Intensive Care Medicine, University of Saarland, D-66421 Homburg/Saar, Germany. 2 Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, D-53119 Bonn, Germany

Corresponding author. E-mail: wolfram.wilhelm@uniklinik-saarland.de
{dagger}This study was presented in part at the American Society of Anesthesiologists meeting on October 16, 2002, Orlando, USA.

Background. The Alaris AEP monitorTM (Alaris, UK, version 1.4) is the first commercially available auditory evoked potential (AEP) monitor designed to estimate the depth of anaesthesia. It generates an ‘Alaris AEP index’ (AAI), which is a dimensionless number scaled from 100 (awake) to 0. This study was designed to compare AAI and BISTM (Aspect, USA, version XP) values at different levels of anaesthesia.

Methods. Adult female patients were premedicated with diazepam 0.15 mg kg–1 orally on the morning of surgery. Electrodes for BIS and Alaris AEP monitoring and a headphone to give auditory stimuli were applied as recommended by the manufacturers. Anaesthesia was induced with remifentanil (0.4 µg kg–1 min–1) and a propofol target-controlled infusion (DiprifusorTM TCI, AstraZeneca, Germany) to obtain a predicted concentration of initially 3.5 µg ml–1. After loss of consciousness the patients were given 0.5 mg kg–1 of atracurium. After tracheal intubation, remifentanil was given at 0.2 µg kg–1 min–1 and the propofol infusion was adjusted to obtain BIS target values of 30, 40, 50, and 60. AAI and BIS values were recorded and matched with the predicted propofol effect-site concentrations. Prediction probability was calculated for consciousness vs unconsciousness. Values are mean (SD).

Results. Fifty female patients, 53 (15), range 18–78 yr, ASA I or II were studied. Mean values before induction of anaesthesia were 95 (4), range 99–82 for BIS and 85 (12), range 99–55 for AAI. With loss of eyelash reflex both values were significantly reduced to 64 (13), range 83–39 for BIS (P<0.05) and 61 (22), range 99–15 for AAI (P<0.05). The prediction probability PK for consciousness vs unconsciousness (i.e. loss of eyelash reflex) was better for BIS (PK=0.99) than for AAI (PK=0.79). At a BIS of 30, 40, 50, and 60 the corresponding AAI values were 15 (6), 20 (8), 28 (11), and 40 (16), and these were significantly different.

Conclusions. During propofol-remifentanil anaesthesia a decrease of the depth of anaesthesia as indicated by BIS monitoring is accompanied by corresponding effects shown by the AAI. However, wide variation in the awake values and considerable overlap of AAI values between consciousness and unconsciousness, suggests further improvement of the AAI system is required.

Br J Anaesth 2003; 91: 336–40


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