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BJA Advance Access originally published online on October 22, 2006
British Journal of Anaesthesia 2006 97(6):817-821; doi:10.1093/bja/ael278
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Skin conductance monitoring compared with Bispectral Index® to assess emergence from total i.v. anaesthesia using propofol and remifentanil

T. Ledowski1,*, J. Bromilow1, M. J. Paech1,2, H. Storm3, R. Hacking1 and S. A. Schug1,2

1 Department of Anaesthesia and Pain Medicine, Royal Perth Hospital Wellington Street Campus, Perth WA 6000, Australia.
2 School of Medicine and Pharmacology, The University of Western Australia Perth, Australia.
3 The Skills Training Centre, University of Oslo Norway

*Corresponding author. E-mail: thomas.ledowski{at}health.wa.gov.au

Background. Arousal after sevoflurane anaesthesia has been detectable by monitoring changes in skin conductance (SC) with similar accuracy as monitoring Bispectral Index (BIS®). As SC monitoring detects changes in sympathetic tone, the measurements might be confounded by the sympatholytic properties of propofol, a component of total i.v. anaesthesia (TIVA). Therefore in this study, monitoring of SC during emergence from TIVA was compared with the monitoring of BIS®.

Methods. Twenty-five patients undergoing plastic surgery were investigated. The number of fluctuations of SC per second (NFSC), BIS® and haemodynamic variables [systolic blood pressure (SBP) and heart rate (HR)] were recorded simultaneously. The performance of the monitoring devices in distinguishing between the clinical states ‘steady-state anaesthesia’, ‘first clinical reaction’ and ‘extubation’ were compared using the method of prediction probability (Pk) calculation.

Results. BIS® showed the best performance in distinguishing between ‘steady-state anaesthesia’ and ‘first reaction’ (Pk BIS® 0.99 vs NFSC 0.80; P<0.01), and ‘steady-state anaesthesia’ and ‘extubation’ (Pk BIS® 1.00 vs NFSC 0.91; P<0.05); the time from first change of BIS® or NFSC to a first clinical reaction was significantly longer for NFSC (median BIS® 135 s vs NFSC 191 s; P<0.05). BIS® and NFSC performed better in distinguishing between the investigated clinical states than SBP and HR.

Conclusions. In this study, BIS® was found to predict arousal with a higher probability but slower response times than NFSC in patients waking after TIVA.


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T. Ledowski, J. Preuss, A. Ford, M. J. Paech, C. McTernan, R. Kapila, and S. A. Schug
New parameters of skin conductance compared with bispectral index(R) monitoring to assess emergence from total intravenous anaesthesia
Br. J. Anaesth., October 1, 2007; 99(4): 547 - 551.
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