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BJA Advance Access originally published online on August 18, 2007
British Journal of Anaesthesia 2007 99(4):456-460; doi:10.1093/bja/aem243
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Muscle relaxation and depth of anaesthesia: where is the missing link?

The first 150 words of the full text of this article appear below.

In the last few years, several monitors have been developed to assess the depth of anaesthesia and to discriminate between its pharmacodynamic components. Most of those monitors have been initially designed to assess the hypnotic component of anaesthesia. Experience has progressively revealed that several factors other than external artifacts can alter the interpretation of what is said to be the depth of anaesthesia, that is, the value of the indices.1 Among those factors, the pharmacodynamic interaction between anaesthetic agents plays a key role,2 and neuromuscular blocking agents (NMBAs) can, theoretically, be involved in that interaction. The calculation of depth of anaesthesia indices is frequently based on EEG recordings. The frequency band associated with EMG activity is close to that of the EEG. As NMBAs modulate EMG activity, they may artificially modify the calculated index3 or suppress valuable information from the signal. Given these theoretical considerations, the variability of the algorithms . . . [Full Text of this Article]

Influence of muscle relaxation on depth of anaesthesia

Effect of muscle relaxation on the calculation of depth of anaesthesia indices

Frequency bands of interest and artifact rejection algorithms
Bispectral index
Spectral entropy of the electroencephalogram
The A-Line autoregressive index
Other available monitors
Influence of electromyographic activity on the agreement between indices
Suppression of information through suppression of electromyographic activity
Reversal of muscle relaxation and depth of anaesthesia

Conclusions

V. Bonhomme* and P. Hans

University Department of Anaesthesia and Intensive Care Medicine
CHR de la Citadelle Boulevard du 12eme de Ligne, 1
4000 Liege
Belgium

* E-mail: vincent.bonhomme@chu.ulg.ac.be


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