AAI Index Research Articles

ANALYSIS OF OPTIONS FOR THE INDUCTION OF ANESTHESIA FOR CAESAREAN SECTION

Purpose: to compare the depth of anesthesia and hemodynamic reactions during general anesthesia for caesarean section. Materials and Methods: 45 pregnant women scheduled for caesarean section under general anesthesia were enrolled. All patients were divided into 3 groups (15 patients in each), depending on the general anesthetics. In the 1st group used sodium thiopental 5 mg / kg, in the 2nd sodium thiopental 5 mg / kg with sevoflurane (0.5 MAC), 3rd propofol 2.5 mg / kg. Mean arterial pressure (MAP) and index of AAI were estimated at six basic stages of the operation. Results: the highest rates of mean arterial pressure and AAI index were observed in the first group. Summary: the use of a mixture of thiopental sodium dose of 5 mg/kg with sevoflurane (0.5 MAC) or propofol dose of 2.5 mg / kg provide a sufficient surgical level of depth of anesthesia in the main stages of the operation; allow minimize hypertensive response for intubation and surgical trauma in comparison with the thiopental sodium dose of 5 mg/kg.

Pharmacokinetics and pharmacodynamics of propofol in cancer patients undergoing major lung surgery.

Despite the growing number of cancer cases and cancer surgeries around the world, the pharmacokinetics (PK) and pharmacodynamics (PD) of anesthetics used in this population are poorly understood. Patients operated due to cancer are usually in severe state and often require chemotherapy. It might affect the PK/PD of drugs used in this population. Therefore, in this study we explored the PK/PD of propofol in cancer patients having a major lung surgery. 23 patients that underwent a propofol–fentanyl total intravenous anesthesia were included in the analysis. A large set of demographic, biochemical and hemodynamic parameters was collected for the purpose of covariate analysis. Nonlinear mixed effect modeling in NONMEM was used to analyze the collected data. A three-compartment model was sufficient to describe PK of propofol. The anesthetic effect (AAI index) was linked to the propofol effect site concentrations through a sigmoidal E max model. A slightly higher value of clearance, a lower value of distribution clearance, and a decreased volume of peripheral compartment were observed in our patients, as compared with the literature values reported for healthy volunteers by Schnider et al. and by Eleveld et al. Despite these differences, both models led to a clinically insignificant bias of −8 and −1 % in concentration predictions, as reflected by the median performance error. The C e50 and propofol biophase concentration at the time of postoperative orientation were low and equaled 1.40 and 1.13 mg/L. The population PK/PD model was proposed for cancer patients undergoing a major lung surgery. The large body of studied covariates did not affect PK/PD of propofol significantly. The modification of propofol dosage in the group of patients under study is not necessary when TCI-guided administration of propofol by means of the Schnider model is used.Electronic supplementary materialThe online version of this article (doi:10.1007/s10928-015-9404-6) contains supplementary material, which is available to authorized users.

Comparison of two depth of anaesthesia monitors during general anaesthesia: Electrophysiological and clinical assessment

Cerebral state monitor (CSM) is a recently developed anaesthesia depth monitor based on EEG measurement. Medline search confirmed that the accuracy of this monitor has already been compared with BIS monitoring; however, we did not find any studies comparing CSM monitor with AEP monitoring. Therefore, the aim of our study was to investigate the correlation between AAI using AEP monitor and CSI (cerebral state index) using CSM monitor. Prospective, observational study involving 39 ASA I-III patients undergoing lumbar discuss hernia operation. Simultaneous registration of CSI and AAI was performed during general anaesthesia. The identical values were off-line analysed. Additionally in 20 patients parallel registration of CSI and AAI was undertaken while anaesthesia was guided based on routine clinical signs. While analysing the data in the superficial, ideal and deep anaesthesia zones, we found that a relationship between CSI and AAI is weak. Our patients spent roughly the half of the clinical anaesthesia in the ideal zone based on the AAI index and less than 50% based on CSI. Almost one fifth of clinical anaesthesia based on AAI and nearly 40% based on CSI was spent in the deep anaesthesia zones. A superficial anaesthesia has been detected in 27% of time based on AAI and 17% based on CSI. CSI and AAI weakly correlated to each other. Depth of anaesthesia monitors may be useful in detecting patients who spend valuable time within the deep anaesthetic zone.

Multi-channel electrical bioimpedance: a non-invasive method to simultaneously measure cardiac output and individual arterial limb flow in patients with cardiovascular disease

Cardiac output is the fundamental determinant of peripheral blood flow however; optimal regional tissue perfusion is ultimately dependant on the integrity of the arterial conduits that transport flow. A complete understanding of tissue perfusion requires knowledge of both cardiac and peripheral blood flow. Existing noninvasive devices do not simultaneously assess the cardiac and peripheral circulations. Multi-channel electrical bioimpedance (MEB) measures cardiac output and peripheral flow simultaneously. Assessment of the accuracy of MEB to measure cardiac output in patients with clinical heart failure (group 1) and to measure regional arterial limb flow in patients with exertional leg pain clinically thought to have peripheral arterial disease (group 2). Cardiac output was measured by MEB in 44 patients with moderate to severe clinical heart failure (group 1) and was compared to a cardiac output measured by 2D-Echo Doppler. Peripheral blood flow (regional ankle and arm flow) was measured by MEB in another group of 25 patients with exertional leg pain clinically thought to be claudication (group 2). The MEB ankle/arm flow ratio (AAI index) was then compared to a conventional ankle/brachial pressure ratio (ABI index). There was excellent correlation between the mean cardiac index by MEB (2.01 l/min/m(2)) and by 2D-Echo Doppler (2.06 l/min/m(2)) and bias and precision was 0.05 (2.4%) and +/-0.48 l/min/m(2) (+/-23%), respectively. The correlation was maintained for each measurement over a wide range of cardiac indices. There was good correlation between AAI and ABI measurements (P < 0.05). MEB accurately measures cardiac output in patients with moderate to severe clinical heart failure and accurately measures regional arterial limb flow in patients with peripheral arterial disease.

Preliminary assessment of the AAI Index® during isoflurane anaesthesia in dogs undergoing clinical procedures

The auditory evoked potential (AEP) is correlated to anaesthetic depth. The AEP has been used in rats, pigs, dogs and humans to assess anaesthetic depth. This study was undertaken to determine whether the AAI Index derived from the AEP correlated with changes in end tidal isoflurane concentration in dogs. The average AAI Index was 21.8 +/- 10.5 and isoflurane concentration was 1.7 +/- 0.4%. Data were divided into 0.5% intervals of end tidal anaesthetic agent concentration (ETAA). When ETAA values were higher than 2.5% the AAI values were 2.1-2.5%, 1.6-2.0% and 1.1-1.5% higher than AAI values although not statistically different. The 2.1-2.5 % interval was statistically different from the 1.1-1.5% and <1.1% interval. The 1.6-2.0% interval was statistically different from the 1.1-1.5% and the <1.1% intervals. The 1.1-1.5% interval was statistically different from the <1.1% interval. The correlation between the AAI Index and isoflurane was -0.176 and was statistically significant (P = 0.0009). A linear regression between the AAI Index and isoflurane revealed the following relationship: AAI = 29.074 - (4.2755 x isoflurane) with a power of 0.913. The polynomial regression relationship was AAI = 53.334 - (35.715 x isoflurane) + (10.322 x isoflurane2) - (0.43646 x isoflurane3) with a power of 0.999. The AAI Index was found to correlate with changes in isoflurane concentration.

Multi-Channel Electrical Bioimpedance: A New Noninvasive Method To Simultaneously Measure Cardiac And Peripheral Blood Flow

We sought to assess the ability of a new multi-channel electrical bioimpedance (MEB) methodology to accurately measure both cardiac blood flow and peripheral limb blood flow. Cardiac output is the primary determinant of peripheral blood flow; however, optimal regional tissue perfusion is ultimately dependent on the patency of the arterial conduits that transport that flow. A complete understanding of regional tissue perfusion requires knowledge of both cardiac and peripheral blood flow. Existing noninvasive devices do not simultaneously assess the cardiac and peripheral circulations. Cardiac blood flow (cardiac output) was measured by MEB in 30 healthy volunteers and was compared to a 2D-Echo Doppler cardiac output. Peripheral blood flow (regional ankle and arm flow) was measured by MEB in 15 healthy volunteers. The MEB ankle/arm flow ratio (AAI index) was then compared to a conventional ankle/brachial pressure ratio (ABI index). There was good correlation between the mean cardiac index by MEB (3.08 l/min/m2) and by Echo Doppler (3.13 l/min/m2) and bias and precision was 0.051 (1.6%) and +/-0.52 l/min/m2 (+/-17%), respectively. The close correlation was maintained for each measurement over a wide range of cardiac indices. There was good correlation between AAI and ABI measurements (p < 0.05) with a sensitivity of 100% and specificity of 100%. MEB methodology can precisely measure cardiac output and peripheral limb flow in healthy volunteers.

Bispectral index and A-line AAI index as guidance for desflurane-remifentanil anaesthesia compared with a standard practice group: a multicentre study

This study was designed to investigate the impact of bispectral index (BIS) or A-line AAI index (based on middle-latency auditory evoked potential) monitoring on recovery times and drug consumption when compared with standard anaesthetic practice during desflurane-remifentanil anaesthesia. After having obtained approval from the institutional review board and written informed consent, 200 adult patients undergoing minor surgical procedures were randomized to receive a desflurane-remifentanil anaesthetic controlled either solely by clinical parameters or by BIS or AAI to the following target values: during maintenance of anaesthesia to a value of '50' (BIS) or '30' (AAI), 15 min before the end of surgery to '60' (BIS) or '45' (AAI). Recovery times and drug consumption were recorded by a blinded investigator. Compared with standard practice, patients with BIS or AAI monitoring needed similar desflurane concentrations (standard practice 2.9 [0.5] vol%, BIS 3.3 [0.9] vol%, AAI 2.6 [0.5] vol%), and had similar recovery times (open eyes 5.6 [2.5] min, 5.9 [3.4] min, 5.0 [3.1] min; extubation 6.3 [2.4] min, 6.6 [3.5] min, 5.6 [3.0] min; stating name 7.3 [2.4] min, 7.6 [3.5] min, 7.3 [6.6] min). Compared with standard anaesthetic practice BIS and AAI guided titration to the used target ranges did not result in a reduction of desflurane consumption or recovery times during minor surgery with use of remifentanil.

Does the A-line ARX-Index provide a reasonable assessment of anaesthetic depth in dogs undergoing routine surgery?

The monitoring of anaesthetic depth is usually based on the subjective assessment of the patient. An objective assessment of anaesthesia has only recently become possible. The auditory-evoked response has predictable changes in response to increasing doses of anaesthetic agents. Recent advances have brought about a regression model with exogenous input of the auditory-evoked response, the A-line ARX-Index (AAI Index). The AAI Index is a dimensionless number between 0 and 100. This technology has been incorporated into the AEP (auditory-evoked potential) monitor that is utilised to assess anaesthetic depth in humans. This study was undertaken to determine if the AEP monitor was useful in dogs. Ten dogs were enrolled in the study. After a full clinical and otoscopic examination, dogs were premedicated with acetylpromazine and morphine. Anaesthesia was induced with thiopentone and maintained with halothane. End-tidal carbon dioxide, temperature, pulse oximetry, blood pressure and the electrocardiogram were monitored and recorded every 5 minutes. Anaesthetic depth was assessed as either being adequate or inadequate by the anaesthetist during surgery. An AEP monitor was attached to the patient and automatically collected AAI Index data. The anaesthetist was blinded to the AEP monitor. Following the completion of the surgical procedure, the patient was allowed to wake up with the AEP monitor attached. The AAI Index was analysed to compare adequate with inadequate anaesthesia during the period of surgery and awake with sleep data during recovery. All AAI Index values associated with inadequate anaesthesia were greater than 31 while adequate values were less than 35. The difference between the groups was statistically significant and the power was 0.97. Statistically, the awake and sleep values were significantly different with a power of 0.99. From this study it can be concluded that the AAI Index shows good prospect for the evaluation of anaesthetic depth in dogs undergoing surgery. A larger study is needed to confirm these results.