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A comparative study on adequate anesthesia depth: clinical judgement and the Narcotrend® measurement

PURPOSE: To compare the clinical judgement of electroencephalogram (EEG)-naïve anesthesiologists with an EEG-based measurement of anesthetic depth (AD) using the Narcotrend® monitor. METHODS: In this prospective cohort study including 600 patients, AD during stable anesthesia was assessed by clinica...

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Autores principales: Puchner, Wolfgang F., Dünser, Martin W., Paulus, Patrick, Neuner, Markus P., Mayer, Charlotte L., Pomberger, Irmgard M., Hackl, Ruth, Meier, Jens M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7214482/
https://www.ncbi.nlm.nih.gov/pubmed/32128723
http://dx.doi.org/10.1007/s12630-020-01602-x
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author Puchner, Wolfgang F.
Dünser, Martin W.
Paulus, Patrick
Neuner, Markus P.
Mayer, Charlotte L.
Pomberger, Irmgard M.
Hackl, Ruth
Meier, Jens M.
author_facet Puchner, Wolfgang F.
Dünser, Martin W.
Paulus, Patrick
Neuner, Markus P.
Mayer, Charlotte L.
Pomberger, Irmgard M.
Hackl, Ruth
Meier, Jens M.
author_sort Puchner, Wolfgang F.
collection PubMed
description PURPOSE: To compare the clinical judgement of electroencephalogram (EEG)-naïve anesthesiologists with an EEG-based measurement of anesthetic depth (AD) using the Narcotrend® monitor. METHODS: In this prospective cohort study including 600 patients, AD during stable anesthesia was assessed by clinical judgement of the attending, EEG-blinded anesthesiologist (using a scale staging the AD as mid-adequate, adequate but fairly deep, or adequate but fairly light) and by simultaneously recorded Narcotrend measurements. RESULTS: In 42% of patients (n = 250), the anesthesiologist’s clinical judgement was in agreement with anesthetic levels as measured by the Narcotrend monitor. In 46% of patients (n = 274), the anesthesiologist’s judgement and the Narcotrend monitor differed by one AD level (minor discordance). Major discordance was observed in 76 (13%) measurements (judged deeper than measured, n = 29 [5%]; judged lighter than measured, n = 47 [8%]). In 7% of patients (n = 44), the Narcotrend index was outside the limits of adequate AD (too deep, n = 28 [5%]; too superficial, n = 16 [3%]). The overall level of agreement between the anesthesiologist’s judgement and the Narcotrend monitor was not statistically significant (Cohen’s kappa, −0.039; P = 0.17). Using a random forests algorithm, age, mean blood pressure, the American Society of Anesthesiologists classification, body mass index, and frailty were the variables with the highest relative feature importance to predict the level of agreement. CONCLUSION: These results suggest that clinical judgement of AD during stable anesthesia was not in agreement with EEG-based assessment of anesthetic depth in 58% of cases. Nevertheless, this finding could be influenced by the lack of validated scales to clinically judge AD. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT02766894); registered 10 May, 2016.
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spelling pubmed-72144822020-05-14 A comparative study on adequate anesthesia depth: clinical judgement and the Narcotrend® measurement Puchner, Wolfgang F. Dünser, Martin W. Paulus, Patrick Neuner, Markus P. Mayer, Charlotte L. Pomberger, Irmgard M. Hackl, Ruth Meier, Jens M. Can J Anaesth Reports of Original Investigations PURPOSE: To compare the clinical judgement of electroencephalogram (EEG)-naïve anesthesiologists with an EEG-based measurement of anesthetic depth (AD) using the Narcotrend® monitor. METHODS: In this prospective cohort study including 600 patients, AD during stable anesthesia was assessed by clinical judgement of the attending, EEG-blinded anesthesiologist (using a scale staging the AD as mid-adequate, adequate but fairly deep, or adequate but fairly light) and by simultaneously recorded Narcotrend measurements. RESULTS: In 42% of patients (n = 250), the anesthesiologist’s clinical judgement was in agreement with anesthetic levels as measured by the Narcotrend monitor. In 46% of patients (n = 274), the anesthesiologist’s judgement and the Narcotrend monitor differed by one AD level (minor discordance). Major discordance was observed in 76 (13%) measurements (judged deeper than measured, n = 29 [5%]; judged lighter than measured, n = 47 [8%]). In 7% of patients (n = 44), the Narcotrend index was outside the limits of adequate AD (too deep, n = 28 [5%]; too superficial, n = 16 [3%]). The overall level of agreement between the anesthesiologist’s judgement and the Narcotrend monitor was not statistically significant (Cohen’s kappa, −0.039; P = 0.17). Using a random forests algorithm, age, mean blood pressure, the American Society of Anesthesiologists classification, body mass index, and frailty were the variables with the highest relative feature importance to predict the level of agreement. CONCLUSION: These results suggest that clinical judgement of AD during stable anesthesia was not in agreement with EEG-based assessment of anesthetic depth in 58% of cases. Nevertheless, this finding could be influenced by the lack of validated scales to clinically judge AD. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT02766894); registered 10 May, 2016. Springer International Publishing 2020-03-03 2020 /pmc/articles/PMC7214482/ /pubmed/32128723 http://dx.doi.org/10.1007/s12630-020-01602-x Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Reports of Original Investigations
Puchner, Wolfgang F.
Dünser, Martin W.
Paulus, Patrick
Neuner, Markus P.
Mayer, Charlotte L.
Pomberger, Irmgard M.
Hackl, Ruth
Meier, Jens M.
A comparative study on adequate anesthesia depth: clinical judgement and the Narcotrend® measurement
title A comparative study on adequate anesthesia depth: clinical judgement and the Narcotrend® measurement
title_full A comparative study on adequate anesthesia depth: clinical judgement and the Narcotrend® measurement
title_fullStr A comparative study on adequate anesthesia depth: clinical judgement and the Narcotrend® measurement
title_full_unstemmed A comparative study on adequate anesthesia depth: clinical judgement and the Narcotrend® measurement
title_short A comparative study on adequate anesthesia depth: clinical judgement and the Narcotrend® measurement
title_sort comparative study on adequate anesthesia depth: clinical judgement and the narcotrend® measurement
topic Reports of Original Investigations
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7214482/
https://www.ncbi.nlm.nih.gov/pubmed/32128723
http://dx.doi.org/10.1007/s12630-020-01602-x
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