Cheung Yuen M, Scoones Gail P, Hoeks Sanne E, Stolker Robert J, Weber Frank
Department of Anesthesiology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands.
Paediatr Anaesth. 2013 Oct;23(10):891-7. doi: 10.1111/pan.12235. Epub 2013 Aug 2.
The aepEX Plus monitor (aepEX) utilizes a mid-latency auditory evoked potential-derived index of depth of hypnosis (DoH).
This observational study evaluates the performance of the aepEX as a DoH monitor for pediatric patients receiving propofol-remifentanil anesthesia.
aepEX and BIS values were recorded simultaneously during surgery in three groups of 25 children (aged 1-3, 3-6 and 6-16 years). Propofol was administered by target-controlled infusion. The University of Michigan Sedation Scale (UMSS) was used to clinically assess the DoH during emergence. Prediction probability (P(k)) and receiver operating characteristics (ROC) analyses were performed to assess the accuracy of both DoH monitors. Nonlinear regression analysis was used to describe the dose-response relationships for the aepEX, the BIS, and propofol plasma concentrations (Cp).
The P(k) for the aepEX and BIS was 0.36 and 0.21, respectively (P = 0.010). ROC analysis showed an area under the curve of 0.77 and 0.88 for the aepEX and BIS, respectively (P = 0.644). At half-maximal effect (EC(50)), C(p) of 3.13 μg·ml(-1) and 3.06 μg·ml(-1) were observed for the aepEX and BIS, respectively. The r(2) for the aepEX and BIS was 0.53 and 0.82, respectively.
The aepEX performs comparable to the BIS in differentiating between consciousness and unconsciousness, while performing inferior to the BIS in terms of distinguishing different levels of sedation and does not correlate well with the C(p) in children receiving propofol-remifentanil anesthesia.
aepEX Plus监测仪（aepEX）利用中潜伏期听觉诱发电位得出的催眠深度指数（DoH）。
本观察性研究评估aepEX作为接受丙泊酚-瑞芬太尼麻醉的儿科患者DoH监测仪的性能。
在三组各25名儿童（年龄1至3岁、3至6岁和6至16岁）手术期间同时记录aepEX和脑电双频指数（BIS）值。丙泊酚采用靶控输注给药。密歇根大学镇静量表（UMSS）用于在苏醒期临床评估DoH。进行预测概率（P(k)）和受试者工作特征（ROC）分析以评估两种DoH监测仪的准确性。采用非线性回归分析描述aepEX、BIS和丙泊酚血浆浓度（Cp）的剂量反应关系。
aepEX和BIS的P(k)分别为0.36和0.21（P = 0.010）。ROC分析显示aepEX和BIS的曲线下面积分别为0.77和0.88（P = 0.644）。在半数最大效应（EC(50)）时，aepEX和BIS的Cp分别为3.13 μg·ml(-1)和3.06 μg·ml(-1)。aepEX和BIS的r(2)分别为0.53和0.82。
在区分意识和无意识方面，aepEX的表现与BIS相当，但在区分不同镇静水平方面不如BIS，并且在接受丙泊酚-瑞芬太尼麻醉的儿童中与Cp的相关性不佳。
