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Background: The aepEXplus monitoring system, which uses mid-latency auditory evoked potentials to measure depth of hypnosis, was evaluated in pediatric patients receiving desflurane-remifentanil anesthesia., Methods: Seventy-five patients, 1-18 years of age (stratified for age; 1-3, 3-6, 6-18 years, for subgroup analyses), were included in this prospective observational study. The aepEX and the bispectral index (BIS) were recorded simultaneously, the latter serving as a reference. The ability of the aepEX to detect different levels of consciousness, defined according to the University of Michigan Sedation Scale, investigated using prediction probability (Pk), and receiver operating characteristic (ROC) analysis, served as the primary outcome parameter. As a secondary outcome parameter, the relationship between end-tidal desflurane and the aepEX and BIS values were calculated by fitting in a nonlinear regression model., Results: The Pk values for the aepEX and the BIS were, respectively, .68 (95% CI, 0.53-0.82) and .85 (95% CI, 0.73-0.96; P = .02). The aepEX and the BIS had an area under the ROC curve of, respectively, 0.89 (95% CI, 0.80-0.95) and 0.76 (95% CI, 0.68-0.84; P = .04). The maximized sensitivity and specificity were, respectively, 81% (95% CI, 61%-93%) and 86% (95% CI, 74%-94%) for the aepEX at a cutoff value of >52, and 69% (95% CI, 56%-81%) and 70% (95% CI, 57%-81%) for the BIS at a cutoff value of >65. The age-corrected end-tidal desflurane concentration associated with an index value of 50 (EC50) was 0.59 minimum alveolar concentration (interquartile range: 0.38-0.85) and 0.58 minimum alveolar concentration (interquartile range: 0.41-0.70) for, respectively, the aepEX and BIS (P = .69). Age-group analysis showed no evidence of a difference regarding the area under the ROC curve or EC50., Conclusions: The aepEX can reliably differentiate between a conscious and an unconscious state in pediatric patients receiving desflurane-remifentanil anesthesia.

Background: The aepEX is a measure of depth of hypnosis (DoH), derived from processed mid-latency auditory evoked potentials., Objectives: To evaluate the aepEX as a measure of DoH in children receiving sevoflurane-remifentanil anesthesia., Methods: aepEX and bispectral index (BIS) were recorded simultaneously in 75 children, (1-3, 3-6, and 6-18 years), receiving sevoflurane at endtidal concentrations (ETsevo ) between 1.5 and 0.5 MAC. The ETsevo at which the aepEX and BIS had a value of 50 (EC50aep EX and EC50BIS ) was calculated by nonlinear regression analysis. The accuracy of aepEX and BIS to predict the DoH was assessed by prediction probability (Pk ) and receiver operating characteristics (ROC) analysis., Results: Seventy-four children were included for analysis. The EC50aep EX (2.68%) and EC50BIS (2.10%) were comparable; the same accounts for the EC50aep EX of the different age groups and the EC50aep EX and EC50BIS of corresponding age groups. The EC50BIS in children aged 1-3 years was lower than in the older age groups (P < 0.05). Pk values of the aepEX (0.32, CI 95% 0.08-0.56) and BIS (0.47, CI 95% 0.19-0.75) were comparable. The area under the ROC curve was 0.72 (CI 95%: 0.62-0.82) and 0.67 (CI95%: 0.56-0.77) for the aepEX and BIS, respectively (P = 0.54). Optimal cutoff values were >60 (aepEX) and >68 (BIS), with corresponding specificities 91%, CI 95%: 80-97% (aepEX) and 66%, CI 95%: 52-77% (BIS)., Conclusions: In this study with children receiving sevoflurane anesthesia, the aepEX outperformed the BIS in distinguishing unconsciousness from consciousness. Both indices performed equally bad in differentiating different levels of DoH., (© 2014 John Wiley & Sons Ltd.)

Background: The aepEX Plus monitor (aepEX) utilizes a mid-latency auditory evoked potential-derived index of depth of hypnosis (DoH)., Objective: This observational study evaluates the performance of the aepEX as a DoH monitor for pediatric patients receiving propofol-remifentanil anesthesia., Methods: 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)., Results: 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., Conclusion: 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., (© 2013 John Wiley & Sons Ltd.)

Background The aep EX is a measure of depth of hypnosis (DoH), derived from processed mid-latency auditory evoked potentials. Objectives To evaluate the aep EX as a measure of DoH in children receiving sevoflurane-remifentanil anesthesia. Methods aep EX and bispectral index ( BIS) were recorded simultaneously in 75 children, (1-3, 3-6, and 6-18 years), receiving sevoflurane at endtidal concentrations ( ETsevo) between 1.5 and 0.5 MAC. The ETsevo at which the aep EX and BIS had a value of 50 ( EC50aep EX and EC50 BIS) was calculated by nonlinear regression analysis. The accuracy of aep EX and BIS to predict the DoH was assessed by prediction probability (Pk) and receiver operating characteristics ( ROC) analysis. Results Seventy-four children were included for analysis. The EC50aep EX (2.68%) and EC50 BIS (2.10%) were comparable; the same accounts for the EC50aep EX of the different age groups and the EC50aep EX and EC50 BIS of corresponding age groups. The EC50 BIS in children aged 1-3 years was lower than in the older age groups ( P < 0.05). Pk values of the aep EX (0.32, CI 95% 0.08-0.56) and BIS (0.47, CI 95% 0.19-0.75) were comparable. The area under the ROC curve was 0.72 ( CI 95%: 0.62-0.82) and 0.67 ( CI95%: 0.56-0.77) for the aep EX and BIS, respectively ( P = 0.54). Optimal cutoff values were >60 (aep EX) and >68 ( BIS), with corresponding specificities 91%, CI 95%: 80-97% (aep EX) and 66%, CI 95%: 52-77% ( BIS). Conclusions In this study with children receiving sevoflurane anesthesia, the aep EX outperformed the BIS in distinguishing unconsciousness from consciousness. Both indices performed equally bad in differentiating different levels of DoH. [ABSTRACT FROM AUTHOR]

Background The aep EX Plus monitor (aep EX) utilizes a mid-latency auditory evoked potential-derived index of depth of hypnosis ( Do H). Objective This observational study evaluates the performance of the aep EX as a Do H monitor for pediatric patients receiving propofol-remifentanil anesthesia. Methods aep EX 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 Do H during emergence. Prediction probability ( Pk) and receiver operating characteristics ( ROC) analyses were performed to assess the accuracy of both Do H monitors. Nonlinear regression analysis was used to describe the dose-response relationships for the aep EX, the BIS, and propofol plasma concentrations ( Cp). Results The Pk for the aep EX 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 aep EX and BIS, respectively ( P = 0.644). At half-maximal effect ( EC50), Cp of 3.13 μg·ml−1 and 3.06 μg·ml−1 were observed for the aep EX and BIS, respectively. The r2 for the aep EX and BIS was 0.53 and 0.82, respectively. Conclusion The aep EX 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 Cp in children receiving propofol-remifentanil anesthesia. [ABSTRACT FROM AUTHOR]