Application of Bispectral Index® and Narcotrend® index to the measurement of the electroencephalographic effects of isoflurane with and without burst suppression

Background: The Narcotrend(R) monitor (MonitorTechnik, Bad Bramstedt, Germany) has recently been introduced as an intraoperative monitor of anesthetic state, based on a classification scheme originally developed for visual assessment of the electroencephalogram. The authors compared the performance of the Narcotrend(R) index (software version 4.0) to the Bispectral Index(R) (BIS(R), version XP; Aspect Medical Systems, Natick, MA) as electroencephalographic measures of isoflurane drug effect during general anesthesia. Methods: The authors observed 15 adult patients scheduled to undergo radical prostatectomy with a combined epidural-isoflurane general anesthesia technique. At least 45 min after induction of general anesthesia, during a phase of constant surgical stimulation, end-tidal isoflurane concentrations were varied between 0.5 and 2.0 multiples of minimum alveolar concentration, and the BIS(R) and the Narcotrend(R) index were recorded. The prediction probability (P-K) was calculated for the BIS(R) and the Narcotrend(R) index to predict isoflurane effect compartment concentration for each measure. The correlation analysis of the BIS(R) and the Narcotrend(R) index with the isoflurane effect compartment concentration was obtained by pharmacodynamic modeling based on two sigmoidal curves to account for the discontinuity in both indices with the onset of burst suppression. Results: The prediction probabilities were indistinguishable (BIS(R) P-K = 0.72 +/- 0.07 (mean +/- SD); range, 0.61-0.84; Narcotrend(R) index P-K = 0.72 +/- 0.10; range, 0.51-0.87), as were the correlations between the electroencephalographic measures and isoflurane effect compartment concentrations (BIS(R) R-2 = 0.82 +/- 0.12; Narcotrend(R) index R-2 = 0.85 +/- 0.09). The pharmacodynamic models for the BIS(R) and the Narcotrend(R) index yielded nearly identical results. Conclusions: The BIS(R) and the Narcotrend(R) index detected the electroencephalographic effects of isoflurane equally. Combining two fractional sigmoid E-max models adequately described the data before and after the onset of burst suppression.