Cerebral state monitor, a new small handheld EEG monitor for determining depth of anaesthesia: a clinical comparison with the bispectral index during day-surgery

Background and objective: The cerebral state index (CSI (TM)) derived from a new small handheld electroencephalogram monitor was studied during routine day surgical anaesthesia titrated according to the bispectral index (BIS (TM)). The objective was to determine the degree of agreement between the two monitors. Methods: Anaesthesia was induced with propofol and fentanyl (0.1 mg) in 38 patients undergoing general anaesthesia for routine day-surgery. Maintenance anaesthesia (sevoflurane (20/38), desflurane (10/38) or propofol (8/38)) titrated by BIS XP (Aspect Medical, Natwick, MA, USA) and BIS and CSI (cerebral State Monitor, Danmeter; Odense, Denmark) index values were recorded every minute. No patient received muscle relaxation. Observer's Assessment of Alertness/Sedation rating scale was used to assess level of sedation. Results: Pair-wise recordings (914) of CSI and BIS were collected. The indices showed similar pattern and decreased with increasing level of sedation, however with large ranges for each level of sedation. Median indices were similar during surgery (BIS: 50 (14-89); CSI: 51 (7-88)) and both indices increased (P < 0.01) when minor movements occurred (BIS 65 (40-83); CST 67 (40-89)). During maintenance of anaesthesia CSI > 20% from BIS-Index in 24% of readings, and on rare occasions CSI indices deviated > 100% from the BIS reading. When BIS < 40, CSI decreased slower than BIS and with wider spreading. Conclusions: When used for day-surgery anaesthesia without muscle relaxation, CSI and BIS show similar patterns and numerical values but with the incidence of occasionally large discrepancies between pair-wise readings. Which monitor is the more dependable remains to be established and cannot be implied from this initial explorative study.