Narcotrend® and Bispectral Index® monitor are superior to classic electroencephalographic parameters for the assessment of anesthetic states during propofol-remifentanil anesthesia

Background: A new electroencephalogram monitor, the Narcotrend(R), was developed to measure anesthetic depth. The authors compared the Narcotrend(R), the Bispectral Index(R), and classic electroencephalographic and hemodynamic parameters during anesthesia with propofol and remifentanil. Methods: The authors investigated 25 patients undergoing laminectomy at different anesthetic states: awake, steady state anesthesia, first reaction during emergence, and extubation. Narcotrend(R) value; BIS; relative power (percent) in delta, theta, alpha, and beta; median frequency; spectral edge frequency; and hemodynamic parameters were recorded simultaneously. The ability of the classic and processed electroencephalographic and hemodynamic parameters to predict the clinically relevant anesthetic states of awake, steady state anesthesia, first reaction, and extubation was tested using prediction probability. Results: Only the Narcotrend(R) was able to differentiate between awake versus steady state anesthesia and steady state anesthesia versus first reaction/extubation with a prediction probability value of more than 0.90. Conclusions: Modern electroencephalographic parameters, especially Narcotrend(R), are more reliable indicators for the clinical assessment of anesthetic states than classic parameters.