Impact of the AEP‐Monitor/2‐derived composite auditory‐evoked potential index on propofol consumption and emergence times during total intravenous anaesthesia with propofol and remifentanil in children

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Abstract
Background: The composite auditory evoked potential index (cAAI), derived from the AEP Monitor/2 (version 1.6; Danmeter A/S, Odense, Denmark) is a measure of the hypnotic component of general anaesthesia. The purpose of this study was to evaluate the impact of cAAI guidance on propofol consumption and emergence times in children receiving total intravenous anaesthesia (TIVA) with propofol and remifentanil. Methods: Twenty children, aged 3–11 years, scheduled for strabismus repair under TIVA with propofol and remifentanil were enrolled. Remifentanil was given to all patients at a constant infusion rate of 0.3 µg kg−1 min−1 throughout the anaesthesia. Patients were randomly allocated to receive a continuous propofol infusion adjusted either according to a conventional clinical practice (Group C, n = 10) or guided by cAAI‐monitoring (Group G, n = 10, target cAAI 25–35). All patients were connected to the AEP Monitor/2, but in group C the anaesthetist was blinded to cAAI values. Propofol consumption (mgkg−1h−1) and emergence times (min) were the primary and secondary outcome measures. Results: Propofol consumption and emergence times (mean ± SD) were significantly lower in group G compared to group C (Propofol: G: 4.2 ± 1.7 vs. C 6.4 ± 1.3 mg kg−1 h−1; P < 0.01; emergence times: G: 5.1 ± 3.7 vs. C 13.2 ± 8.2 min; P < 0.01). Intraoperative cAAI values (median [interquartile range]) were significantly higher in group G (23.9 [18–29.7]) than in group C (18.4 [16.0–22.1]; P < 0.01). Haemodynamic variables remained stable within age‐related limits, and there were no observations of adverse events, especially no clinical signs of intraoperative awareness in any patient. Conclusion: Composite auditory evoked potential index monitoring during propofol/remifentanil‐TIVA in children results in reduced propofol consumption and faster emergence.