• Yuen M Cheung, Gail P Scoones, Robert J Stolker, and Frank Weber.
• Department of Anesthesiology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands.
• Paediatr Anaesth. 2014 Jul 1; 24 (7): 760-5.

BackgroundThe aepEX is a measure of depth of hypnosis (DoH), derived from processed mid-latency auditory evoked potentials.ObjectivesTo evaluate the aepEX as a measure of DoH in children receiving sevoflurane-remifentanil anesthesia.MethodsaepEX 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.ResultsSeventy-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).ConclusionsIn 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.

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