Time delay of index calculation - Analysis of cerebral state, bispectral, and narcotrend indices

Background: On the basis of electroencephalographic analysis, several parameters have been proposed as a measure of the hypnotic component of anesthesia. All currently available indices have different time lags to react to a change in the level of anesthesia. The aim of this study was to determine the latency of three frequently used indices: the Cerebral State Index (Dan-meter, Odense, Denmark), the Bispectral index (Aspect Medical Systems Inc., Newton, MA), and the Narcotrend index (MonitorTechnik, Bad Bramstedt, Germany). Methods: Artificially generated signals were used to produce up to 14 constant index values per monitor that indicate awake state, general anesthesia, and deep anesthesia and smaller steps in between. The authors simulated loss of and return to consciousness by changing between the artificial electroencephalographic signals in a full-step and two stepwise approaches and measured the time necessary to adapt the indices to die particular input signal. Results: Time delays between 14 and 155 s were found for all indices. These delays were not constant. Results were different for decreasing and increasing values and between the full-step and the stepwise approaches. Calculation time depended on the particular starting and target index value. Conclusions: The time delays of the tested indices may limit their value in prevention of recall of intraoperative events. Furthermore, different latencies for decreasing and increasing values may indicate a limitation of these monitors for pharmacodynamic studies.