The Clinical Study Of Efficancy Of AAI As A Tool For Predicting Acceptable Tracheal Intubation Condition

Partâ… Objective We aimed to determine the clinically required depth of anaesthesia,measured by the A-line^TM AEP Monitor and expressed as A-Line ARX IndexTM (AAI)for probability of acceptable conditions for endotracheal intubation during fentanyland propofol TCI anaesthesia.Methods 100 ASAâ… orâ…¡patients, were randomized to AAI 15, 20, 25, 30 and35 which resulted in an over representation of these levels. Before induction five rains,fentanyl 3ug/kg was given intravenously. The effect site concentration of propofolwas initially set at 3ug/ml and successively increased by 0.5ug/ml every time untilthe appointed depth of anaesthesia was reached.Ventilation was assisted if respirationbecame shallow, Once the alarm sounded,indicating that the required level ofanaesthesia had been reached, intubation of the trachea was attempted and conditionsgraded according to the criteria of Grants given in Table1. SBP, DBP, HR, AAI, SpO₂,intubation score (following Grants method) and all side effects and adjuvant drugswere recorded at six time points during induction of anesthesia: before induction time,reached AAI,0 rain after intubation, 2 rain after intubation, 4 min after intubation.Results At AAI=35, we found acceptable conditions in 25% of patients. Propofolconcentration of effect site (Ce_PROP)was 3.533±0.595ug/ml; AAI=30,45%, Ce_PROP4.095±0.649ug/ml; AAI=25,65%, Ce_PROP 4.748±0.852ug/ml; AAI=20,75%, Ce_PROP5.012±0.725; AAI=15,95%, Ce_PROP 5.514±0.549ug/ml. AAI ED50, ED95 ofacceptable intubation conditions were ED50=27.325,ED50(Feiller)CI95=31.057-24.621. ED95=14.824, CI95=17.7-10.0 Ce_PROPEC50=4.2469ug/ml,CI95=3.9412-4.4961ug/ml, Ce_PROP EC95=5.9656ug/ml,CI95=5.4287-7.2525ug/ml.Conclusions AAI indicates the depth of anaesthesia necessary for acceptableendotracheal intubation conditions under the conditions of the present study. AAI was a better predictor and may turn out to be more useful in the clinical setting. AAIED95=14.824 and Ce_PROP EC95=5.9656ug/ml are suitable anesthesia depth forinmbation during 3ug/kg fentanyl and propofol TCI anaesthesia. Partâ…¡Objective We aimed to determine the clinically required depth of anaesthesia,measured by the A-lineTM AEP Monitor and expressed as A-Line ARX IndexTM(AAI) for probability of acceptable conditions for endotracheal intubation duringremifentanyl and propofol anaesthesia by TCI technique,and compare with fentanyl.Methods 80 ASAâ… orâ…¡patients, were randomized to AAI 10,15, 20,25 groupswhich resulted in an representation of these levels, induction, remifentanyl 3ng/mlwas given through TCI intravenously,,propofol begin infusion after reachremifentanyl concentration The effect site concentration of propofol was initially setat 2ug/ml and successively increased by 0.5ug/ml every time until the appointeddepth of anaesthesia was reached.Ventilation was assisted if respiration becameshallow, Once the alarm sounded, indicating that the required level of anaesthesia hadbeen reached, intubation of the trachea was attempted and conditions gradedaccording to the criteria of Grants. SBP, DBP, HR, AAI, SpO₂, intubationscore(following Grants method) and all side effects and adjuvant drugs wererecorded at six time points during induction of anesthesia: before induction time,reached AAI,0 rain after intubation, 2 min after intubation, 4 rain after intubation.Results At AAI=25, we found acceptable conditions in 55% of patients,Propofol concentration of effect site (Ce_PROP) was 3.161±0.554ug/ml;AAI=20,75%, Ce_PROP 3.587±0.803ug/ml; AAI=15,95%, Ce_PROP 3.862±0.727ug/ml; AAI=10,100%, Ce_PROP 4.716±0.722. AAI ED50=25.671CI95=36.896-22.523; ED95=14.878, CI9517.5-8.6; Ce_PROP EC50=3.1414ug/ml,CI95=2.676-3.3297ug/ml; Ce_PROP EC95=3.9963ug/ml, CI95=3.7292-4.9796ug/ml.Conclusions It is perfect of induction of anaesthesia with target controlledinfusion of remifentanil and propofol for acceptable endotracheal intubationconditions under the conditions of the present study. Synergism of remifentanil withpropofol is stronger than fentanyl. AAI ED95=14.878and Ce_PROP EC95=3.9963ug/mlare suitable anesthesia depth for intubation during 3ng/ml remifentanil and propofol TCI anaesthesia.