The narcotrend™ monitor and the electroencephalogram in propofol-induced sedation

BACKGROUND: The Narcotrend™ (NCT) is a one-channel electroencephalogram (EEG) monitor of the level of sedation. It is based on a visual EEG scoring system, which was developed by Loomis and modified by Kugler, to yield a visual expert classification (VEC) scheme for differentiation of six levels of sedation (A-F), which are subdivided into 16 substages. We designed the present study to test whether results of the automated classification of one-channel NCT input reflect those from VEC of five-channel EEG. METHODS: Twelve healthy male volunteers received propofol using two different infusion regimens in a randomized, crossover design with concomitant NCT monitoring and VEC. Scoring results of NCT were compared with those of VEC. RESULTS: During the infusion period, score differences of more than three substages were observed in 14 of 24 (= 58%) propofol administrations (4%-7% of total data). Often, the NCT indicated lighter sedation than VEC, which revealed more δ activity from nonfrontal leads. During recovery, NCT reported deeper sedation than VEC in 6 of 24 (= 25%) propofol administrations. Discordant trends (periods of at least five subsequent epochs with monotonic, but opposite trends for both NCT and VEC) were noted in 9 of 24 propofol administrations (37%). Furthermore, NCT had several periods when no staging information was displayed, varying from a few seconds to 10 min. CONCLUSIONS: As the algorithm of NCT is proprietary and not accessible to the public, reasons for the observed differences between NCT and VEC cannot be analyzed and explanations must remain speculative.