Predicting sensitivity to general anesthesia: Bispectral index versus Checkpoint-Decomposition Algorithm

Despite a large effort in EEG signal processing, classification algorithms, deep-learning approach, predicting the sensitivity to general anesthesia (GA) remains a daunting hurdle. We compare here the ability of the Bispectral Index™ (BIS™), developed more that twenty years ago to monitor the depth of anesthesia, with the real-time checkpoint-decomposition algorithm (CDA) to evaluate the patient sensitivity from the early induction phase of GA. Using EEG recorded in children anesthetised with propofol, we computed three parameters extracted from the BIS: 1- the minimum value (nadir) of the BIS, 2- the time to reach the minimum and 3- the duration spent below 40 during the first 10 minutes. Using a logistic regression procedure, we report that these parameters provide a poor prediction of sensitivity compared to the CDA, that combined the first occurrence time of iso-electric EEG traces, fraction of suppressions of the alpha-band and its first occurrence time. Finally, we correlate the BIS values with the maximum power frequency of the alpha-band, the proportion of alpha-suppressions (alpha S) and iso-electric suppressions (IES) as well as the alpha and delta power ratios. To conclude, the checkpoint-decomposition algorithm complements the EEG indices such as the BIS to anticipate the sensitivity to GA. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: For each patient, two or more plateaus of 10 minutes duration were applied with a fixed concentration: one or more random concentrations and one for which the BIS value was maintained at 50. This study was approved by the Ethics Committee CPP Saint Antoine, Paris, France (Approval number: 04605). Written and informed consent was obtained from children and their parents. The protocol has been therefore performed in accordance with the ethical standards laid down in 1964 declaration of Helsinki and its later amendments. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data available upon reasonable request