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DepthofanesthesiaChristopherD.KentandKarenB.DominoDepartmentofAnesthesiologyandPainMedicine,PurposeofreviewUniversityofWashingtonSchoolofMedicine,Seattle,Washington,USAThepresentreviewarticleprovidesasummaryoftherecentliteratureevaluatingthetechnologyformonitoringdepthofanesthesiaandpatientoutcomesassociatedCorrespondencetoKarenB.Domino,MD,MPH,DepartmentofAnesthesiologyandPainMedicine,withitsuse.UniversityofWashingtonSchoolofMedicine,1959RecentfindingsNEPacificStreet,Box356540,Seattle,WA98195-6540,USAThetentativeandcontroversialfindingsofa2006studysuggestingacorrelationofTel:+12066162627;fax:+12065432958;mortalitywithlowerintraoperativebispectralindexscoreswerereproducedinamoree-mail:kdomino@u.washington.edurecentstudy,butthecorrelationcouldbeaccountedforbycontrollingforpatientCurrentOpinioninAnaesthesiology2009,comorbidities,particularlymalignancy.Inalargetrialinvolvingpatientsathighriskfor22:782–787awareness,generalanesthesiawithvolatileagentsguidedbybispectralindexmonitoringwasassociatedwithalowincidenceofawareness,butnomoresothantheuseofalarmsforlimitsonvolatileagentconcentration.Studiescomparingbothemergingandmoreestablishedbrainfunctionmonitorssuggestthat,inspiteoftheirdifferentalgorithmsforprocessingandfilteringelectromyographicsignal,manymonitorsareaffectedbytheuseofneuromuscularblockingagents.Recentevidenceisconsistentwithpreviousstudiesthatdescribeanonlinearmodelforthedose–responseofEEGparameterstoincreasingconcentrationofanestheticagentswithadosingplateauresponseoveraclinicallyrelevantdoserange.SummaryThegoalofpreciselydosedgeneralanesthesiaguidedbybrainmonitoringremainselusive.Keywordsdepthofanesthesia,depthofhypnosismonitors,EEGmonitoring,intraoperativebrainfunctionmonitorsCurrOpinAnaesthesiol22:782–787ß2009WoltersKluwerHealth|LippincottWilliams&Wilkins0952-7907onthebalancebetweentwoantagonisticfactors:theIntroductionanestheticdoseandsurgicalstimulation.OptimaldepthMeasuringdepthofanesthesiaisanattempttoquantifyofanesth
