Performance of the bispectral index and electroencephalograph derived parameters of anesthetic depth during emergence from xenon and sevoflurane anesthesia

J Clin Monit Comput. 2023 Feb;37(1):71-81. doi: 10.1007/s10877-022-00860-y. Epub 2022 Apr 19.


Many processed EEG monitors (pEEG) are unreliable when non-GABAergic anesthetic agents are used. The primary aim of the study was to compare the response of the Bispectral Index (BIS) during emergence from anesthesia maintained by xenon and sevoflurane. To better understand the variation in response of pEEG to these agents, we also compared several EEG derived parameters relevant to pEEG monitoring during emergence. Twenty-four participants scheduled for lithotripsy were randomized to receive xenon or sevoflurane anesthesia. Participants were monitored with the BIS and had simultaneous raw EEG collected. BIS index values were compared at three key emergence timepoints: first response, eyes open and removal of airway. Two sets of EEG derived parameters, three related to the BIS: relative beta ratio, SynchFastSlow and SynchFastSlow biocoherence, and two unrelated to the BIS: spectral edge frequency and the composite cortical state, were calculated for comparison. BIS index values were significantly lower in the xenon group than the sevoflurane group at each emergence timepoint. The relative beta ratio parameter increased significantly during emergence in the sevoflurane group but not in the xenon group. The spectral edge frequency and composite cortical state parameters increased significantly in both groups during emergence. The BIS index is lower at equivalent stages of behavioural response during emergence from xenon anesthesia when compared to sevoflurane anesthesia, most likely due to differences in how these two agents influence the relative beta ratio. The spectral edge frequency and composite cortical state might better reflect emergence from xenon anaesthesia.Clinical trial number and registry Australia New Zealand Clinical Trials Registry Number: ACTRN12618000916246.

Keywords: Bispectral analysis; Depth of anesthesia monitoring; Electroencephalogram; Frequency domain analysis; Sevoflurane; Xenon.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Anesthesia*
  • Anesthetics, Inhalation*
  • Electroencephalography
  • Humans
  • Methyl Ethers*
  • Sevoflurane
  • Xenon


  • Sevoflurane
  • Xenon
  • Anesthetics, Inhalation
  • Methyl Ethers

Associated data

  • ANZCTR/ACTRN12618000916246