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Open Med (Wars). 2018 Nov 24;13:583-596. doi: 10.1515/med-2018-0087. eCollection 2018.

How Bispectral Index Compares to Spectral Entropy of the EEG and A-line ARX Index in the Same Patient.

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Department Anaesthesia and Intensive Care Medicine Innsbruck Medical University, Innsbruck Austria.
Department of Biostatistics and Documentation, Innsbruck Medical University, Innsbruck Austria.
Department of Pathology, Innsbruck Medical University, Innsbruck Austria.
Department of Statistics, Leopold-Franzens University, Innsbruck Austria.
Department of Anaesthesia and Intensive Care Medicine, Innsbruck Medical University, A-6020 Innsbruck, Anichstrasse 35, Innsbruck Austria.



Bispectral index (BIS) monitoring of depth of anesthesia has pioneered the field for more recent monitoring devices like the A-line ARX Index (AAI) or the state (SE) and response entropy (RE) monitoring devices. Following an observational design the present study aimed to simultaneously compare in the same patient recorded BIS, AAI and entropy values.


Data from patients (n = 32) undergoing minor gynecological operations were analyzed. For all patients, standardized anesthesia was used. Before induction of anesthesia AEP electrodes, BIS and entropy sensors were simultaneously placed on the forehead and recordings were started at 3 minutes before induction and continued until patient transfer to the postanesthesia care unit. Markers were set at defined landmarks.


Anesthesia reduced mean BIS, AAI and entropy values. During uneventful, and even more pronounced, during eventful anesthesia BIS/ entropy and BIS/ AAI values showed better correlation than did AAI and entropy values. The prediction probability (Pk) of AAI (0.824 ± 0.036) and RE (0.786 ± 0.040) or SE (0.781 ± 0.040) for preanesthesia awake, postanesthesia awake or anesthesia was comparable and significantly greater than that of BIS (0.705 ± 0.047). However, only 20% of BIS, AAI and entropy values simultaneously categorized the state of the patient as awake, inadequate anesthesia, optimal anesthesia or deep anesthesia.


The prediction probability (Pk) of entropy and AAI was comparable and better than that of BIS. However, agreement between BIS, AAI and entropy measurements on patient state was poor.


A-line ARX Index (AAI) State (SE) response (RE) Entropy; Bispectral index (BIS); Depth of anaesthesie prediction probability (Pk); Same patient

Conflict of interest statement

Conflict of interest: Authors state no conflict of interest.

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