An unexpected increase of entropy in a sleepwalking disorder patient during propofol and remifentanil anesthesia: a case report

Abstract

We report a case of increased values of entropy parameters Response Entropy (RE) and State Entropy (SE) during intravenous general anesthesia in a sleepwalking patient. An ASA class II, 64-year-old woman with stress incontinence underwent mid-urethral sling surgery. Prior to surgery, the patient had been administered paroxetine, valproic acid and clonazepam for the treatment of sleepwalking disorder. After 10 min of target-controlled infusion of propofol and remifentanil, entropy values increased up to 94 (RE) and 88 (SE) for 10 min. The target effect-site concentrations of anesthetics increased from 4 to 7 µg/ml propofol and 4 ng/ml remifentanil, at which point values fell back to adequate anesthesia levels. Episodes of recall or of explicit memories did not occur during the anesthesia. In conclusion, sleepwalking patients with long-term use medications may need increment of anesthetic dose caused by the anesthetic drug metabolism activation or impairment or immaturity of inhibitory circuits in brain.

Unusual elevation in Entropy but not in PSI during general anesthesia: a case report

“…Although Entropy has been shown to have a high predictive power for the loss of consciousness (LOC) or return of consciousness (ROC) in various clinical situations [ 4 ], there are some case reports on unexpected predictions using Entropy [ 7 ]. In addition to Entropy, other EEG-derived indices may also inaccurately reflect a patient’s consciousness [ 8 , 9 ].…”