Comparison of Entropy and Bispectral Index during Propofol and Fentanyl Sedation in Monitored Anaesthesia Care

Balcı, Canan; Karabekir, Hamit Selim; Sivaci, Remziye

doi:10.1177/147323000903700508

Cited by 16 publications

(12 citation statements)

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“…Entropy is an EEG based monitor to assess the depth of anesthesia and also as an tool to titrate sedation. [ 4 5 ] It calculates two numerical parameters: State entropy (SE, range: 0-91) and RE (range: 0-100). The recommended level of SE values for sedation has been described as between 60 and 75.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of subarachnoid block with bupivacaine and bupivacaine with fentanyl on entropy and sedation: A prospective randomized double-blind study

Varma

Darlong

Pandey

et al. 2014

J Anaesthesiol Clin Pharmacol

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Background and Aims:We studied the state entropy to monitor the sedative effect of subarachnoid block (SAB) using bupivacaine alone or combination of bupivacaine and fentanyl. The effect of use of fentanyl via the subarachnoid route on the sedation level was also studied using the entropy scores and the decrease in the requirement of propofol used as an adjuvant sedative drug.Materials and Methods:In this prospective randomized double-blind study, 30 patients of age 18-70 years requiring SAB were enrolled for the study. Patients with any known allergy to study drugs, contraindication for SAB, obesity, neurological or psychiatric disease on concurrent medication and refusal were excluded from the study. Patients were randomly allocated into two groups: Group C: SAB was administered with 2.5 mL (12.5 mg) of 0.5% hyperbaric bupivacaine; Group D: SAB was administered with 2.5 mL of 2 mL (10 mg) of 0.5% hyperbaric bupivacaine and 0.5 mL (25 μg) fentanyl. Propofol infusion was started if the state entropy (SE) value was ≥75, at the rate of 100 μg/kg/min till the SE value reaches in the range of 60-75 (recorded as onset time). Thereafter the infusion rate was titrated to maintain SE value between 60 and 75. The level of sedation was measured with SE and Ramsay sedation (RS) scale.Results:The demographic profile and baseline parameters, were comparable in two groups (P > 0.05). After SAB, decrease in SE and response entropy was noted in both the groups and fall was significant in Group D (P < 0.0001). The total propfol required in thew two groups were comparable being 3.97 ± 2.14 mg/kg in Group C and 3.41 ± 2.34 mg/kg in Group D (P = 0.342). The change in the mean RS values was from 1.17 ± 0.38 to 1.69 ± 0.47 in Group D (P = 0.06), whereas in Group C it was from 1.03 ± 0.18 to 1.43 ± 0.50 (P = 0.041) within 20 min of SAB.Conclusion:Subarachnoid block causes sedation per se, but the level of sedation is not clinically significant and the sedation caused is not enough to avoid sedative agents for allaying anxiety in patients intraoperatively. The sedative effect of SAB was enhanced by adding intrathecal fentanyl probably because of better quality of SAB. SE showed good correlation with RS scaling system. Therefore, SE may be used as reliable tool to titrate sedation in patients undergoing surgery under SAB.

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Section: Discussionmentioning

confidence: 99%

“…Balci et al . [ 4 ] used state entropy (SE) as an objective tool to titrate sedation in patients who were operated under monitored anesthesia care where they concluded that SE is a reliable indicator of sedation in nonparalyzed patients similar to BIS.…”

Section: Introductionmentioning

confidence: 99%

Comparison of subarachnoid block with bupivacaine and bupivacaine with fentanyl on entropy and sedation: A prospective randomized double-blind study

Varma

Darlong

Pandey

et al. 2014

J Anaesthesiol Clin Pharmacol

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“…Because the MOAA/S scale is categorical, ordered categorical models were fitted to the data, using NONMEM (version 7.2), but with a logistic function and the conditional Laplacian method of estimation. Studies (Sandler and Sparks, 2000 ; Zhong et al, 2005 ; Barakat et al, 2007 ; Balci et al, 2011 ; Colin et al, 2017 ) have shown that there is a good positive correlation between MOAA/S score and BIS. Therefore, we assumed that MOAA/S score related effect-site concentration was the same as that of BIS.…”

Section: Methodsmentioning

confidence: 98%

Population Pharmacokinetic/Pharmacodynamic Model-Guided Dosing Optimization of a Novel Sedative HR7056 in Chinese Healthy Subjects

Zhou

Huang

et al. 2018

Front. Pharmacol.

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HR7056 is a new benzodiazepine, showing more faster acting onset and recovery than currently available short-acting sedatives. To avoid inadequate anesthesia and predict return of cognition, allowing for immediate neurological evaluation, HR7056 pharmacokinetics and pharmacodynamics were characterized in Chinese healthy subjects. We report on modeling of the data and simulations of dosage regimens for future study. Up to 63 subjects were evaluated, using Bispectral Index (BIS) and Modified Observer's Assessment of Alertness/Sedation (MOAA/S) as pharmacodynamics endpoints. A three-compartment model best described HR7056 pharmacokinetics. Total clearance was 1.49 L min−1, central volume was 2.1 L, inter-compartmental clearances were 0.96 and 0.27 L min−1, respectively. The population mean pharmacodynamic parameters were as follows: BIS, E0: 95.3; IC50: 503 ng mL−1; γ: 1.5; ke0: 0.0855 min−1; Imax: 47.9 and MOAA/S, IC50: 436 ng mL−1; γ: 1.5; ke0: 0.05 min−1; Imax: 27.9. The model simulation will enable maintenance doses to be given more accurately for future study.Clinical Trial Registration: identifier: NCT01970072

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“…[23] In addition, a strong correlation between these 2 indices has been found similarly to the sedation scores described in the operating room. [2425] It was, also, found reliable during propofol and fentanyl sedation in monitored anesthesia care[26] and to monitor conscious sedation in endstage cancer patients at home. [27] Moreover, Anderson and Jakobsson demonstrated that increasing levels of sedation provided by propofol during induction of anesthesia decreased the entropy indices significantly and that entropy values at loss of response to verbal commands was significantly different from fully awake values.…”

Section: Discussionmentioning

confidence: 99%

Spectral entropy as an objective measure of sedation state in midazolam-premedicated patients

Mowafi

2012

Saudi J Anaesth

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Context:Objective assessment of sedation depth is a valuable target. Spectral entropy is an anesthetic depth monitor based on the analysis of the electroencephalogram signal.Aims:To evaluate the performance of spectral entropy as an objective measure of sedation state in midazolam-premedicated patients and to correlate it with a clinically assessed sedation score.Settings and Design:This prospective double-blind placebo-controlled study was performed in King Fahd Hospital of the university.Methods:Eighty adult ASA I–II patients were randomly assigned into 4 groups. Patients were premedicated using 0.02, 0.04, or 0.06 mg/kg midazolam or saline intramuscularly. The effect of these doses on the Observer's Assessment of Alertness and Sedation (OAA/S) scale, hemodynamic variables, response entropy (RE), and state entropy (SE), was evaluated at 10, 20, and 30 min after premedication.Statistical analysis:Spearman Rank-order correlation analysis to examine the relation between OAA/S and entropy. The ability of spectral entropy to predict the depth of sedation was evaluated using Smith prediction probability.Results:Midazolam doses ≥0.04 mg/kg produced significant decreases in RE, SE, and OAA/S scores. There was a strong correlation between midazolam dose and OAA/S scale, RE, and SE since Spearman Rank R values were 0.792, 0.822, and 0.745, respectively (P<0.001). In addition, RE and SE were strong predictors of OAA/S level during midazolam sedation with no significant difference in prediction between the 2 entropy components.Conclusions:Spectral entropy is a reliable measure for the sedative premedication. It may be used to objectively assess the adequacy of midazolam premedication and to determine the dose requirement.

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Comparison of Entropy and Bispectral Index during Propofol and Fentanyl Sedation in Monitored Anaesthesia Care

Cited by 16 publications

References 20 publications

Comparison of subarachnoid block with bupivacaine and bupivacaine with fentanyl on entropy and sedation: A prospective randomized double-blind study

Comparison of subarachnoid block with bupivacaine and bupivacaine with fentanyl on entropy and sedation: A prospective randomized double-blind study

Population Pharmacokinetic/Pharmacodynamic Model-Guided Dosing Optimization of a Novel Sedative HR7056 in Chinese Healthy Subjects

Spectral entropy as an objective measure of sedation state in midazolam-premedicated patients

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