Recovery from Paralysis with Succinylcholine Increased Response Entropy and Emg but not State Entropy

Baughman, Verna L.; Hoffman, William E.; Koenig, Heidi M.; Wheeler, Peggy L.; Ananda, Ranga C.; Wang, Mathew

doi:10.1007/s10877-005-3373-z

Cited by 5 publications

(3 citation statements)

References 12 publications

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“…These increases were associated with the appearance of EMG in the EEG raw signal. The recovery from succinylcholine paralysis increased RE and EMG but not the SE values (Baughman et al 2005). Their findings and those of our study suggest the increase in the difference between RE and SE is not a good indicator of nociception.…”

Section: Entropy and Muscle Relaxationcontrasting

confidence: 55%

EEG-based monitoring during general anaesthesia and sedation. Studies on cardiac surgery and status epilepticus patients

Musialowicz

2013

Acta Anaesthesiol Scand

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T he aim of this study was to evaluate and compare the utility of different electroencephalography (EEG)-based neuromonitoring methods during general anaesthesia for cardiac surgery and sedation in the intensive care unit (ICU). In the first study, midlatency auditory-evoked potentials (MLAEPs) were evaluated as a measure of the sedation level in cardiac surgery patients during post-operative sedation. The purpose of this study was to evaluate whether graded changes in sedation induced by pre-and post-operative sedative drugs can be detected by any of the components of MLAEPs. The latency of the Nb component increased significantly after pre-medication, and during deep and moderate sedation, and remained increased the day after surgery. The Na-Pa amplitude was decreased during deep sedation compared with baseline and moderate sedation. In the second study, MLAEPs were evaluated in cardiac surgery patients when anaesthesia was guided with the aid of the bispectral index (BIS). It was tested whether the parameters derived from EEG indicate similar states of anaesthesia with the two different anaesthesia techniques. At similar BIS levels, the latency of the Nb component of MLAEPs was significantly increased after intubation, and both the Nb and Pa components were significantly increased after sternotomy in patients anaesthetised with isoflurane compared with propofol. Our results suggest that the parallel use of these two methods can show differences in the components of anaesthesia. In the third study, the feasibility of the BIS index to assess the EEG burst suppression pattern during anaesthesia for refractory status epilepticus (RSE) in the ICU was evaluated. An excellent correlation was found between the BIS index and bursts per minute in the raw EEG. BIS monitoring represents a useful alternative for titration of an anaesthetic agent to reach sufficient suppression in the EEG. In the fourth study, state entropy (SE) values were compared with the BIS index in patients undergoing general anaesthesia for cardiac surgery. Response entropy (RE) as a predictor for surgical noxious stimulation was also evaluated. A poor agreement between SE and BIS index values was found, but RE was a good predictor of arousal after surgical stimulation.In conclusion, in EEG-based monitoring for the assessment of hypnosis during cardiac surgery, different indices show poor agreement (BIS vs. SE) and indicate different components of anaesthesia (MLAEP vs. BIS). In the ICU settings, EEG-based methods can be used to titrate various levels of sedation and to monitor the response to RSE treatment. List of published papers1. Musialowicz T, Hynynen M, Yppärilä H, Pölönen P, Ruokonen E, Jakob SM. Midlatency auditory-evoked potentials in the assessment of sedation in cardiac surgery patients. J Cardiothorac Vasc Anesth 2004; 18: 559-62. 2. Musialowicz T, Niskanen M, Yppärilä-Wolters H, Pöyhönen M, Pitkänen O, Hynynen M. Auditory evoked potentials in bispectral index-guided anaesthesia for cardiac surgery. Eur J Anaesthesiol 2007; 24: 571-9. 3....

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Section: Entropy and Muscle Relaxationcontrasting

confidence: 55%

EEG-based monitoring during general anaesthesia and sedation. Studies on cardiac surgery and status epilepticus patients

Musialowicz

2013

Acta Anaesthesiol Scand

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“…Recently, Takizawa and colleagues [24] Several investigators evaluating BIS devices [25,26], reported a significant impact of the f-EMG on BIS, whereas only a few studies demonstrated less impact of f-EMG on SE [9,27].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Spectral Entropy and Bispectral Index Electroencephalography in Coronary Artery Bypass Graft Surgery

Baulig

Seifert

Schmid

et al. 2010

Journal of Cardiothoracic and Vascular Anesthesia

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Objective: The study's aim was to compare Response (RE) and State Entropy (SE) with Bispectral Index (BIS) electroencephalography (EEG) as an alternative cerebral monitoring tool in patients scheduled for coronary artery bypass graft surgery.Design: Prospective, observational single-center study Setting: University HospitalParticipants: Thirty patients undergoing coronary artery bypass graft surgery receiving remifentanil-propofol anaesthesia.Interventions Surgery was performed with cardiopulmonary bypass (CPB) and cardiac arrest in fifteen patients, with CPB without cardiac arrest in nine patients and without CPB in six patients. Measurements and Main results RE, SE, BIS, burst suppression ratio (BSR) and frontalelectromyography (f-EMG) were detected simultaneously. RE and SE compared favorably to BIS and their correlations were strong (r 2 = 0.6, r 2 = 0.55, respectively). Mean bias of RE and BIS was -1.8, but limits of agreement were high (+20.5/-24.1). RE and SE tended to be lower than the BIS values in the CPB subgroups. Detection of BSR was similar with RE and SE, and the BIS. A strong correlation existed between BIS and f-EMG (r 2 = 0.62), in contrast to RE (r 2 = 0.45) and SE (r 2 =0.39). BIS monitoring was significantly more disturbed than RE and SE with 9.1 ±10.9% and 0.1±0.2% of the total anesthesia time, respectively. Neither implicit nor explicit memory was demonstrated.Conclusion RE and SE are comparable with the BIS but showed significantly less interference from f-EMG and superior resistance against artefacts. Thus, Spectral Entropy is more suitable than the BIS during propfol-remifentanil anesthesia in cardiac surgery patients. Words: 2482

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“…Baughman et al [8] zeigten, dass nach Sedierung mit Isofluran und Relaxierung mit Succinylcholin RE und SE sowie das EMG sanken. Nach Erholung von der Paralyse stiegen EMG und RE wieder an, während SE stabil blieb.…”

Section: Unterscheidung Von Verschiedenen Zeitpunkten Der Anästhesieunclassified

Messung der Narkosetiefe

2007

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One of the most important mandates of the anaesthesiologist is to control the depth of anaesthesia. An unsolved problem is that a straight definition of the depth of anaesthesia does not exist. Concerning this it is rational to separate hypnosis from analgesia, from muscle relaxation and from block of cardiovascular reactions. Clinical surrogate parameters such as blood pressure and heart rate are not well-suited for a valid statement about the depth of hypnosis. To answer this question the brain has become the focus of interest as the target of anaesthesia. It is possible to visualize the brain's electrical activity from anelectroencephalogram (EEG). The validity of the spontaneous EEG as an anesthetic depth monitor is limited by the multiphasic activity, especially when anaesthesia is induced (excitation) and in deep anaesthesia (burst suppression). Recently, various commercial monitoring systems have been introduced to solve this problem. These monitoring systems use different interpretations of the EEG or auditory-evoked potentials (AEP). These derived and calculated variables have no pure physiological basis. For that reason a profound knowledge of the algorithms and a validation of the monitoring systems is an indispensable prerequisite prior to their routine clinical use. For the currently available monitoring systems various studies have been reported. At this time it is important to know that the actual available monitors can only value the sedation and not the other components of anaesthesia. For example, they cannot predict if a patient will react to a painful stimulus or not. In the future it would be desirable to develop parameters which allow an estimate of the other components of anaesthesia in addition to the presently available monitoring systems to estimate sedation and muscle relaxation. These could be sensoric-evoked potentials to estimate analgesia and AEPs for the detection of awareness.

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Recovery from Paralysis with Succinylcholine Increased Response Entropy and Emg but not State Entropy

Abstract: Although RE and EMG increased during recovery from paralysis with succinylcholine, SE, an indicator of EEG, was not stimulated. EMG activity may not be an indicator of patient arousal after succinylcholine treatment.

Cited by 5 publications

References 12 publications

EEG-based monitoring during general anaesthesia and sedation. Studies on cardiac surgery and status epilepticus patients

EEG-based monitoring during general anaesthesia and sedation. Studies on cardiac surgery and status epilepticus patients

Comparison of Spectral Entropy and Bispectral Index Electroencephalography in Coronary Artery Bypass Graft Surgery

Messung der Narkosetiefe

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