Spectral entropy measurement of patient responsiveness during propofol and remifentanil. A comparison with the bispectral index †

Vanluchene, Ann; Struys, Michel; Heyse, Björn; Mortier, Éric

doi:10.1093/bja/aeh251

Cited by 105 publications

(72 citation statements)

References 24 publications

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“…Because the OAA ⁄ S scale [1] has been validated for propofol sedation in the clinical setting [5,9,14], we chose it as our benchmark in this study. However like all observer-administered sedation scales, it is subjective.…”

Section: Discussionmentioning

confidence: 99%

“…Simple and quick to use, they are limited at deeper levels of sedation when the patient can no longer report the scale. Bispectral index (BIS) [4] and spectral entropy [5] are useful in predicting the likelihood of continued response to verbal command during propofol infusion, they are less reliable for monitoring the effects of lighter levels of sedation [23,24].…”

Section: Discussionmentioning

confidence: 99%

“…Different sedation scales [1][2][3] are all subjective, relying on assessments made by either patient or observer. A variety of objective electrophysiological monitoring including bispectral index [4], spectral entropy [5], Narcotrend TM [6] and auditory evoked potentials [7,8] are of some value but all share the disadvantage of not assessing patient responsiveness. Recently, both auditory and visual reaction times have been correlated with the level of sedation produced by propofol infusion [9].…”

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confidence: 99%

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Evaluation of a new method of assessing depth of sedation using two‐choice visual reaction time testing on a mobile phone*

Thomson¹,

Nimmo²,

Tiplady³

et al. 2008

Anaesthesia

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SummaryThe utility of two‐choice visual reaction time testing using a specially programmed mobile telephone as a measure of sedation level was investigated in 20 healthy patients sedated with target controlled infusions of propofol. At gradually increasing target concentrations visual reaction time was compared with patient‐assessed visual analogue scale sedation scores and an observer‐rated scale. Propofol sedation caused dose‐dependent increases in visual reaction time and visual analogue scale scores that were statistically significant when the calculated effect‐site concentration reached 0.9 μg.ml−1 (p < 0.05) and 0.5 μg.ml−1 (p < 0.01) respectively. While visual analogue scale scores were more sensitive at lower levels of sedation than visual reaction time, the latter demonstrated marked increase in values at higher levels of sedation. Visual reaction time may be useful for identifying impending over‐sedation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Evaluation of a new method of assessing depth of sedation using two‐choice visual reaction time testing on a mobile phone*

Thomson¹,

Nimmo²,

Tiplady³

et al. 2008

Anaesthesia

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“…Auditory evoked potentials may be a better indicator of conscious status as they appear to be independent of the anaesthesia regimen but the reading is less graded than the BIS and the earphones make patient communication difficult [14,22]. Spectral entropy appears to have a similar sensitivity as BIS [23]. Therefore, although the ability of BIS as a reliable monitor for sedation has been questioned [2], it does appear to be one of the simplest and most reliable monitors currently available for this purpose.…”

Section: Discussionmentioning

confidence: 99%

A study to assess the value of bispectral analysis in intravenous sedation with midazolam during third molar surgery under local anaesthesia

et al. 2008

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SummaryThis study aimed to determine whether bispectral index (BIS) can be used as an indicator of sedation and recovery with intravenous midazolam. In Part A, 30 healthy patients undergoing third molar extraction under local anaesthesia were recruited. They were sedated with intravenous midazolam titrated to clinical endpoints. BIS values were recorded when adequately sedated (BIS S ) and when clinical recovery criteria were met (BIS R ). In Part B, another 30 patients were sedated to the range of BIS S obtained in Part A. Recovery was assessed postoperatively when the range of BIS R from Part A was reached. BIS titrated patients required less midazolam (p < 0.001). Seventy percent of Part B patients required increments of midazolam during surgery, compared to 16.7% in Part A (p < 0.001). Total dose of midazolam given was lower in Part B (p = 0.025). BIS is not effective as a sole indicator of endpoint in sedation with intravenous midazolam.

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“…The propofol effect site concentration has shown a good correlation to anesthetic depth in several studies, in particular in controlled patient groups; therefore, it was used in this study to evaluate the performance of the CSI as a cerebral drug effect monitor in comparison to BIS and AAI 60 . [7][8][9]26 Even more important, a depth of anesthesia monitor should first of all correlate well with the clinical state of the patient, with minimum time delay and variation. To investigate this, we selected the OAA/S score because it provides a good correlation with a clinical reflection of the hypnotic component of anesthesia and has been tested prospectively, 27 although it has its limitations, as we pointed out in a previous article.…”

Section: Discussionmentioning

confidence: 99%

Cerebral State Index during Propofol Anesthesia

Jensen

Litvan²,

Revuelta

et al. 2006

Anesthesiology

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Background The objective of this study was to prospectively test the Cerebral State Index designed for measuring the depth of anesthesia. The Cerebral State Index is calculated using a fuzzy logic combination of four subparameters of the electroencephalographic signal. The performance of the Cerebral State Index was compared with that of the Bispectral Index and the A-Line ARX Index. Methods This study applied raw data from two previously published clinical protocols. The patients in protocol 1 were given a continuous propofol infusion, 300 ml/h, until 80% of burst suppression occurred. In protocol 2, a stepwise increased target-controlled infusion of propofol was administered to patients until loss of response to noxious stimuli while the Observer's Assessment of Alertness and Sedation was registered every 4 min. The Cerebral State Index was calculated off-line from the recorded electroencephalographic data. The Spearman rank correlation coefficient between electronic indices and the effect site concentration of propofol was calculated along with the prediction probability of each index to predict the Observer's Assessment of Alertness and Sedation level. Results The Spearman rank correlation coefficients between the Cerebral State Index, Bispectral Index, and A-Line ARX Index and the propofol effect site concentration were -0.94, -0.89, and -0.82, respectively, in protocol 1, whereas the prediction probability values between the Cerebral State Index, Bispectral Index, and A-Line ARX Index and the Observer's Assessment of Alertness and Sedation score in protocol 2 were 0.92, 0.93, and 0.91, respectively. Conclusion The Cerebral State Index detects well the graduated levels of propofol anesthesia when compared with the propofol effect site concentration and the Observer's Assessment of Alertness and Sedation score.

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Spectral entropy measurement of patient responsiveness during propofol and remifentanil. A comparison with the bispectral index †

Cited by 105 publications

References 24 publications

Evaluation of a new method of assessing depth of sedation using two‐choice visual reaction time testing on a mobile phone*

Evaluation of a new method of assessing depth of sedation using two‐choice visual reaction time testing on a mobile phone*

A study to assess the value of bispectral analysis in intravenous sedation with midazolam during third molar surgery under local anaesthesia

Cerebral State Index during Propofol Anesthesia

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