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

Kim, Young Sung; Chung, Dongik; Oh, Seok Kyeong; Won, Young Ju

doi:10.1186/s12871-018-0486-8

Cited by 12 publications

(11 citation statements)

References 19 publications

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“…Another experienced implication was studied by Aho et al, they found inconsistent values recorded by entropy concomitantly with raw EEG signal during general anaesthesia, electrocautery-induced artefacts. episodic EMG activity revealed non-relevant BIS and entropy indices with the raw EEG signals [12].…”

Section: Discussionmentioning

confidence: 99%

Erector spinae plane block combined with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery

Siam

Aliaa

El-Medany

et al. 2020

Egyptian Journal of Anaesthesia

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Background: Perioperative pain management should be planned preoperatively and based on usage of pharmacological and non-pharmacological modalities as a multimodal analgesia (MMA). Regional anaesthesia has superior advantages than opioid-based anaesthesia and is one of the cornerstones of the Enhanced Recovery After Surgery (ERAS) especially in Patients undergoing spine surgery having already troublesome chronic pain and analgesic use. The present study was carried out to compare erector spinae plane block (ESP) with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery. Materials and Methods: This study was done on thirty adult patients of both sexes scheduled for elective lumbar spine surgery under general anaesthesia. They were randomly categorized into two equal groups (fifteen patients each); ESP was used for group I, and MMA was used for group II. Data was collected on anaesthetic requirements based on entropy monitoring and haemodynamic parameters, stress response measurement based on serum cortisol and blood glucose levels, controlled hypotensive anaesthesia; various drugs required and doses given, intraoperative and postoperative analgesia, postanaesthesia care unit data concerning recovery. Results: The group I (ESP) had statistically significant decrease of the response and the response-state entropy difference levels when compared to the group II (MMA) after stimulus and during the 1st time interval. The incidence of hemodynamic changes was significantly higher in the group I (ESP) than group II (MMA). Only the serum cortisol but not the blood glucose levels had statistically significant lower mean values 4 h postoperatively in group I (ESP) compared to group II (MMA). The patients received ESP had statistically significant lower mean expired isoflurane concentration, decreased emergence time, intraoperative fentanyl consumption and total dose of pethidine given up to 8 hrpostoperatively. Conclusions: Erector spinae plane block (ESP) can be considered safe and effective perioperative analgesic modality for lumbar spine simple decompression surgery. It helps in controlled hypotensive anaesthetic technique and decreases inhalational anaesthetics and intraoperative opioid requirements.

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Section: Discussionmentioning

confidence: 99%

Erector spinae plane block combined with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery

Siam

Aliaa

El-Medany

et al. 2020

Egyptian Journal of Anaesthesia

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“…Recently, Kim et al. 10 added support to this contention with a case of an unusual increase in entropy by EMG activity, which was not indicated by the patient state index.…”

Section: Discussionmentioning

confidence: 98%

Entropy values are closely related to the degree of neuromuscular block during desflurane anesthesia: a case report

Lim

Kim

et al. 2019

J Int Med Res

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The Entropy™ module and bispectral index (BIS) depth-of-anesthesia monitors have been shown to be influenced by electromyographic (EMG) activity. The increase in entropy and BIS values is most likely caused by increased EMG activity and a higher level of consciousness. A strong EMG activity can increase entropy and BIS values because it is impossible to separate electroencephalography (EEG) from EMG, and this results from their overlapping power spectra. Thus, the entropy module may be more affected by EMG compared with the BIS module because it has more overlap with the power spectra of EEG and EMG. Several studies have suggested that EMG activity is most likely to increase, especially as it relates to the level of total intravenous anesthesia without a muscle relaxant or an insufficient analgesic level, which results in falsely increased entropy values. We present the case of a patient whose entropy values were falsely elevated by increased EMG activity resulting from light neuromuscular block or nociceptive stimuli during surgery even when undergoing desflurane anesthesia. This was closely related to the change in the neuromuscular block level and it was influenced by the degree of analgesia and the remifentanil infusion rate.

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“…Despite these limitations, our results provide meaningful information in interpreting the BIS and entropy in children with cerebral palsy, in whom entropy may help distinguish consciousness from unconsciousness as well as the BIS. Considering that entropy describes the irregularity, complexity, or unpredictability of the EEG [ 20 ] and assuming that BIS reflects the EEG characteristics of the general population (see the Appendix ), entropy may be useful for CP patients. Furthermore, looking to exhibiting hysteresis, both BIS and entropy can be said to suggest that the limits of the EEG signal processing for real-time evaluation of consciousness [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Bispectral Index and Entropy During Sevoflurane Anesthesia Induction in Children with and without Diplegic Cerebral Palsy

Kim

Won

Jeong

et al. 2019

Entropy

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Background: This study compared the correlation of bispectral index (BIS) or entropy with different sevoflurane concentrations between children with and without cerebral palsy (CP) during induction. Methods: For eighty-two children (40 CP and 42 non-CP children), anesthesia was induced with sevoflurane. BIS and entropy (response entropy and state entropy (RE and SE)) were recorded before and after the induction of anesthesia at end-tidal sevoflurane concentrations of 1–3 vol%. The sedation status was assessed using an Observer’s Assessment of Alertness/Sedation scale. The ability to predict awareness was estimated using the area under the receiver-operator characteristic curve (AUC) analysis. Results: RE, SE and BIS values decreased continuously over the observed concentration range of sevoflurane in both groups. The SE values while awake and the RE, SE, BIS values at 3 vol% sevoflurane were lower in children with CP than in those without CP. The AUC of the BIS was significantly better than RE or SE in children without CP. The AUC of the BIS was not significantly higher than that of the RE or SE in children with CP. Conclusion: BIS seems better correlated than entropy with the clinical state of loss of response in children without CP, but not in those with CP.

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

Cited by 12 publications

References 19 publications

Erector spinae plane block combined with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery

Erector spinae plane block combined with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery

Entropy values are closely related to the degree of neuromuscular block during desflurane anesthesia: a case report

A Comparison of Bispectral Index and Entropy During Sevoflurane Anesthesia Induction in Children with and without Diplegic Cerebral Palsy

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