Use of Spectral Entropy Monitoring in Reducing the Quantity of Sevoflurane as Sole Inhalational Anesthetic and in Decreasing the Need for Antihypertensive Drugs in Total Knee Replacement Surgery

Abstract

Using spectral entropy monitoring for guiding the depth of sevoflurane anesthesia in total knee replacement surgery can reduce its consumption and the frequency of use of antihypertensive drugs.

Clinical effectiveness and cost-effectiveness of depth of anaesthesia monitoring (E-Entropy, Bispectral Index and Narcotrend): a systematic review and economic evaluation

“…The method of allocation concealment was considered to pose unclear risk of bias in all seven of the trials, either because no relevant information was reported 58,61,62 or sealed envelopes were used for allocation codes, but it was not stated whether or not the envelopes were opaque. [54][55][56][57] Anaesthetists who administered anaesthesia according to standard clinical monitoring were blinded to E-Entropy values.…”

“…56 Two trials were considered at high risk of attrition bias because the rate of attrition was ≥10% in at least one of the study arms, and not balanced across the arms. 58,62 The remaining two trials were judged to have unclear risk of attrition bias because of incomplete outcome data, either because attrition was not reported at all 55 or it was not reported separately by study arm. …”

“…Two trials were funded by non-commercial sponsors, which were a university 54 and a national science organisation. 58 The remaining three E-Entropy trials were supported by the E-Entropy device manufacturer (GE Healthcare; formerly Datex-Ohmeda), either through provision of equipment alone 55,61 or through provision of equipment, funding and also technical support. 57 The authors of this latter trial 57 included a research engineer, research scientist and chief scientist of the device manufacturer and two medical advisors to the device manufacturer.…”

“…The study that involved the most extensive links with the manufacturer 57 was deemed by the reviewers to be at high risk of bias because of a high likelihood of conflicting interests. In the four E-Entropy trials that were not supported by the E-Entropy device manufacturer, three did not refer to conflict of interests 54,58,62 and one stated that no conflicts were disclosed. 56 The seven E-Entropy studies were published during 2005 to 2010 and ranged in their total sample size from 50 to 335 patients.…”

Entropy-Guided Depth of Anesthesia in Critically Ill Polytrauma Patients

“…They reported statistically significant consumption of sevoflurane in patients receiving Entropy monitoring (27.79 mL ± 7.4 mL vs. 31.42 mL ± 6.9 mL, p <0.05). 9 A high percentage of polytraumatized patients have cranio-cerebral traumas requiring neurosurgical interventions. In this regard, there could be a number of problems with the accuracy of Entropy monitoring.…”