Spectral Entropy as a Monitor of Depth of Propofol Induced Sedation
Tóm tắt
The aim of this prospective, observational study was to evaluate State and Response entropy (EntropyTM Monitor, GE Healthcare, Finland), indices as measures of moderate (“conscious”) sedation in healthy adult patients receiving a low dose propofol infusion. Sedation was evaluated using: (I) the responsiveness component of the OAA/S scale␣(Observer’s Assessment of Alertness/Sedation scale) and (II) multi-channel electroencephalogram (EEG) interpretation by a clinical expert. 12 ASA I patients were recruited. A target-controlled infusion of propofol was administered (using Schnider’s pharmacokinetic model) with␣an initial effect site concentration set to 0.5 µg ml−1. A␣4 minute equilibrium period was allowed. This concentration was increased at 4 minute intervals by 0.5 µg ml−1 to a maximum of 2.0 µg ml−1. State (SE) and Response (RE), entropy values were recorded for each 4 minute epoch together with clinical sedation scores (OAA/S) and continuous multi-channel EEG. The multi-channel EEG recorded during the final minute of each 4 minute epoch or “patient/time unit” was presented to a neurophysiologist who assigned a label “sedated/not sedated”. SE/RE values were compared in patient/time units with clinical or EEG evidence of sedation versus those without. Mean SE and RE values were less in patient/time units when clinical evidence of sedation was present, [mean = 86.8 (95% CI, 84.0–88.3) and 94.3 (95%CI, 92–96.1)], P = 0.002 and P = 0.001, respectively. In patient/time units assigned the label “sedated” by the clinical neurophysiologist assessing the multi-channel EEG, SE and RE values were less [mean = 87.5 (95% CI, 86.3–88.4) and 95.0 (95% CI, 93.8–96.1)] P = 0.001 and P < 0.001, respectively. A statistically significant decrease in SE and RE values was demonstrated in patient/time units in which clinical or EEG evidence of sedation was present. We conclude that spectral entropy offers potential as a monitor of propofol induced sedation
Tài liệu tham khảo
Bailey P, Zuccaro G Sedation for endoscopic procedures: not as simple as it seems. Am J Gastroenterol 2006;101(9):2008–2010
Jensen EW, Litvan H, Struys MM, Martinez-Vazquez P. Pitfalls and challenges when assessing the depth of hypnosis during general anaesthesia by clinical signs and electronic indices. Acta Anaesthesiol Scand 2004;48(10):1260–1267
Ramsay M, Sevage T, Simpson B, Goodwin R. Controlled sedation with alphaxalone-alphadalone. Br Med J 1974;2:656–659
Chernik D, Gillings D, Laine H, Hendler J, Silver J, Davison A, Schwam E, Siegel J. Validity and reliability of the observer’s assessment of alertness/sedation scale: study with intravenous midazolam. J Clin Psychopharmacol 1990;10:244–251
Kishimoto T, Kadoya C, Sneyd R, Samra S, Domino E. Topographic electroencepalogram of propofol-induced conscious sedation. Clin Pharmacol Therapeut 1995;58:666–674
Viertio-Oja H, Maja V, Sarkela M, Talja P, Tenkanen N, Tolvanen-Laakso H, Paloheimo M, Vakkuri A, Yli-Hankala A, Merilainen P. Description of the Entropy algorithm as applied in the Datex-Ohmeda S/5 Entropy Module. Acta Anaesthesiol Scand 2004;48(2):154–161
Rautee R, Sampson T, Sarkela M, Melto S, Hovilehto S, Van-Gils M. Application of spectral entropy to EEG and Facial EMG frequency bands for the assessment of level of sedation in ICU. In: 26th Annual International Conference of the IEEE EMBS; 2004 September 1–5; San Francisco, CA, USA; 2004
Hernandez-Gancedo C, Pestana D, Perez-Chrzanowska H, Martinez-Casanova E, Criado A. Comapring entropy and bispectral index with the ramsay score in sedated ICU patients. J Clin Monit. Comput 2007;21:295–302
Schneider T, Minto S, Shafer S, Gambus P, Andresen C, Goodale D, Youngs E. The influence of age on propofol pharmacodynamics. Anesthesiology 1999;90:1502–1516
Schneider T, Minto C, Gambus P. The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers. Anesthesiology 1998;90:1502–1516
Niedermeyer E. Sleep and EEG. In: Niedermeyer E, Lopez-da-Silva F, eds, Electroencephalography. Basic Principles, Clinical Applications, and Related Fields. 3rd Edition. Baltimore: Williams and Wilkins; 1999: 174–189
Ferenets R, Vanluchene A, Lipping T, Heyse B, Struys M. Behavior of entropy/complexity measures of the electroencephalogram during propofol-induced sedation: dose-dependent effects of remifentanil. Anesthesiology 2007;106(4):696–706
Kuizenga K, Wierda J, Kalkman C. Biphasic EEG changes in relation to loss of consciousness during induction with, thiopental, propofol, etomidate, midazolam or sevoflurane. Br J Anaesth 2001;86(3):354–360
Anderson R, Barr G, Owall A, Jakobsson J. Entropy during propofol hypnosis, including an episode of wakefulness. Anaesthesia 2004;59:52–56
Doenicke A, Kugler J, Kochs E, Muckter H, Hoernecke R, Conzen P, Bromber H, Schneider G. The narcotrend monitor and the electroencephalogram in propofol-induced sedation. Anesth Analg 2007;105:982–992
Bauerle K, Greim C, Schroth M, Geisselbrecht M, Kobler A, Roewer N. Prediction of depth of sedation and anaesthesia by the Narcotrend EEG monitor. Br J Anaes 2004;92(6):841–845
Sadhasivam S, Ganesh A, Robinson A, Kaye R, Watcha M. Validation of the bispectral index monitor for measuring depth of sedation in children. Anesth Analg 2006;102:383–388
Iannuzzi M, Iannuzzi E, Rossi F, Berrino L, Chiefari M. Relatioship between Bispectral index, electroencephalographic state entropy and effect-site EC50 for propofol at different clinical endpoints. Br J Anaes 2005;94:492–495
Struys M, Vereecke H, Moerman A, Jensen E, Verhaeghen D, DeNeve N, Dumortier F, Mortier E. Ability of the bispectral index, autoregressive modelling with exogenous input-derived auditory evoked potentials, and predicted propofol concentrations to measure patient responsiveness during anesthesia with propofol and remifentanil. Anesthesiology 2003;99:802–812
Struys M, DeSmet T, Depoorter B, Versichelen L, Mortier E, Dumortier F, Shafer S, Rolly G. Comparison of plasma compartment versus two methods for effect compartment-controlled target controlled infusion for propofol. Anesthesiology 2000;90:399–406