[en] Background. The spectral entropy of the electroencephalogram has been proposed to monitor the depth of anaesthesia. State Entropy (SE) reflects the level of hypnosis. Response Entropy (RE), computed from electroencephalogram and facial muscle activity, reflects the response to nociceptive stimulation. We evaluated the effect of rocuronium on Bispectral Index (TM) (BIS) and entropy responses to laryngoscopy. Methods. A total of 25 patients were anaesthetized with propofol using a target-controlled infusion. At steady state, they randomly received 0.6 mg kg(-1) rocuronium (R) or saline (S). After 3 min, a 20 s laryngoscopy was applied. BIS, RE and SE were recorded continuously and averaged over 1 min during baseline, at steady state, 2 min after R or S administration (R/S+2) and 0, 1, 2 and 3 min after laryngoscopy (L0, L1, L2, L3). Results. At R/S+2, the RE-SE gradient was higher in Group S than in Group R. Laryngoscopy provoked an increase in BIS, RE and SE. Comparing R/S+2 and L0 values in Groups R and S, BIS increased from 43 (6) to 49 (8) and 42 (9) to 51 (15), SE increased from 43 (7) to 50 (8) and 41 (10) to 55 (12), and RE increased from 46 (8) to 54 (9) and 47 (12) to 66 (15), respectively. BIS and SE did not differ between groups. At L0, RE and RE-SE were higher in Group S [66 (15) and 11 (4), respectively] than in Group R [54 (9) and 4 (2), respectively]. Conclusions. Rocuronium alters the RE-SE gradient and the RE and RE-SE responses to laryngoscopy. Muscle relaxation may confound interpretation of entropy monitoring.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Hans, Pol ; Université de Liège - ULiège > Département des sciences cliniques > Anesthésie et réanimation
Giwer, Jérôme ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
Brichant, Jean-François ; Université de Liège - ULiège > Département des sciences cliniques > Anesthésie et réanimation
DEWANDRE, Pierre-Yves ; Centre Hospitalier Universitaire de Liège - CHU > Département d'Anesthésie et réanimation > Service d'anesthésie - réanimation
Bonhomme, Vincent ; Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques
Language :
English
Title :
Effect of an intubation dose of rocuronium on Spectral Entropy and Bispectral Index (TM) responses to laryngoscopy during propofol anaesthesia
Glass PS, Bloom M, Kearse L, Rosow C, Sebel P, Manberg P. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology 1997; 86: 836-47
Gan TJ, Glass PS, Windsor A, et al. Bispectral index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anesthesia. BIS Utility Study Group. Anesthesiology 1997; 87: 808-15
Song D, Joshi GP, White PF. Titration of volatile anesthetics using bispectral index facilitates recovery after ambulatory anesthesia. Anesthesiology 1997; 87: 842-8
Forbes AR, Cohen NH, Eger EI. Pancuronium reduces halothane requirement in man. Anesth Analg 1979; 58: 497-9
Bruhn J, Bouillon TW, Shafer SL. Electromyographic activity falsely elevates the bispectral index. Anesthesiology 2000; 92: 1485-7
Riess ML, Graefe UA, Goeters; C, van Aken H, Bone HG. Sedation assessment in critically ill patients with bispectral index. Eur J Anaesthesiol 2002; 19: 18-22
Vivien B, Di Maria S, Ouattara A, Langeron O, Coriat P, Riou B. Overestimation of Bispectral Index in sedated intensive care unit patients revealed by administration of muscle relaxant. Anesthesiology 2003; 99: 9-17
Vasella FC, Frascarolo P, Spahn DR, Magnusson L Antagonism of neuromuscular blockade but not muscle relaxation affects depth of anaesthesia. Br J Anaesth 2005; 94: 742-7
Marsh B, White M, Morton N, Kenny GN. Pharmacokinetic model driven infusion of propofol in children. Br J Anaesth 1991; 67: 41-8
Simmons LE, Riker RP, Prato BS, Fraser GL. Assessing sedation during intensive care unit mechanical ventilation with the Bispectral Index and the Sedation-Agitation Scale. Crit Care Med 1999; 27: 1499-504
Lanier WL, Iaizzo PA, Milde JH, Sharbrough FW. The cerebral and systemic effects of movement in response to a noxious stimulus in lightly anesthetized dogs. Possible modulation of cerebral function by muscle afferents. Anesthesiology 1994; 80: 392-401
Viertio-Oja H, Maja V, Sarkela M, et al. Description of the Entropy algorithm as applied in the Datex-Ohmeda S/5 Entropy Module. Acta Anaesthesiol Scand 2004; 48: 154-61
Wheeler P, Hoffman WE, Baughman VL, Koenig H. Response entropy increases during painful stimulation. J Neurosurg Anesthesiol 2005; 17: 86-90