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Related Experiment Videos

BIS and Entropy in the elderly.

G Arnold1, M Kluger, L Voss

  • 1Department of Anaesthesia and Perioperative Medicine, North Shore Hospital, Takapuna, Auckland, New Zealand. glennarnold@btinternet.com

Anaesthesia
|August 19, 2007
PubMed
Summary
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Monitoring general anesthesia in elderly patients using processed electroencephalogram (EEG) showed potential. Processed electroencephalogram (EEG) indices like Bispectral Index (BIS) and Response Entropy (RE) were often outside target ranges.

Area of Science:

  • Anesthesiology
  • Geriatric Medicine
  • Neuroscience

Background:

  • Titrating general anesthesia in elderly patients is challenging due to complex physiological and pathological factors.
  • Processed electroencephalogram (EEG) monitoring may offer a way to optimize hypnotic levels in this population.
  • Existing research on EEG-guided anesthesia in the elderly is limited.

Purpose of the Study:

  • To prospectively evaluate the utility of processed EEG indices, specifically Bispectral Index (BIS) and Response Entropy (RE), for monitoring general anesthesia in elderly patients undergoing hip fracture repair.
  • To assess the correlation between BIS and RE values during anesthesia maintenance.
  • To determine the time spent within, above, and below target hypnotic ranges.

Main Methods:

Related Experiment Videos

  • Prospective study of 16 patients aged over 65 undergoing hip fracture repair under general anesthesia.
  • Experienced anesthesiologists were blinded to BIS (XP) and Entropy values.
  • EEG indices (BIS and RE) were continuously monitored throughout the procedure.

    • Main Results:

    • Pre-induction EEG indices did not correlate with age or Mini-Mental State Examination (MMSE) scores.
    • During maintenance, BIS (XP) and RE were within the target range (40-60) for 45% and 32% of the total time, respectively.
    • BIS (XP) and RE values were frequently outside the target range, with BIS (XP) below 40 for 44% and RE below 40 for 55% of the time.
    • BIS (XP) and RE correlated well in 12 patients, but significant discrepancies (>20 points) were observed in four patients.

    Conclusions:

    • Processed EEG monitoring, including BIS and RE, may not consistently maintain hypnotic levels within the recommended range during general anesthesia in elderly patients.
    • The variability and discrepancies observed between BIS and RE suggest caution when using these indices for titration in this demographic.
    • Further research is needed to refine EEG-based anesthetic management strategies for the elderly population.