[Effect of cisatracurium on entropy index of children undergoing sevoflurane anesthesia]

Objective: To investigate the effect of cisatracurium on entropy index of children undergoing sevoflurane anesthesia. Methods: Forty-five child patients (ASAⅠ-Ⅱ) who underwent cleft lip and palate repair surgery in Beijing Stomatological Hospital were selected from June to November in 2015. They aged from 8 to 24 months and were randomly divided into 3 groups, as well as maintained at different end-tidal sevoflurane concentrations (C(ET)Sev), respectively. The C(ET)Sev in Group Ⅰ was 2.5%, with a total number of 15 cases. The C(ET)Sev in Group Ⅱ was 3.0%, with a total number of 16 cases. The C(ET)Sev in Group Ⅲ was 3.5%, with a total number of 14 cases. After the child patients were sent into operating room, their ulnar nerves underwent train-of-four stimulation (TOF) inspection using Datex-Ohmeda anesthesia workstation. The four muscle twitches orderly occurring on abductor pollicis muscle were recorded as T(1,)T(2,)T(3) and T(4,)respectively. The level of state entropy (SE) and reactive entropy (RE) was monitored by the entropy index module. 6% of sevoflurane high-flow inhalation was used to induce children's sleep, and the oxygen flow was adjusted to 2 L/min. Also, the C(ET)Sev in 3 groups maintained at 2.5%, 3.0% and 3.5%, respectively, which lasted for more than 10 min. Then, they were administered with 0.15 mg/kg cisatracurium, and the level of SE and RE in 3 groups was recorded when they were before the drug delivery of cisatracurium (t(1)), 50% inhibition of T(1) (t(2)), 75% inhibition of T(1) (t(3)) and 100% inhibition of T(1) (t(4)), respectively. Results: At the time of t(1,)t(2,)t(3) and t(4,)the SE values in Group Ⅰ were (55±19), (53±20), (48±18) and (43±16), respectively, and the differences were statistically significant (F=3.881, P<0.05). The SE values in Group Ⅱ were (42±19), (41±21), (39±18), (31±13), and the differences were statistically significant (F=3.463, P<0.05). The SE values in Group Ⅲ were (34±11), (33±16), (33±14) and (32±13), respectively. The differences were not statistically significant (F=0.162, P>0.05). At the time of t(1,)t(2,)t(3) and t(4,)the RE values in Group Ⅰ were (54±13), (48±11), (34±13) and (30±13) respectively, and the differences were statistically significant (F=36.975, P<0.01). The RE values in Group Ⅱ were (43±13), (38±13), (33±12) and (28±11) respectively, the differences were statistically significant (F=12.438, P<0.01). The RE values in Group Ⅲ were (34±10), (33±11), (31±12) and (25±11) respectively, and the differences were statistically significant (F=6.019, P<0.01). The RE values of child patients in Group Ⅰ, Ⅱ and Ⅲ decreased after the drug delivery of cisatracurium. Conclusion: The muscle relaxants (cisatracurium) will decrease the entropy index of children undergoing sevoflurane anesthesia, but will not affect their SE values under deep anesthesia.