Effect of entropy-guided low-flow desflurane anaesthesia on laryngeal mask airway removal time in children undergoing

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Shivangi Mishra1, Renu Sinha1, Bikash Ranjan Ray1

  • 1Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

Indian Journal of Anaesthesia
|July 3, 2019
PubMed

Insights

Entropy-guided anesthesia using desflurane significantly speeds up laryngeal mask airway removal and reduces anesthetic consumption in pediatric ophthalmic surgery patients. This method offers a faster recovery profile for children.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Pharmacology

Background:

  • Entropy-guided titration of anesthetics like isoflurane and sevoflurane improves recovery in children.
  • The role of entropy in guiding desflurane anesthesia recovery is not well-established.
  • This study investigates entropy's impact on desflurane anesthesia in pediatric ophthalmic surgery.

Purpose of the Study:

  • To compare laryngeal mask airway (LMA) removal time and desflurane consumption between entropy-guided and minimal alveolar concentration (MAC)-guided titration.
  • To evaluate the efficacy of entropy monitoring in low-flow desflurane anesthesia for pediatric patients.
  • To determine if entropy guidance leads to faster emergence from anesthesia.

Main Methods:

  • Eighty American Society of Anesthesiologists grade I-II children (2-14 years) undergoing elective ophthalmic surgery were randomized.
  • Anesthesia was maintained with low-flow desflurane (0.75 L/min) guided by either state entropy (40-60) or MAC (1-1.3).
  • LMA removal time, hemodynamic parameters, and desflurane consumption were recorded.

Main Results:

  • LMA removal time was significantly shorter in the entropy-guided group (4.34 ± 2.03 min) compared to the MAC-guided group (8.8 ± 2.33 min) (P < 0.0001).
  • Desflurane consumption was significantly lower in the entropy-guided group (18.7 ± 5.07 mL) versus the MAC-guided group (25.3 ± 8.11 mL) (P < 0.0001).

Conclusions:

  • Entropy-guided low-flow desflurane anesthesia facilitates quicker LMA removal in children.
  • This approach also leads to reduced desflurane usage during pediatric ophthalmic procedures.
  • Entropy monitoring is a valuable tool for optimizing desflurane anesthesia in pediatric patients.
Abstract

Keywords:
Childrenconsumptiondesfluraneentropylaryngeal mask airwaylow-flow anaesthesiaminimum alveolar concentration

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