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A Comparison of Bispectral Index and Entropy During Sevoflurane Anesthesia Induction in Children with and without
Young Sung Kim1, Young Ju Won1, Hyerim Jeong1
1Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul 08308, Korea.
Insights
In children, bispectral index (BIS) and entropy monitoring during sevoflurane anesthesia showed different correlations in those with and without cerebral palsy (CP). BIS correlated better with clinical response in non-CP children but not in CP patients.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
- Neuroscience
Background:
- Cerebral palsy (CP) can alter anesthetic responses.
- Monitoring depth of anesthesia is crucial in pediatric patients.
Purpose of the Study:
- To compare the correlation between bispectral index (BIS) and entropy (response entropy [RE] and state entropy [SE]) with sevoflurane concentrations in children with and without CP.
- To evaluate the ability of BIS and entropy to predict awareness during sevoflurane induction in these groups.
Main Methods:
- Eighty-two children (40 CP, 42 non-CP) received sevoflurane induction.
- BIS, RE, and SE were recorded at sevoflurane concentrations of 1-3 vol%.
- Area under the receiver-operator characteristic curve (AUC) analysis assessed prediction of awareness.
Main Results:
- BIS, RE, and SE values decreased with increasing sevoflurane concentrations in both groups.
- Children with CP had lower SE (awake) and BIS, RE, SE (at 3 vol%) values compared to non-CP children.
- BIS showed better predictive ability for awareness in non-CP children, whereas this difference was not significant in CP children.
Conclusions:
- BIS correlation with clinical response during sevoflurane anesthesia differs between children with and without CP.
- Entropy monitoring may be a viable alternative to BIS in children with CP for assessing anesthetic depth.
Background:
This study compared the correlation of bispectral index (BIS) or entropy with different sevoflurane concentrations between children with and without cerebral palsy (CP) during induction.
Methods:
For eighty-two children (40 CP and 42 non-CP children), anesthesia was induced with sevoflurane. BIS and entropy (response entropy and state entropy (RE and SE)) were recorded before and after the induction of anesthesia at end-tidal sevoflurane concentrations of 1-3 vol%. The sedation status was assessed using an Observer's Assessment of Alertness/Sedation scale. The ability to predict awareness was estimated using the area under the receiver-operator characteristic curve (AUC) analysis.
Results:
RE, SE and BIS values decreased continuously over the observed concentration range of sevoflurane in both groups. The SE values while awake and the RE, SE, BIS values at 3 vol% sevoflurane were lower in children with CP than in those without CP. The AUC of the BIS was significantly better than RE or SE in children without CP. The AUC of the BIS was not significantly higher than that of the RE or SE in children with CP.
Conclusion:
BIS seems better correlated than entropy with the clinical state of loss of response in children without CP, but not in those with CP.
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