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Age-Dependent Entropic Features During Propofol Anesthesia in Developing Brain

Yue Zhang1, Zhen-Hu Liang2,3, Xin Wang2

  • 1From the Department of Anesthesiology, Peking University First Hospital, Beijing, China.

Anesthesia and Analgesia
|July 10, 2025
PubMed

Insights

Permutation entropy (PeEn) effectively monitors anesthetic depth in children, distinguishing unresponsiveness from recovery. Brain complexity, measured by PeEn and Sample Entropy (SampEn), decreases with age during propofol anesthesia.

Area of Science:

  • Anesthesiology
  • Neuroscience
  • Biomedical Engineering

Background:

  • Accurate monitoring of anesthetic depth in pediatric patients is critical.
  • Existing devices often fail to account for age-related brain changes, leading to inaccurate depth assessments in children.
  • Entropy analysis shows promise for monitoring consciousness during anesthesia, but its use in children requires further investigation.

Purpose of the Study:

  • To evaluate the effectiveness of entropic measures, specifically permutation entropy (PeEn) and Sample Entropy (SampEn), for monitoring propofol-induced anesthesia depth in children.
  • To investigate the age-related dynamics of these entropic features during anesthesia.
  • To compare the performance of entropic measures with the Bispectral Index (BIS) in pediatric anesthesia.

Main Methods:

  • Prospective study of frontal electroencephalogram (EEG) recordings from 77 children (1-18 years) undergoing propofol anesthesia.
  • Calculation of spectral power, PeEn, SampEn, beta ratio, and BIS during wakefulness, maintenance, and recovery phases.
  • Assessment of the accuracy of EEG measures in distinguishing between unresponsive states and clinical recovery, and analysis of age-related changes in entropic features.

Main Results:

  • Propofol anesthesia significantly decreased frontal PeEn and increased SampEn, with PeEn returning to baseline upon recovery, unlike BIS.
  • PeEn demonstrated high accuracy (96.6%) in distinguishing unresponsiveness from recovery, outperforming BIS in toddlers (94.7% vs 88.9%).
  • Frontal PeEn and SampEn decreased with age during propofol maintenance, indicating reduced neural circuit connectivity, with adolescents showing significantly lower values.

Conclusions:

  • Frontal PeEn is a reliable indicator for differentiating propofol-induced unresponsiveness from recovery in pediatric patients.
  • The observed decrease in frontal complexity (PeEn and SampEn) with age suggests neurophysiological maturation of the frontal cortex, particularly during adolescence.
  • Entropic measures offer a valuable, age-aware approach to monitoring anesthetic depth in children.
Abstract

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