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Bispectral index and electroencephalographic entropy in patients undergoing aortocoronary bypass grafting

Published online by Cambridge University Press:  01 September 2007

A. Lehmann ,
M. Schmidt ,
C. Zeitler ,
A.-H. Kiessling ,
F. Isgro  and
J. Boldt
A. Lehmann*
Affiliation:
Klinikum der Stadt Ludwigshafen, Department of *Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
M. Schmidt
Affiliation:
Klinikum der Stadt Ludwigshafen, Department of *Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
C. Zeitler
Affiliation:
Klinikum der Stadt Ludwigshafen, Department of *Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
A.-H. Kiessling
Affiliation:
Klinikum der Stadt Ludwigshafen, Department of †Cardiac Surgery, Ludwigshafen, Germany
F. Isgro
Affiliation:
Klinikum der Stadt Ludwigshafen, Department of †Cardiac Surgery, Ludwigshafen, Germany
J. Boldt
Affiliation:
Klinikum der Stadt Ludwigshafen, Department of *Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
*
Correspondence to: Dr Andreas Lehmann, Department of Anaesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Postfach 21 73 52, D-67073 Ludwigshafen, Germany. E-mail: lehmanna@klilu.de; Tel: +49 621 503 3000; Fax: +49 621 503 3024
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Summary

Background and objective

This study was conducted to compare bispectral index, state entropy and response entropy in patients undergoing coronary artery bypass grafting.

Methods

In 66 patients, anaesthesia was maintained at two different levels using bispectral index. Doses of sufentanil and midazolam were adjusted to achieve a bispectral index in the range of 45–55 in 33 patients (BIS 50 group) and 35–44 in another 33 patients (BIS 40 group). Simultaneously, state entropy and response entropy were recorded.

Results

The targeted values of bispectral index were achieved in both groups and the bispectral index values differed significantly during whole anaesthesia. Median response entropy and state entropy fell to 19–26 during anaesthesia in both groups. Response entropy and state entropy values in the two groups differed significantly only after induction of anaesthesia and did not differ during further anaesthesia. There was no explicit intraoperative recall in both groups. Patients in Group BIS 40 received significantly (P < 0.05) more sufentanil than the BIS 50 group (704 ± 181 μg vs. 490 ± 107 μg, respectively) and midazolam (18.5 ± 6.1 mg vs. 15.6 ± 3.8 mg, respectively). After cardiopulmonary bypass, significantly (P < 0.05) more patients in Group BIS40 needed inotropic support with dobutamine (79%) than in the BIS50 group (52%). Time to extubation did not differ between the two groups.

Conclusion

In patients undergoing coronary artery bypass grafting, no relationship was found between bispectral index levels and state entropy and response entropy at two different stages of a sufentanil–midazolam anaesthesia. A bispectral index level of 45–55 reduced anaesthetic medications used and the need for inotropic support.

Keywords

ELECTROENCEPHALOGRAPHY, bispectral index, entropySURGERY CARDIACCORONARY ARTERY GRAFTING
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 9 , September 2007 , pp. 751 - 760
Copyright
Copyright © European Society of Anaesthesiology 2007

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References

1.Johansen, JW, Sebel, PS. Development and clinical application of elctroencephalographic bispectrum monitoring. Anesthesiology 2000; 93: 1336–1344.CrossRefGoogle ScholarPubMed
2.Rampil, IJ. A primer for EEG signal processing in anesthesia. Anesthesiology 1998; 89: 980–1002.CrossRefGoogle ScholarPubMed
3.Viertio-Oja, H, Maja, V, Sarkela, M et al. . Description of the Entropy™ algorithm as applied in the Datex-Ohmeda S/5™ entropy module. Acta Anaesthesiol Scand 2004; 48: 154–161.CrossRefGoogle ScholarPubMed
4.Vakkuri, A, Yli-Hankala, A, Talja, P et al. . Time-frequency balanced spectral entropy as a measure of anaesthetic drug effect in central nervous system during sevoflurane, propofol, and thiopental anaesthesia. Acta Anaesthesiol Scand 2004; 48: 145–153.CrossRefGoogle Scholar
5.Lehmann, A, Karzau, J, Boldt, J, Thaler, E, Lang, J, Isgro, F. Bispectral index-guided anesthesia in patients undergoing aortocoronary bypass grafting. Anesth Analg 2003; 96: 336–343.Google ScholarPubMed
6.Dowd, NP, Cheng, DC, Karski, JM, Wong, DT, Munro, JA, Sandler, AN. Intraoperative awareness in fast-track cardiac anesthesia. Anesthesiology 1998; 89: 1068–1073.CrossRefGoogle ScholarPubMed
7.Ellerkmann, RK, Liermann, VM, Alves, TM et al. . Spectral entropy and bispectral index as measures of the electroencephalographic effects of sevoflurane. Anesthesiology 2004; 101: 1275–1282.CrossRefGoogle ScholarPubMed
8.Bruhn, J, Lehmann, LE, Ropcke, H, Bouillon, TW, Hoeft, A. Shannon entropy applied to the measurement of the electroencephalographic effects of desflurane. Anesthesiology 2001; 95: 30–35.CrossRefGoogle Scholar
9.Bruhn, J, Ropcke, H, Hoeft, A. Approximate entropy as an electroencephalographic measure of anesthetic drug effect during desflurane anaesthesia. Anesthesiology 2000; 92: 715–726.CrossRefGoogle Scholar
10.Kreuer, S, Bruhn, J, Larsen, R, Bauer, C, Wilhelm, W. Comparison of BIS and AAI as measures of anaesthetic drug effect during desflurane-remifentanil anaesthesia. Acta Anaesthesiol Scand 2004; 48: 1168–1173.CrossRefGoogle ScholarPubMed
11.Mi, WD, Sakai, T, Kudo, T, Kudo, M, Matsuki, A. Performance of bispectral index and auditory evoked potential monitors in detecting loss of consciousness during anaesthetic induction with propofol with and without fentanyl. Eur J Anaesthesiol 2004; 21: 807–811.CrossRefGoogle ScholarPubMed
12.Koitabashi, T, Johansen, JW, Sebel, PS. Remifentanil dose/electroencephalogram bispectral response during combined propofol/regional anesthesia. Anesth Analg 2002; 94: 1530–1533.CrossRefGoogle ScholarPubMed
13.Forestier, F, Hirschi, M, Rouget, P et al. . Propofol and sufentanil titration with the bispectral index to provide anesthesia for coronary artery surgery. Anesthesiology 2003; 99: 334–346.CrossRefGoogle ScholarPubMed
14.Schmidt, GN, Bischoff, P, Standl, T, Hellstern, A, Teuber, O, Schulte Esch, J. Comparative evaluation of the Datex-Ohmeda S/5 entropy module and the bispectral index monitor during propofol-remifentanil anesthesia. Anesthesiology 2004; 101: 1283–1290.CrossRefGoogle ScholarPubMed
15.Vanluchene, AL, Struys, MM, Heyse, BE, Mortier, EP. Spectral entropy measurement of patient responsiveness during propofol and remifentanil. A comparison with the bispectral index. Br J Anaesth 2004; 93: 645–654.CrossRefGoogle ScholarPubMed
16.Brunner, MD, Braithwaite, P, Jhaveri, R et al. . MAC reduction of isoflurane by sufentanil. Br J Anaesth 1994; 72: 42–46.CrossRefGoogle ScholarPubMed
17.Sleigh, JW, Steyn-Ross, DA, Steyn-Ross, ML, Grant, C, Ludbrook, G. Cortical entropy changes with general anaesthesia: theory and experiment. Physiol Meas 2004; 25: 921–934.CrossRefGoogle ScholarPubMed
18.Bauer, M, Wilhelm, W, Kraemer, T et al. . Impact of bispectral index monitoring on stress response and propofol consumption in patients undergoing coronary artery bypass surgery. Anesthesiology 2004; 101: 1096–1104.CrossRefGoogle ScholarPubMed
19.Myles, PS, Hunt, JO, Fletcher, H et al. . Remifentanil, fentanyl, and cardiac surgery: a double-blinded, randomized, controlled trial of costs and outcomes. Anesth Analg 2002; 95: 805–812.CrossRefGoogle ScholarPubMed
20.Bruhn, J, Bouillon, TW, Radulescu, L, Hoeft, A, Bertaccini, E, Shafer, SL. Correlation of approximate entropy, bispectral index, and spectral edge frequency 95 (SEF95) with clinical signs of ‘anaesthetic depth’ during coadministration of propofol and remifentanil. Anesthesiology 2003; 98: 621–627.CrossRefGoogle ScholarPubMed
21.Ranta, SO, Herranen, P, Hynynen, M. Patients’ conscious recollections from cardiac anesthesia. J Cardiothorac Vasc Anesth 2002; 16: 426–430.CrossRefGoogle ScholarPubMed
22.Myles, PS, Leslie, K, McNeil, J, Forbes, A, Chan, MT. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet 2004; 363: 1757–1763.CrossRefGoogle ScholarPubMed