Effect of Use of Entropy Monitoring on Consumption of Sevoflurane Inhalational Agent in Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery: A Randomized, Double Blinded, Controlled Study
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Abstract
Background: Monitoring the depth of Anesthesia using Entropy modality is essential and resourceful as it allows for more accurate hypnotic drug administration and decreased anesthetic drug consumption and shortens the recovery time. This study was performed to evaluate the effect of entropy monitoring on Sevoflurane consumption in patients undergoing Off Pump Coronary Artery Bypass Graft Surgery.
Methods: A total of 60 patients of ages between 40 – 70 years and of either sex with American Society of Anesthesiologist (ASA) grade 2 and 3, planned for Off Pump Coronary Artery Bypass Graft Surgery were randomly allocated to two groups in this Randomized Controlled Trial. In the control group i.e. Group B, Sevoflurane was titrated according to changes in clinical parameters (Heart Rate (HR) and Blood Pressure (BP) changes within 20% of baseline values) and in the study group i.e. Group A, Sevoflurane was titrated to maintain State Entropy (SE) values between 40-60 accordingly. Response Entropy (RE) and State Entropy (SE) values were continuously recorded in both the groups but were displayed on the monitor only in the study group and were not displayed to the anesthesiologist in the control group. The entropy values, Sevoflurane Consumption and recovery times were compared amongst the two groups. Patients in both the groups were ventilated on Volume Control Mode of ventilator with 100% oxygen @ 2L/min.
Results: There were no significant results in terms of age, sex, ASA Grade and NYHA Grade amongst the two groups. Sevoflurane consumption and time of recovery were significantly reduced in the study group i.e. Group A than the Control group i.e. Group B (p value <0.001; Sevoflurane consumption: 7.03±0.67 ml/hr vs 12.42±0.68 ml/hr; Recovery Time 6.47±0.65 hr vs 12.05±1.11 hr). Response and State Entropy values were lower in the control group than the study group (p < 0.001) during the maintenance phase of anesthesia. Systolic Blood Pressure values during skin incision, sternotomy and at the time of completion of all grafts were significantly lower in study group as compared to the control group.
Conclusion: Monitoring the Depth of Anesthesia using Entropy Monitoring leads to significant reduction in Sevoflurane consumption and significant faster recovery rate from surgery.
[2] Daunderer M, Schwender D. Depth of Anesthesia, awareness and EEG. Anaesthetist. 2001;50(12):950-3
[3] El Hor T, Van Der Linden P, De Hert S, Mélot C, Bidgoli J. Impact of Entropy Monitoring on Volatile Anesthetic Uptake. Anesthesiology. 2013; 118(4): 868-73.
[4] John F. Butterworth, David C. Mackey, John D. Wasnick. Morgan & Mikhail’s Clinical Anaesthesiology. 6th edition. United States. McGraw – Hill Education. 2018
[5] Aho AJ, Yli - Hankala A, Lyytikainen LP, Jäntti V. Facial muscle activity, Response Entropy, and State Entropy indices during noxious stimuli in propofol – nitrous oxide or propofol – nitrous oxide – remifentanil anaesthesia without neuromuscular block. Br J Anaesth. 2009; 102(2): 227-33
[6] Vakkuri A, Yli-Hankala A, Talja P, Mustola S, Tolvanen-Laakso H, Sampson T, et al. Time– frequency balanced spectral entropy as a measure of anesthetic drug effect in central nervous system during sevoflurane, propofol, and thiopental anesthesia. Acta Anaesthesiol Scand. 2004; 48(2):145-53
[7] Bonhomme V, Hans P. Monitoring depth of anaesthesia: Is it worth the effort? Eur J Anaesthesiol 2004; 21(6):423-8
[8] Viertiö-Oja H, Maja V, Särkelä M, Talja P, Tenkanen N, Tolvanen-Laakso H, et al. Description of the Entropy algorithm as applied in the Datex-Ohmeda S/5 Entropy Module. Acta Anaesthesiol Scand. 2004; 48(2):154-61.
[9] Bignami E, Biondi-Zoccai G, Landoni G, Fochi O, Testa V, Sheiban I, et al. Volatile anesthetics reduce mortality in cardiac surgery. J Cardiothorac Vasc Anesth. 2009; 23(5):594-9
[10] Vakkuri A, Yli-Hankala A, Sandin R, Mustola S, Høymork S, Nyblom S, et al. Spectral entropy monitoring is associated with reduced propofol use and faster emergence in propofol – nitrous oxide – alfentanil anesthesia. Anesthesiology. 2005; 103(2):274-9
[11] Liu SS. Effects of Bispectral Index monitoring on ambulatory anesthesia: A meta-analysis of randomized controlled trials and a cost analysis. Anesthesiology. 2004; 101(2):311-5
[12] Takamatsu I, Ozaki M, Kazama T. Entropy indices vs the bispectral index for estimating nociception during sevoflurane anaesthesia. Br J Anaesth.2006; 96(5):620-6
[13] Smajic J, Praso M, Hodzic M, Hodzic S, Srabovic-Okanovic A, Smajic N, et al. Assessment of depth of anesthesia: PRST score versus bispectral index. Med Arh. 2011; 65(4):216-20
[14] Baulig W, Seifert B, Schmid ER, Schwarz U. Comparison of Spectral Entropy and Bispectral Index Electroencephalography in Coronary Artery Bypass Graft Surgery. J Cardiothorac Vasc Anesth. 2010; 24(4): 544-9
[15] Elgebaly AS, El Mourad MB, Fathy SM. The role of entropy monitoring in reducing propofol requirements during open heart surgeries. A prospective randomized study. Ann Card Anaesth. 2020; 23(3):272-276
[16] Jiahai M, Xueyan W, Yonggang X, Jianhong Y, Qunhui H, Zhi L, et al. Spectral Entropy Monitoring Reduces Anesthetic Dosage for Patients Undergoing Off – Pump Coronary Artery Bypass Graft Surgery. J Cardiothorac Vasc Anesth. 2012; 26(5):818-21.
[17] Choi SR, Lim YH, Lee SC, Lee JH, Chung CJ. Spectral entropy monitoring allowed lower sevoflurane concentration and faster recovery in children. Acta Anaesthesiol Scand. 2010; 54(7):859-62.
[18] Wu SC, Wang PC, Liao WT, Shih TH, Chang KA, Lin KC, et al. Use of spectral entropy monitoring in reducing the quantity of Sevoflurane as sole inhalational anesthetic and in decreasing the need for antihypertensive drugs in total knee replacement surgery. Acta Anaesthesiol Taiwan. 2008; 46(3):106-11.
[19] Hooda S, Kaur K, Rattan KN, Thakur AK, Kamal K. Trapezius squeeze test as an indicator for depth of anaesthesia for laryngeal mask airway insertion in children. J Anaesthesiol Clin Pharmacol. 2012; 28(1):28-31.
[20] Kapoor MC. Depth of anaesthesia monitoring in cardiac surgery – Standard of care soon? Ann Card Anaesth. 2020; 23(3):260-1
[21] Monk TG, Saini V, Weldon BC, Sigl JC. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg. 2005; 100(1):4-10.
[22] Sessler DI, Sigl JC, Kelley SD, Chamoun NG, Manberg PJ, Saager L, et al. Hospital stay and mortality are increased in patients having a "triple low" of low blood pressure, low bispectral index, and low minimum alveolar concentration of volatile anesthesia. Anesthesiology. 2012;116(6):1195-203.
[23] Leslie K, Myles PS, Forbes A, et al. The effect of bispectral index monitoring on long-term survival in the B-aware trial. Anesth Analg. 2010; 110(3):816-22.
[24] Berger M, Burke J, Eckenhoff R, Mathew J. Alzheimer's disease, anesthesia, and surgery: a clinically focused review. J Cardiothorac Vasc Anesth. 2014; 28(6):1609-23.
[25] De Hert SG, ten Broecke PW, Mertens E, Van Sommeren EW, De Blier IG, et al. Sevoflurane but not propofol preserves myocardial function in coronary surgery patients. Anesthesiology. 2002; 97(1):42-9.
[26] Ellerkmann RK, Liermann VM, Alves TM, Wenningmann I, Kreuer S, Wilhelm W, et al. Spectral entropy and bispectral index as measures of the electroencephalographic effects of sevoflurane. Anesthesiology. 2004; 101(6):1275-82
[27] Aimé I, Verroust N, Masson-Lefoll C, Taylor G, Laloë PA, Liu N, et al. Does monitoring bispectral index or spectral entropy reduce sevoflurane use? Anesth Analg. 2006; 103(6):1469-77
[28] Goyal KA, Nileshwar A, Budania LS, Gaude Y, Mathew S, Vaidya S. Evaluation of effect of entropy monitoring on isoflurane consumption and recovery from anesthesia. J Anaesthesiol Clin Pharmacol. 2017; 33(4):529-533
[29] Shafiq F, Naqvi HI, Ahmed A. Effects of bispectral index monitoring on isoflurane consumption and recovery profiles for anesthesia in an elderly asian population. J Anaesthesiol Clin Pharmacol. 2012; 28(3):348-52.
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| Issue | Vol 9 No 2 (2023): Spring |
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| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v9i2.12514 | |
| Keywords | ||
| Coronary artery bypass graft (CABG) Electroencephalography (EEG) Response entropy (RE) State Entropy(SE) Bispectral index (BIS) Sevoflurane Depth of anesthesia Entropy monitoring | ||
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