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Impact of entropy monitoring on volatile anesthetic uptake

Tarek El Hor, Philippe Van der Linden, Stefan De Hert UGent, Christian Melot and Javad Bidgoli (2013) ANESTHESIOLOGY. 118(4). p.868-873
abstract
Background: Electroencephalogram-derived monitoring to assess anesthetic depth may allow more accurate hypnotic drug administration, resulting in decreased anesthetic drug consumption. The authors hypothesized that the use of M-Entropy monitoring (Datex-Ohmeda, Helsinki, Finland) is associated with reduced sevoflurane uptake (primary outcome) in patients undergoing major abdominal surgery. Methods: A total of 50 patients with an American Society of Anesthesiology score of II-III, scheduled for elective laparoscopic rectosigmoidectomy were randomized into two groups in this randomized controlled trial. In the control group, the target expiratory fraction of sevoflurane was adapted according to standard clinical practice. In the study group, the target expiratory fraction of sevoflurane was adapted to maintain state entropy values between 40 and 60. State entropy values were continuously recorded in both groups but were not available to the anesthesiologist in the control group. In both groups, patients were ventilated using the auto-control mode of the Zeus (R) (Drager, Lubeck, Germany) respirator, which allows precise measurements of sevoflurane uptake. Sufentanil was administered using a target-controlled infusion system. Results: Demographics did not differ between groups. During the anesthesia maintenance phase, state entropy values were lower in the control group than the study group (P < 0.0001). Sevoflurane uptake was higher in the control group than the study group (5.2 +/- 1.4 ml/h vs. 3.8 +/- 1.5 ml/h; P = 0.0012). Three patients in the control group developed intraoperative hypotension compared with none in the study group (P = 0.03). Conclusions: Monitoring the depth of anesthesia using M-Entropy was associated with a significant reduction in sevoflurane uptake.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
SEVOFLURANE, LOW BISPECTRAL INDEX, MORTALITY, SURGERY, ELECTROENCEPHALOGRAM, REMIFENTANIL, RECOVERY
journal title
ANESTHESIOLOGY
Anesthesiology
volume
118
issue
4
pages
868 - 873
Web of Science type
Article
Web of Science id
000316355000016
JCR category
ANESTHESIOLOGY
JCR impact factor
6.168 (2013)
JCR rank
1/29 (2013)
JCR quartile
1 (2013)
ISSN
0003-3022
DOI
10.1097/ALN.0b013e3182850c36
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
4315637
handle
http://hdl.handle.net/1854/LU-4315637
date created
2014-02-28 11:22:13
date last changed
2016-12-19 15:44:56
@article{4315637,
  abstract     = {Background: Electroencephalogram-derived monitoring to assess anesthetic depth may allow more accurate hypnotic drug administration, resulting in decreased anesthetic drug consumption. The authors hypothesized that the use of M-Entropy monitoring (Datex-Ohmeda, Helsinki, Finland) is associated with reduced sevoflurane uptake (primary outcome) in patients undergoing major abdominal surgery.
Methods: A total of 50 patients with an American Society of Anesthesiology score of II-III, scheduled for elective laparoscopic rectosigmoidectomy were randomized into two groups in this randomized controlled trial. In the control group, the target expiratory fraction of sevoflurane was adapted according to standard clinical practice. In the study group, the target expiratory fraction of sevoflurane was adapted to maintain state entropy values between 40 and 60. State entropy values were continuously recorded in both groups but were not available to the anesthesiologist in the control group. In both groups, patients were ventilated using the auto-control mode of the Zeus (R) (Drager, Lubeck, Germany) respirator, which allows precise measurements of sevoflurane uptake. Sufentanil was administered using a target-controlled infusion system.
Results: Demographics did not differ between groups. During the anesthesia maintenance phase, state entropy values were lower in the control group than the study group (P {\textlangle} 0.0001). Sevoflurane uptake was higher in the control group than the study group (5.2 +/- 1.4 ml/h vs. 3.8 +/- 1.5 ml/h; P = 0.0012). Three patients in the control group developed intraoperative hypotension compared with none in the study group (P = 0.03).
Conclusions: Monitoring the depth of anesthesia using M-Entropy was associated with a significant reduction in sevoflurane uptake.},
  author       = {El Hor, Tarek and Van der Linden, Philippe and De Hert, Stefan and Melot, Christian and Bidgoli, Javad},
  issn         = {0003-3022},
  journal      = {ANESTHESIOLOGY},
  keyword      = {SEVOFLURANE,LOW BISPECTRAL INDEX,MORTALITY,SURGERY,ELECTROENCEPHALOGRAM,REMIFENTANIL,RECOVERY},
  language     = {eng},
  number       = {4},
  pages        = {868--873},
  title        = {Impact of entropy monitoring on volatile anesthetic uptake},
  url          = {http://dx.doi.org/10.1097/ALN.0b013e3182850c36},
  volume       = {118},
  year         = {2013},
}

Chicago
El Hor, Tarek, Philippe Van der Linden, Stefan De Hert, Christian Melot, and Javad Bidgoli. 2013. “Impact of Entropy Monitoring on Volatile Anesthetic Uptake.” Anesthesiology 118 (4): 868–873.
APA
El Hor, T., Van der Linden, P., De Hert, S., Melot, C., & Bidgoli, J. (2013). Impact of entropy monitoring on volatile anesthetic uptake. ANESTHESIOLOGY, 118(4), 868–873.
Vancouver
1.
El Hor T, Van der Linden P, De Hert S, Melot C, Bidgoli J. Impact of entropy monitoring on volatile anesthetic uptake. ANESTHESIOLOGY. 2013;118(4):868–73.
MLA
El Hor, Tarek, Philippe Van der Linden, Stefan De Hert, et al. “Impact of Entropy Monitoring on Volatile Anesthetic Uptake.” ANESTHESIOLOGY 118.4 (2013): 868–873. Print.