Spectral entropy as a measure of hypnosis and hypnotic drug effect of total intravenous anesthesia in children during slow induction and maintenance

J.G.M. Klockars (Corresponding Author), A. Hiller, S. Münte, Mark van Gils, T. Taivainen

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Abstract

BACKGROUND: We evaluated whether spectral entropy (SpE) can measure the depth of hypnosis and the hypnotic drug effect in children during total intravenous anesthesia. METHODS: Sixty healthy children, aged 3-16 yr, were studied. Anesthesia was induced with an increasing target controlled infusion of propofol, and maintained by a stable remifentanil infusion and variable concentrations of target controlled infusion propofol. Depth of hypnosis was assessed according to the University of Michigan Sedation Scale (UMSS). Estimated plasma (C.P.) and pseudo effect site (Ceff) propofol concentrations reflected the hypnotic drug effect. Patients were stratified to three age groups. The correlations between SpE versus UMSS, C.P., and Ceff were analyzed by Prediction Probability (Pk). The pharmacodynamic relationship between SpE and C.P., and the differences of SpE values between the age groups at the corresponding UMSS levels, were studied. RESULTS: Respective mean Pk values for the youngest, middle, and oldest age groups were: 1) during induction: SpE versus UMSS 0.87, 0.87, and 0.93; SpE versus C.P. 0.92, 0.95, and 0.97; and SpE versus Ceff 0.88, 0.94, and 0.95; 2) during maintenance: SpE versus Ceff 0.86, 0.75, and 0.81. The pharmacodynamic analysis determined an association between SpE and C.P. that followed the Emax model closely. There were significant differences in SpE values between age groups at corresponding UMSS sedation levels. CONCLUSIONS: SpE measures the level of hypnosis and hypnotic drug effect in children during total intravenous anesthesia. There is an age dependency associated with SpE. Anesthesia should not be steered solely on the basis of SpE.
Original languageEnglish
Pages (from-to)340-351
Number of pages11
JournalAnesthesiology
Volume116
Issue number2
DOIs
Publication statusPublished - 2012
MoE publication typeA1 Journal article-refereed

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Intravenous Anesthesia
Hypnosis
Entropy
Hypnotics and Sedatives
Maintenance
Pharmaceutical Preparations
Propofol
Age Groups
Anesthesia

Cite this

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title = "Spectral entropy as a measure of hypnosis and hypnotic drug effect of total intravenous anesthesia in children during slow induction and maintenance",
abstract = "BACKGROUND: We evaluated whether spectral entropy (SpE) can measure the depth of hypnosis and the hypnotic drug effect in children during total intravenous anesthesia. METHODS: Sixty healthy children, aged 3-16 yr, were studied. Anesthesia was induced with an increasing target controlled infusion of propofol, and maintained by a stable remifentanil infusion and variable concentrations of target controlled infusion propofol. Depth of hypnosis was assessed according to the University of Michigan Sedation Scale (UMSS). Estimated plasma (C.P.) and pseudo effect site (Ceff) propofol concentrations reflected the hypnotic drug effect. Patients were stratified to three age groups. The correlations between SpE versus UMSS, C.P., and Ceff were analyzed by Prediction Probability (Pk). The pharmacodynamic relationship between SpE and C.P., and the differences of SpE values between the age groups at the corresponding UMSS levels, were studied. RESULTS: Respective mean Pk values for the youngest, middle, and oldest age groups were: 1) during induction: SpE versus UMSS 0.87, 0.87, and 0.93; SpE versus C.P. 0.92, 0.95, and 0.97; and SpE versus Ceff 0.88, 0.94, and 0.95; 2) during maintenance: SpE versus Ceff 0.86, 0.75, and 0.81. The pharmacodynamic analysis determined an association between SpE and C.P. that followed the Emax model closely. There were significant differences in SpE values between age groups at corresponding UMSS sedation levels. CONCLUSIONS: SpE measures the level of hypnosis and hypnotic drug effect in children during total intravenous anesthesia. There is an age dependency associated with SpE. Anesthesia should not be steered solely on the basis of SpE.",
author = "J.G.M. Klockars and A. Hiller and S. M{\"u}nte and {van Gils}, Mark and T. Taivainen",
year = "2012",
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language = "English",
volume = "116",
pages = "340--351",
journal = "Anesthesiology",
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Spectral entropy as a measure of hypnosis and hypnotic drug effect of total intravenous anesthesia in children during slow induction and maintenance. / Klockars, J.G.M. (Corresponding Author); Hiller, A.; Münte, S.; van Gils, Mark; Taivainen, T.

In: Anesthesiology, Vol. 116, No. 2, 2012, p. 340-351.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Spectral entropy as a measure of hypnosis and hypnotic drug effect of total intravenous anesthesia in children during slow induction and maintenance

AU - Klockars, J.G.M.

AU - Hiller, A.

AU - Münte, S.

AU - van Gils, Mark

AU - Taivainen, T.

PY - 2012

Y1 - 2012

N2 - BACKGROUND: We evaluated whether spectral entropy (SpE) can measure the depth of hypnosis and the hypnotic drug effect in children during total intravenous anesthesia. METHODS: Sixty healthy children, aged 3-16 yr, were studied. Anesthesia was induced with an increasing target controlled infusion of propofol, and maintained by a stable remifentanil infusion and variable concentrations of target controlled infusion propofol. Depth of hypnosis was assessed according to the University of Michigan Sedation Scale (UMSS). Estimated plasma (C.P.) and pseudo effect site (Ceff) propofol concentrations reflected the hypnotic drug effect. Patients were stratified to three age groups. The correlations between SpE versus UMSS, C.P., and Ceff were analyzed by Prediction Probability (Pk). The pharmacodynamic relationship between SpE and C.P., and the differences of SpE values between the age groups at the corresponding UMSS levels, were studied. RESULTS: Respective mean Pk values for the youngest, middle, and oldest age groups were: 1) during induction: SpE versus UMSS 0.87, 0.87, and 0.93; SpE versus C.P. 0.92, 0.95, and 0.97; and SpE versus Ceff 0.88, 0.94, and 0.95; 2) during maintenance: SpE versus Ceff 0.86, 0.75, and 0.81. The pharmacodynamic analysis determined an association between SpE and C.P. that followed the Emax model closely. There were significant differences in SpE values between age groups at corresponding UMSS sedation levels. CONCLUSIONS: SpE measures the level of hypnosis and hypnotic drug effect in children during total intravenous anesthesia. There is an age dependency associated with SpE. Anesthesia should not be steered solely on the basis of SpE.

AB - BACKGROUND: We evaluated whether spectral entropy (SpE) can measure the depth of hypnosis and the hypnotic drug effect in children during total intravenous anesthesia. METHODS: Sixty healthy children, aged 3-16 yr, were studied. Anesthesia was induced with an increasing target controlled infusion of propofol, and maintained by a stable remifentanil infusion and variable concentrations of target controlled infusion propofol. Depth of hypnosis was assessed according to the University of Michigan Sedation Scale (UMSS). Estimated plasma (C.P.) and pseudo effect site (Ceff) propofol concentrations reflected the hypnotic drug effect. Patients were stratified to three age groups. The correlations between SpE versus UMSS, C.P., and Ceff were analyzed by Prediction Probability (Pk). The pharmacodynamic relationship between SpE and C.P., and the differences of SpE values between the age groups at the corresponding UMSS levels, were studied. RESULTS: Respective mean Pk values for the youngest, middle, and oldest age groups were: 1) during induction: SpE versus UMSS 0.87, 0.87, and 0.93; SpE versus C.P. 0.92, 0.95, and 0.97; and SpE versus Ceff 0.88, 0.94, and 0.95; 2) during maintenance: SpE versus Ceff 0.86, 0.75, and 0.81. The pharmacodynamic analysis determined an association between SpE and C.P. that followed the Emax model closely. There were significant differences in SpE values between age groups at corresponding UMSS sedation levels. CONCLUSIONS: SpE measures the level of hypnosis and hypnotic drug effect in children during total intravenous anesthesia. There is an age dependency associated with SpE. Anesthesia should not be steered solely on the basis of SpE.

U2 - 10.1097/ALN.0b013e3182410b5e

DO - 10.1097/ALN.0b013e3182410b5e

M3 - Article

VL - 116

SP - 340

EP - 351

JO - Anesthesiology

JF - Anesthesiology

SN - 0003-3022

IS - 2

ER -