Auditory Event-Related Potentials, Bispectral Index, and Entropy for the Discrimination of Different Levels of Sedation in Intensive Care Unit Patients

Hænggi, Matthias; Yppärilä-Wolters, Heidi; Buerki, Sarah E.; Schlauri, Rebekka; Korhonen, Ilkka; Takala, Jukka; Jakob, Stephan M.

doi:10.1213/ane.0b013e3181acc85d

Cited by 30 publications

(25 citation statements)

References 49 publications

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“…Processed electroencephalogram models, such as the bispectral index (BIS monitor-Aspect Medical Systems, Covidien, Mansfield, MA), have been introduced into ICUs that may quantitatively monitor the level of consciousness (62). A recent ICU study suggested a satisfactory correlation between BIS values and validated sedation scales (63), whereas others have refuted it (62)(63)(64)(65). Well-designed clinieal trials are needed to validate a correlation between sedation scales and continuous bedside monitors.…”

Section: Awareness During Induced Paralysismentioning

confidence: 99%

The Use of Neuromuscular Blocking Agents in the ICU

Greenberg

Vender

2013

Critical Care Medicine

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Intensivists use neuromuscular blocking agents for a variety of clinical conditions, including for emergency intubation, acute respiratory distress syndrome, status asthmaticus, elevated intracranial pressure, elevated intra-abdominal pressure, and therapeutic hypothermia after ventricular fibrillation-associated cardiac arrest. The continued creation and use of evidence-based guidelines and protocols could ensure that neuromuscular blocking agents are used and monitored appropriately. A collaborative multidisciplinary approach coupled with constant review of the pharmacology, dosing, drug interactions, and monitoring techniques may reduce the adverse events associated with the use of neuromuscular blocking agents.

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Section: Awareness During Induced Paralysismentioning

confidence: 99%

The Use of Neuromuscular Blocking Agents in the ICU

Greenberg

Vender

2013

Critical Care Medicine

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“…Haenggi et al . [25] and other study groups revealed that the BIS reaction to different sedation depths depends on the hypnotics used and shows vast variability. [26272829]…”

Section: Discussionmentioning

confidence: 99%

Propofol versus flunitrazepam for inducing and maintaining sleep in postoperative ICU patients

Engelmann¹,

Wallenborn²,

Olthoff³

et al. 2014

Indian Journal of Critical Care Medicine

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Context:Sleep deprivation is a common problem on intensive care units (ICUs) influencing not only cognition, but also cellular functions. An appropriate sleep-wake cycle should therefore be maintained to improve patients’ outcome. Multiple disruptive factors on ICUs necessitate the administration of sedating and sleep-promoting drugs for patients who are not analgo-sedated.Aims:The objective of the present study was to evaluate sleep quantity and sleep quality in ICU patients receiving either propofol or flunitrazepam.Settings and Design:Monocentric, randomized, double-blinded trial.Materials and Methods:A total of 66 ICU patients were enrolled in the study (flunitrazepam n = 32, propofol n = 34). Propofol was injected continuously (2 mg/kg/h), flunitrazepam as a bolus dose (0.015 mg/kg). Differences between groups were evaluated using a standardized sleep diary and the bispectral index (BIS).Statistical Analysis Used:Group comparisons were performed by Mann-Whitney U-Test. P < 0.05 was considered to be statistically significant.Results:Sleep quality and the frequency of awakenings were significantly better in the propofol group (Pg). In the same group lower BIS values were recorded (median BIS propofol 74.05, flunitrazepam 78.7 [P = 0.016]). BIS values had to be classified predominantly to slow-wave sleep under propofol and light sleep after administration of flunitrazepam. Sleep quality improved in the Pg with decreasing frequency of awakenings and in the flunitrazepam group with increasing sleep duration.Conclusions:Continuous low-dose injection of propofol for promoting and maintaining night sleep in ICU patients who are not analgo-sedated was superior to flunitrazepam regarding sleep quality and sleep structure.

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“…Contrary to our study and previous findings, where spectral entropy was correlated to sedation level, entropy measured from frontal EEG had low validity to differentiate clinical sedation state in critically ill patients managed under routine clinical conditions. [2930] The conflicting results in ICU patients may be due to the fact that these patients may have metabolic disorders, encephalopathies, and brain injuries that can affect the EEG. In addition, several centrally acting drugs that confound the EEG signal may be used during ICU sedation.…”

Section: Discussionmentioning

confidence: 99%

Spectral entropy as an objective measure of sedation state in midazolam-premedicated patients

Mowafi

2012

Saudi J Anaesth

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Context:Objective assessment of sedation depth is a valuable target. Spectral entropy is an anesthetic depth monitor based on the analysis of the electroencephalogram signal.Aims:To evaluate the performance of spectral entropy as an objective measure of sedation state in midazolam-premedicated patients and to correlate it with a clinically assessed sedation score.Settings and Design:This prospective double-blind placebo-controlled study was performed in King Fahd Hospital of the university.Methods:Eighty adult ASA I–II patients were randomly assigned into 4 groups. Patients were premedicated using 0.02, 0.04, or 0.06 mg/kg midazolam or saline intramuscularly. The effect of these doses on the Observer's Assessment of Alertness and Sedation (OAA/S) scale, hemodynamic variables, response entropy (RE), and state entropy (SE), was evaluated at 10, 20, and 30 min after premedication.Statistical analysis:Spearman Rank-order correlation analysis to examine the relation between OAA/S and entropy. The ability of spectral entropy to predict the depth of sedation was evaluated using Smith prediction probability.Results:Midazolam doses ≥0.04 mg/kg produced significant decreases in RE, SE, and OAA/S scores. There was a strong correlation between midazolam dose and OAA/S scale, RE, and SE since Spearman Rank R values were 0.792, 0.822, and 0.745, respectively (P<0.001). In addition, RE and SE were strong predictors of OAA/S level during midazolam sedation with no significant difference in prediction between the 2 entropy components.Conclusions:Spectral entropy is a reliable measure for the sedative premedication. It may be used to objectively assess the adequacy of midazolam premedication and to determine the dose requirement.

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Auditory Event-Related Potentials, Bispectral Index, and Entropy for the Discrimination of Different Levels of Sedation in Intensive Care Unit Patients

Cited by 30 publications

References 49 publications

The Use of Neuromuscular Blocking Agents in the ICU

The Use of Neuromuscular Blocking Agents in the ICU

Propofol versus flunitrazepam for inducing and maintaining sleep in postoperative ICU patients

Spectral entropy as an objective measure of sedation state in midazolam-premedicated patients

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