Entropy monitoring

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Entropy monitoring is a relatively new method of assessing anaesthetic depth. It was commercially developed by Datex-Ohmeda, now part of GE Healthcare.

It relies on a method of assessing the degree of irregularity in electroencephalogram (EEG) signals. The founding principle behind this theory is that the irregularity within an EEG signal decreases with increasing brain levels of anaesthetic drugs. If we relate the irregularity to the entropy within the signal, then an entropy scale can be assigned.

The signal is captured via a forehead mounted sensor, in a similar way employed by bispectral index (BIS).

Entropy monitors produce two numbers (RE - Response Entropy, SE- State Entropy) that are related to frequency bandpass used. Response Entropy incorporates higher frequency components that include that of electromyogram activity. The reason for using higher frequency bandpass in response entropy is to allow faster response from the monitor in relation to clinical state.

Published studies show that entropy scores do relate to clinical levels of anaesthetic depth. Most anaesthetic drugs are detectable by entropy monitoring, a notable exception being nitrous oxide, in common with BIS monitoring. Future studies may show reduced levels of intraoperative awareness when using this type of monitoring. Future studies may also look into possibilities of influence on outcome when using depth of anaesthesia monitoring.

Other Vital signs such as pulse, heart rate, blood pressure, and movement are indirect indicators of consciousness, and when these are combined with expired gas analysis of inhalational anaesthetic agents, an experienced anaesthetist can be confident a patient is unconscious and not aware of their surroundings. However, the direct measurement of brain activity using a basic EEG is purported to measure effects of anaesthetics more comprehensively. This is because as anaesthesia "deepens", there are predictable changes in the EEG including slowing, synchronicity, and burst suppression, that, in the case of BIS (Bispectral index) or Entropy, are converted to a number roughly correlated to the likelihood of awareness.

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References[edit]

  • Bein B: Entropy:Best practice&research clinical anesthesiology.Vol 20. No 1.,pp. 101-109, 2006