title: Electroencephalogram approximate entropy correctly classifies the occurrence of burst suppression pattern as increasing anesthetic drug effect.
abstract: BACKGROUND
  Approximate entropy, a measure of signal complexity and regularity, quantifies electroencephalogram changes during anesthesia. With increasing doses of anesthetics, burst-suppression patterns occur. Because of the high-frequency bursts, spectrally based parameters such as median electroencephalogram frequency and spectral edge frequency 95 do not decrease, incorrectly suggesting lightening of anesthesia. The authors investigated whether the approximate entropy algorithm correctly classifies the occurrence of burst suppression as deepening of anesthesia.
  
  
  METHODS
  Eleven female patients scheduled for elective major surgery were studied. After propofol induction, anesthesia was maintained with isoflurane only. Before surgery, the end-tidal isoflurane concentration was varied between 0.6 and 1.3 minimum alveolar concentration. The raw electroencephalogram was continuously recorded and sampled at 128 Hz. Approximate entropy, electroencephalogram median frequency, spectral edge frequency 95, burst-suppression ratio, and burst-compensated spectral edge frequency 95 were calculated offline from 8-s epochs. The relation between burst-suppression ratio and approximate entropy, electroencephalogram median frequency, spectral edge frequency 95, and burst-compensated spectral edge frequency 95 was analyzed using Pearson correlation coefficient.
  
  
  RESULTS
  Higher isoflurane concentrations were associated with higher burst-suppression ratios. Electroencephalogram median frequency (r = 0.34) and spectral edge frequency 95 (r = 0.29) increased, approximate entropy (r = -0.94) and burst-compensated spectral edge frequency 95 (r = -0.88) decreased with increasing burst-suppression ratio.
  
  
  CONCLUSIONS
  Electroencephalogram approximate entropy, but not electroencephalogram median frequency or spectral edge frequency 95 without burst compensation, correctly classifies the occurrence of burst-suppression pattern as increasing anesthetic drug effect.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany. jbruhn@mailer.meb.uni-bonn.de
authors.forename: J
authors.initials: J
authors.lastname: Bruhn
authors.forename: H
authors.initials: H
authors.lastname: Röpcke
authors.forename: B
authors.initials: B
authors.lastname: Rehberg
authors.forename: T
authors.initials: T
authors.lastname: Bouillon
authors.forename: A
authors.initials: A
authors.lastname: Hoeft
mesh_terms: D000328:Adult; D000465:Algorithms; D000769:Anesthesia, Inhalation / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000493:pharmacokinetics / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000493:pharmacokinetics / Q000494:pharmacology; D004305:Dose-Response Relationship, Drug; D004569:Electroencephalography / Q000379:methods*; D019277:Entropy; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000493:pharmacokinetics / Q000494:pharmacology*; D008875:Middle Aged; D008991:Monitoring, Physiologic; D015742:Propofol / Q000493:pharmacokinetics / Q000494:pharmacology; D012815:Signal Processing, Computer-Assisted
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D007530:Isoflurane; D015742:Propofol