title: Spectral entropy monitoring is associated with reduced propofol use and faster emergence in propofol-nitrous oxide-alfentanil anesthesia.
abstract: BACKGROUND
  This multicenter study evaluated the effect of a new depth of anesthesia-monitoring device based on time-frequency-balanced spectral entropy of electroencephalogram monitoring (GE Healthcare Finland, Helsinki, Finland) on consumption of anesthetic drugs and recovery times after anesthesia.
  
  
  METHODS
  The study was a prospective, randomized, single-blind study performed in six hospitals in Finland, Sweden, and Norway. After institutional review board approval and written informed consent from each patient, the patients were randomly allocated to anesthesia with entropy values either shown (entropy group) or not shown (control group). Anesthesia was maintained with propofol, nitrous oxide, and alfentanil. In the entropy group, propofol was given to keep the state entropy value between 45 and 65, and alfentanil was given to keep the state entropy-response entropy difference below 10 units and heart rate and blood pressure within +/-20% of the baseline values. The control group patients were anesthetized to keep heart rate and blood pressure within +/-20% of the baseline values. Statistical methods included Mann-Whitney U test and unpaired t tests.
  
  
  RESULTS
  A total of 368 patients were studied. In the entropy group, entropy values were higher during the whole operation and especially during the last 15 min (P < 0.001). Consequently, propofol consumption was smaller in the entropy group during the whole anesthesia period (P < 0.001) and especially during the last 15 min (P < 0.001). This shortened the time delay in the early recovery parameters in the entropy group.
  
  
  CONCLUSIONS
  Entropy monitoring assisted titration of propofol, especially during the last part of the procedures, as indicated by higher entropy values, decreased consumption of propofol, and shorter recovery times in the entropy group.
authors.affiliation: Department of Anesthesia and Intensive Care, Surgical Hospital, Helsinki University Hospital, Helsinki, Finland. vakkuri@hus.fi
authors.forename: Anne
authors.initials: A
authors.lastname: Vakkuri
authors.forename: Arvi
authors.initials: A
authors.lastname: Yli-Hankala
authors.forename: Rolf
authors.initials: R
authors.lastname: Sandin
authors.forename: Seppo
authors.initials: S
authors.lastname: Mustola
authors.forename: Siv
authors.initials: S
authors.lastname: Høymork
authors.forename: Stina
authors.initials: S
authors.lastname: Nyblom
authors.forename: Pia
authors.initials: P
authors.lastname: Talja
authors.forename: Timothy
authors.initials: T
authors.lastname: Sampson
authors.forename: Mark
authors.initials: M
authors.lastname: van Gils
authors.forename: Hanna
authors.initials: H
authors.lastname: Viertiö-Oja
mesh_terms: D000328:Adult; D000368:Aged; D015760:Alfentanil / Q000008:administration & dosage*; D000758:Anesthesia; D019277:Entropy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009609:Nitrous Oxide / Q000008:administration & dosage*; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D016037:Single-Blind Method
chemical_list: D015760:Alfentanil; D009609:Nitrous Oxide; D015742:Propofol