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BJA Advance Access published online on March 24, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael064
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted February 8, 2006

Clinical Investigation

A comparison of bispectral index and entropy monitoring, in patients undergoing embolization of cerebral artery aneurysms after subarachnoid haemorrhage

D. Duncan 1 *, K. P. Kelly 1, and P. J. D. Andrews 1

1 Department of Anaesthesia, Critical Care and Pain Medicine, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, Scotland, UK

* To whom correspondence should be addressed.
D. Duncan, E-mail: douglas.duncan{at}btinternet.com


  Abstract

Background. Processed EEG monitoring of anaesthetic depth could be useful in patients receiving general anaesthesia following subarachnoid haemorrhage. We conducted an observational study comparing performance characteristics of bispectral index (BIS) and entropy monitoring systems in these patients.

Methods. Thirty-one patients of the World Federation of Neurosurgeons grades 1 and 2, undergoing embolization of cerebral artery aneurysms following acute subarachnoid haemorrhage, were recruited to have both BIS and entropy monitoring during general anaesthesia. BIS and entropy indices were matched to clinical indicators of anaesthetic depth. Anaesthetists were blinded to the anaesthetic depth monitoring indices. Analysis of data from monitoring devices allowed calculation of prediction probability (PK) constants, and receiver operating characteristic (ROC) analysis to be performed.

Results. BIS and entropy [response entropy (RE), state entropy (SE)] performed well in their ability to show concordance with clinically observed anaesthetic depth. PK values were generally high (BIS 0.966-0.784, RE 0.934-0.663, SE 0.857-0.701) for both forms of monitoring. ROC curve analysis shows a high sensitivity and specificity for all monitoring indices when used to detect the presence or absence of eyelash reflex. Area under curve for BIS, RE and SE to detect the absence or presence of eyelash reflex was 0.932, 0.888 and 0.887, respectively. RE provides earlier warning of return of eyelash reflex than BIS.

Conclusion. BIS and entropy monitoring perform well in patients who receive general anaesthesia after good grade subarachnoid haemorrhage.

Keywords: anaesthetics i.v., propofol; analgesics opioid, remifentanil; complications, haemorrhage, subarachnoid; monitoring, bispectral index; monitoring, entropy.
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