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BJA Advance Access published online on June 9, 2008
British Journal of Anaesthesia, doi:10.1093/bja/aen162
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Effect of landiolol on bispectral index and spectral entropy responses to tracheal intubation during propofol anaesthesia

M. Kawaguchi, I. Takamatsu*, K. Masui and T. Kazama

Department of Anesthesiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan

* Corresponding author. E-mail: tisao{at}ndmc.ac.jp

Background: β1-Adrenoceptor antagonists suppress the haemodynamic and arousal responses to tracheal intubation. The EntropyTM Module shows two spectral entropy-based indices, response entropy (RE) and state entropy (SE). The difference between RE and SE (RE–SE) may reflect nociception during general anaesthesia. In the present study, we investigated the effect of landiolol on entropy indices in response to tracheal intubation.

Methods: A total of 60 patients were randomly assigned to receive saline (Group S), remifentanil (Group R), or landiolol (Group L). Anaesthesia was induced by propofol target-controlled infusion. Two minutes after the induction of anaesthesia, infusion with vecuronium bromide and remifentanil, landiolol, or saline was initiated. Tracheal intubation was performed 7 min after anaesthesia induction. Arterial pressure, heart rate (HR), bispectral index (BIS), and entropy indices were recorded.

Results: In Group S, RE increased significantly after tracheal intubation, but there was no significant increase in BIS or SE. These increases in RE were abolished in Groups R and L. RE–SE increased significantly after tracheal intubation in Group S, whereas no increase in RE–SE was observed in Groups R and L. Increases in mean arterial pressure and HR after tracheal intubation were suppressed in Groups R and L compared with Group S.

Conclusions: RE increased in response to tracheal intubation, whereas BIS and SE did not. Landiolol and remifentanil suppressed the increase in RE after tracheal intubation with significant inhibition of RE–SE difference.

Keywords: anaesthetics i.v., propofol; analgesics opioid, remifentanil; monitoring, bispectral index; monitoring, electroencephalography; sympathetic nervous system, adrenergic block


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