Paolo Martorano Pietro, Falzetti Gabriele, Pelaia Paolo
Department of Neurosciences, Section of Anesthesia and Intensive Care, Azienda Ospedaliero, Universitaria Ospedali Riuniti Umberto I-G Salesi, GM Lancisi, Ancona, Italy.
J Neurosurg Anesthesiol. 2006 Jul;18(3):205-10. doi: 10.1097/01.ana.0000206229.38883.d2.
Spectral Entropy (SpEn) is an alternative tool to the bispectral index (BIS) for monitoring depth of hypnosis. SpEn measures response entropy (RE) and state entropy (SE). This open-label prospective study was designed to evaluate SpEn and BIS in 20 patients undergoing elective supratentorial neurosurgery with craniotomy and resection of brain tumors. SpEn and BIS were obtained continuously by Datex Ohmeda M-entropy module S/5 (Helsinki, Finland) and Aspect Medical System BIS (Newton), respectively. Total intravenous anesthesia was performed in all patients by Fresenius Vial infusion system (Brezins, France) to maintain a plasma concentration of propofol of 2.5 to 5 microg mL(-1) and sufentanil of 0.2 to 0.4 etag mL(-1). SpEn, BIS, the estimated propofol effect-site concentrations (Ce), the mean arterial pressure (MAP), and the heart rate (HR) were recorded during 12 specific events: induction of anesthesia, patient stop counting, loss of blinking reflex, intubation, mayfield pinning, craniotomy, termination of propofol infusion, recovery of blinking reflex, coughing, limb movement, order execution, and extubation. Stated that prediction probability or P(K) represents an indicator probability to predict correctly the rank order of an arbitrary pair of distinct observed indices of depth of hypnosis (ie, clinical settings and SpEn indices, or BIS, Ce, MAP, HR), PK of BIS, SE, RE, and Ce provided a better depth of hypnosis than MAP and HR; RE being the best for rapidity, SE for sensitivity, and BIS for specificity. There is good correlation between the 3 hypnosis indices and Ce. This study demonstrates that SpEn provides a reproducible hypnosis index for patients undergoing supratentorial neurosurgical procedures.
频谱熵（SpEn）是用于监测催眠深度的双谱指数（BIS）的替代工具。SpEn测量反应熵（RE）和状态熵（SE）。本开放性前瞻性研究旨在评估20例接受择期幕上神经外科开颅手术及脑肿瘤切除术患者的SpEn和BIS。SpEn和BIS分别通过Datex Ohmeda M-熵模块S/5（芬兰赫尔辛基）和Aspect Medical System BIS（牛顿）持续获取。所有患者均采用费森尤斯卡比输液系统（法国布雷赞）进行全静脉麻醉，以维持丙泊酚血浆浓度为2.5至5微克/毫升和舒芬太尼为0.2至0.4微克/毫升。在12个特定事件期间记录SpEn、BIS、估计的丙泊酚效应室浓度（Ce）、平均动脉压（MAP）和心率（HR）：麻醉诱导、患者停止计数、眨眼反射消失、插管、Mayfield头架固定、开颅手术、丙泊酚输注终止、眨眼反射恢复、咳嗽、肢体运动、指令执行和拔管。表明预测概率或P（K）代表正确预测任意一对不同观察到的催眠深度指标（即临床情况和SpEn指标，或BIS、Ce、MAP、HR）排名顺序的指标概率，BIS、SE、RE和Ce的PK提供了比MAP和HR更好的催眠深度；RE在快速性方面最佳，SE在敏感性方面最佳，BIS在特异性方面最佳。3种催眠指标与Ce之间存在良好相关性。本研究表明，SpEn为接受幕上神经外科手术的患者提供了一种可重复的催眠指标。
