Edry Ruth, Rovner Marshall, Aizenbud Dror
Department of Anesthesiology, Rambam Health Care Campus, Haifa, Israel.
Alpha Omegan. 2011 Fall-Winter;104(3-4):79-84.
Intravenous sedation is an efficient method to facilitate dental treatment delivery to uncooperative children. Entropy is used for monitoring anesthetic depth. Nonetheless, scarce data is found on entropy monitoring in intellectually-disabled patients during sedation.
This comparative study set out to evaluate entropy values of normal and intellectually-disabled patients during the steady state period of deep sedation and awakening. Additionally, the study aimed to establish whether normal and intellectually-disabled patients reached a comparable clinically assessed state of sedation and the doses of total anesthetic drugs administered.
30 patients were included in the study and divided into two groups: 16 normal and 14 intellectually-disabled children. Ages ranged between 2 to 16 years. All patients were assigned to receive dental treatment under intravenous sedation. Entropy tracings were recorded for all patients. Clinical sedation level was assessed every 5 minutes. Drug administration was guided clinically. The anesthesiologist was blinded to entropy tracing.
Although sedation levels assessed clinically were similar between groups, entropy values were significantly lower in the group of intellectually-disabled patients both during sedation steady state and waking. The total amount of anesthetic drugs administered to normal patients was higher compared to intellectually-disabled patients.
In this study, entropy monitoring was found to be a more sensitive modality for assessing intra-operative brain activity during steady state sedation compared to clinical assessment of sedation. Despite similar clinical assessment of sedation level, brain activity was lower in the intellectually-disabled group as were their anesthetic drug requirements. We conclude that intellectually-disabled patients may need less anesthetic drugs to reach a good level of sedation. Whether the lower level of brain activity during sedation, reflected by lower entropy tracings, is characteristic of the intellectually disabled warrants additional studies.
静脉镇静是为不合作儿童提供牙科治疗的有效方法。熵用于监测麻醉深度。然而，关于智力残疾患者在镇静期间的熵监测数据很少。
本比较研究旨在评估正常和智力残疾患者在深度镇静和苏醒稳态期的熵值。此外，该研究旨在确定正常和智力残疾患者是否达到了可比的临床评估镇静状态以及所用全麻药的剂量。
30例患者纳入研究，分为两组：16例正常儿童和14例智力残疾儿童。年龄在2至16岁之间。所有患者均接受静脉镇静下的牙科治疗。记录所有患者的熵曲线。每5分钟评估一次临床镇静水平。临床指导用药。麻醉医生对熵曲线不知情。
尽管两组间临床评估的镇静水平相似，但智力残疾患者组在镇静稳态期和苏醒期的熵值均显著较低。与智力残疾患者相比，正常患者使用的全麻药总量更高。
在本研究中，发现与临床镇静评估相比，熵监测是评估稳态镇静期间术中脑活动更敏感的方式。尽管镇静水平的临床评估相似，但智力残疾组的脑活动较低，其麻醉药物需求量也较低。我们得出结论，智力残疾患者可能需要较少的麻醉药物来达到良好的镇静水平。较低的熵曲线所反映的镇静期间较低的脑活动水平是否是智力残疾的特征，有待进一步研究。
