Introduction: The Entropy module has been designed to be used alongside current haemodynamic and neuromuscular monitoring parameters

to monitor the delivery and associated effects of anaesthesia (the adequacy of anaesthesia). Three sensors attached to the patients head provide electroencephalography (EEG) and frontal electromyogram (FEMG) readings which are analysed to produce a score of 0-100 for response entropy (RE: response to stimuli; includes higher frequencies upto 47 Hz; reflects both EEG and Frontal EMG activities), a score of 0-91 for state entropy (SE: depth of anaesthesia; calculated over the frequencies ranging from 0.8 to 32 Hz;reflects the patients cortical activity ) and 0100% for burst suppression indication(an isolectric state). This analysis notes the irregularity, complexity, or unpredictability characteristics of a signal. A regular signal where the wavelength and amplitude are constant over time, would have a low entropy value and a signal with an irregular wavelength and amplitude, a higher entropy value. The lower the patient ’s entropy value the more sedated they are. In clinical practice the Entropy module has the capacity to produce continuous data which can be stored and printed off. The difference between RE and SE (RE-SE) mainly reflects EMG activation. RE and (RE-SE) mainly increase in response to noxious stimulation and are thought to be indicators of the adequacy of antinociception. Neuromuscular Blocking Drugs (NMBD’s) which decrease the stretch receptor activity in the muscles and suppress stimulation input to the arousal centres in the brain having a suppressive effect on EEG-derived indices . EMG activation by noxious stimulation, however, contaminates the EEG power spectrum and increase the RE, SE and RE-SE index. NMBD”S decrease the EMG activation and suppress the entropy response to noxious stimulation. Although facial muscles are more resistant than other skeletal muscles to neuromuscular block higher doses of NMBD’s will also suppress facial muscle activity. Use of the entropy module provides the anaesthetist with a method of directly monitoring neural activity in sedated patients that may reduce the amount of anaesthetic delivered and may also reduce recovery time.

We also would be able to correlate the TOF and entropy states to tracheal intubation performed at particular Rocuronium dose and entropy levels. . 1.AIMS & OBJECTIVE : To study Rocuronium dose dependent suppression of Entropy levels (RE. SE & RE-SE) to tracheal intubation during induction with Propofol & Sevoflurane . 2. With this study we would like to conclude the optimum Dose of Rocuronium required to suppress the tracheal intubation induced increase in the RE-SE with Sevoflurane and propofol used as induction agent. To investigate the dose effect of Rocuronium on the RE-SE response to tracheal intubation.

alcohol or drug abuse e) BMI <18. Total 80 patients will be taken into consideration.9.3. Informed consent will be obtained from all patients 3. This study is Approved by the ethics committee of the Sant parmanand Hospital.Material & Methods : 1. 0. Parameters to be recorded for the Study . 2. 20 patients under each Rocuronium doses of 0. head or neck b) Disease or injury affecting CNS (Stroke.  Demographic parameters : a) Age b) Sex c) Weight d) Height e) BMI  Clinical Monitoring parameters : a) MAP b) HR c) SE d) RE e) RE-SE f) Patient movement g) TOF Progress in the case will be done under following Steps : 1. a) b) c) Inclusion criteria of patient’s for the study : ASA physical status I-II Age – 20 to 50 yrs of age Lap cholecystectomy under GA 4. 1. 2. carotid stenosis or any organic brain pathology) c) Recently used Psychoactive or analgesic medication d) Neurological disorders.6.2 mg/kg body weight .5 or > 25 kg/m2 f) Difficult intubation or time taken for intubation is more than 1 min. New delhi. Fulfill the patient’s inclusion criteria. 0. 5. dementia. Exclusion criteria : a) Patient’s with surgery of Brain.

Two minutes of preoxygenation will be given 8.3. The optimal Rocuronium dose usually defined as the lowest dose. Entropy electrodes will be applied on the left side of the forehead in all patients for keeping the consistency.60%– 0. . 18. This value is greater than the range previously reported for adults (0.67%) 10. Tracheal intubation will be done within 1 minutes (Tracheal intubation is defined as the time at which cuff is inflated) any patient that could not be intubated within 1 min will be excluded from the study. the MAC-awake value for sevoflurane in unpremedicated children was 0.9 . When thumb acceleration is depressed by 50 % or more.(This is the noxious stimulation in our study) 15. or 1. Sevoflurane inhalational induction agent maintained at 1% end tidal Sevoflurane. 7.2 mg kg—1) will then be administered 2 minutes after induction. Anaesthesia induction with Propofol (1. All the defined parameters readings will be recorded Just before intubation 16. Ventilation will be controlled to maintain the End tidal CO2 at 35-40 mm Hg with a fresh gas flow of 6L/min 12. Fentanyl or any other analgesic is not given to preserve the sympathetic response to laryngoscopy and intubation. Rocuronium (0 . 13. 5. which allows acceptable intubation conditions in 95% of subjects(ED91 TI). Helinski. of tracheal intubation only the maximum values will be recorded. Patient movement during or after tracheal intubation is also recorded . 0 .5 to 2 mg/kg) in a dose sufficient to abolish the eye lash reflex. 17.6 . Quantified neuromuscular function by stimulation of the ulnar nerve at 0. 0 . Intubation conditions will be assessed 7 min after test drug injection. All monitoring will be performed with a Datex-Ohmeda S/5TM anaesthesia monitor (GE Healthcare. 11.78%. Finland) 4. All the defined parameter readings will be recorded within five min. In the operation theatre perform the following : a) ECG b) Non-invasive Arterial pressure c) Heart rate monitoring d) Pulse oximetry 6.1 Hz to produce contraction of the adductor pollicis muscle using accelerometry.3. 14. No premedication will be given to the patient. intubating conditions are considered acceptable in 97% of patients. 9.

Study Proforma : MAP HR RE SE RE-SE Patient movement TOF 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 .

Sign up to vote on this title
UsefulNot useful