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TECHNOLOGY, COMPUTING, AND SIMULATION

The Influence of a Muscle Relaxant Bolus on Bispectral and Datex-Ohmeda Entropy Values During Propofol-Remifentanil Induced Loss of Consciousness

Ngai Liu, MD^*, Thierry Chazot, MD^*, Isabelle Huybrechts, MD, Jean-Dominique Law-Koune, MD^*, Luc Barvais, MD, and Marc Fischler, MD^*

*Department of Anesthesiology, Hôpital Foch, Suresnes, France; Department of Anesthesiology, Hôpital Erasme, ULB, Brussels, Belgium

Address correspondence and reprint requests to Marc Fischler, MD, Service d’Anesthésie Hôpital Foch, 40 rue Worth, 92151 Suresnes, France. Address e-mail to m.fischler{at}hopital-foch.org.

Studies investigating the influence of muscle relaxants on the bispectral index have yielded contradictory results. In our prospective, randomized, double-blind experiments, patients received a fixed target concentration of remifentanil along with a target-controlled infusion of propofol, titrated until loss of consciousness. Two minutes after loss of consciousness, the study group received a bolus injection of atracurium, whereas the control group received a placebo. The following variables were recorded: bispectral index, spectral edge frequency, electromyographic activity, state entropy, and response entropy provided by the Datex-Ohmeda Entropy monitor. Similar values were obtained in both groups at loss of consciousness. Placebo administration induced a decrease in bispectral index (P < 0.002), spectral edge frequency (P < 0.05), electromyographic activ-ity (P < 0.02), state entropy (P < 0.05), and response entropy (P < 0.01) compared with the values measured at loss of consciousness. Atracurium administration induced a decrease in bispectral index (P < 0.0001), spectral edge frequency (P < 0.01), electromyographic activity (P < 0.0001), state entropy (P < 0.0001), and response entropy (P < 0.0001) values. Decreases in bispectral index (P < 0.05), electromyographic activity (P < 0.0001), and response entropy (P < 0.01) were larger after atracurium than placebo injection. In lightly anesthetized patients, myorelaxant administration decreases bispectral index and response entropy, but not state entropy values.

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