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Effects of Neuromuscular Blockages on Entropy Monitoring During Sevoflurane Anesthesia

Yian Xing, Dian Xu, Yanyifang Xu, Lianhua Chen, Hong Wang, Shitong Li

Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China (mainland)

Med Sci Monit 2019; 25:8610-8617

DOI: 10.12659/MSM.917879

Chinese Clinical Trial Registry # ChiCTR-OOC-16008293

Available online:

Published: 2019-11-15


BACKGROUND: There are no data available on the effects of different degrees of neuromuscular blockade on spectral entropy during sevoflurane anesthesia. This study aimed to observe the effects of different degrees of neuromuscular blockade on state and response entropy during sevoflurane anesthesia.
MATERIAL AND METHODS: Eighty-one female patients were randomized to 9 groups (n=9 per group) according to the concentration of sevoflurane and degree of neuromuscular blockade. Response and state entropy were monitored. The endpoints were: 1) impact of neuromuscular blockade on state entropy and response entropy, and the difference between response entropy and state entropy; and 2) the response of entropy after cutaneous tetanic electrical noxious stimulation to the ulnar nerve under different degrees of neuromuscular blockade and concentrations of sevoflurane.
RESULTS: These were no significant differences in response entropy or state entropy, or differences between response entropy and state entropy among the groups in the awake state (P>0.05). Without noxious stimulation, sevoflurane concentrations and neuromuscular blockade had no significant effects on response entropy or state entropy, or on the difference between response entropy and state entropy (all P>0.05), but sevoflurane concentrations showed a significant effect on state entropy (P<0.05). After noxious stimulation, sevoflurane concentrations and neuromuscular blockade had significant effects on response entropy and state entropy, and on the difference between response entropy and state entropy.
CONCLUSIONS: Response entropy and state entropy decreased with increasing sevoflurane concentration. Neuromuscular blockade did not affect entropy without noxious stimulation. With stimulation, muscle relaxants significantly reduced the changes in entropy, and there were significant effects of neuromuscular blockade and sevoflurane on entropy.

Keywords: Anesthesia, Entropy, Neuromuscular Blockade



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