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Usefulness of permutation entropy as an anesthetic depth indicator in children

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Abstract

Permutation entropy (PE) as a complexity measure has been introduced to monitor anesthetic depth for adult. However, PE has not yet been evaluated for its clinical applicability as an indicator of anesthetic depth in children. Therefore, in order to investigate the validity of PE, we compared PE with BIS using pharmacodynamic (PD) modeling in children. Electroencephalogram (EEG) was obtained from BIS monitor during sevoflurane deepening and lightening protocol. End-tidal sevoflurane concentration (Etsevo) and BIS were measured simultaneously. PE was calculated from the processed EEG with the scale ranging from 0 to 100. NONMEM software was used to investigate the PD relationship between Etsevo with BIS and PE. Adjusted PE (APE) values were decreased as anesthesia deepened. APE and BIS showed significant linear correlation (P < 0.001), indicating that PE also reflects anesthesia depth. PD parameters for APE and BIS were estimated with a sigmoid Emax model which describes the relationship between Etsevo and APE/BIS (E o : 78, E max : 17.6, C e50 : 2.5 vol%; γ: 13.1, k eo : 0.47 min−1 for APE; E o : 89.4; E max : 15.7; C e50 : 2.2 vol%; γ: 6.6, keo: 0.52 min−1 for BIS). PE seems to be a useful indicator of anesthetic depth, which is comparable to BIS in children.

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Acknowledgments

We are grateful to all members in Biomedical Knowledge Engineering Lab, Seoul National University, College of Dentistry for their assistance. And we are also grateful to Professor Satoshi Hagihria for providing Bispectrum Analyzer software.

Conflict of interest

The authors declared no conflict of interest.

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Author notes

    Authors and Affiliations

    1. Biomedical Knowledge Engineering Laboratory, School of Dentistry, Seoul National University, 28 Yeongeon-dong Jongno-gu, Seoul, Republic of Korea

      Pil-Jong Kim & Hong-Gee Kim

    2. Department of Clinical Pharmacology and Therapeutics/Anesthesiology and Pain Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea

      Gyu-Jeong Noh

    3. Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea

      Yong-Seo Koo

    4. Department of Pediatric Dentistry and Dental Research Institute, School of Dentistry, Seoul National University, 28 Yeongeon-dong Jongno-gu, Seoul, 110-768, Republic of Korea

      Teo Jeon Shin

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    1. Pil-Jong Kim
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    Corresponding authors

    Correspondence to Hong-Gee Kim or Teo Jeon Shin.

    Additional information

    Teo Jeon Shin and Hong-Gee Kim equally contributed to this study.

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    Supplementary material 1 (PPTX 190 kb)

    Appendix: NONMEM control code

    Appendix: NONMEM control code

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    Kim, PJ., Kim, HG., Noh, GJ. et al. Usefulness of permutation entropy as an anesthetic depth indicator in children. J Pharmacokinet Pharmacodyn 42, 123–134 (2015). https://doi.org/10.1007/s10928-015-9405-5

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    • DOI: https://doi.org/10.1007/s10928-015-9405-5

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