Skip to main content
Log in

Evaluation of patient state index, bispectral index, and entropy during drug induced sleep endoscopy with dexmedetomidine

Journal of Clinical Monitoring and Computing Aims and scope Submit manuscript

Abstract

Multiple electroencephalographic (EEG) monitors and their associated EEG markers have been developed to aid in assessing the level of sedation in the operating room. While many studies have assessed the response of these markers to propofol sedation and anesthetic gases, few studies have compared these markers when using dexmedetomidine, an alpha-2 agonist. Fifty-one patients underwent drug induced sleep endoscopy with dexmedetomidine sedation. Continuous EEG was captured using SedLine (Masimo, Inc), and a playback system was used to extract the bispectral index (BIS) (Medtronic Inc), the patient state index (PSI) (Masimo, Inc), the state and response Entropy (GE Healthcare), and calculate the spectral edge frequency 95% (SEF95). Richmond Agitation-Sedation Scale (RASS) scores were assessed continually throughout the procedure and in recovery. We assessed the correlation between EEG markers and constructed ordinal logistic regression models to predict the RASS score and compare EEG markers. All three commercial EEG metrics were significantly associated with the RASS score (p < 0.001 for all metrics) whereas SEF95 alone was insufficient at characterizing dexmedetomidine sedation. PSI and Entropy achieved higher accuracy at predicing deeper levels of sedation as compared to BIS (PSI: 58.3%, Entropy: 58.3%, BIS: 44.4%). Lightening secondary to RASS score assessment is significantly captured by all three commercial EEG metrics (p < 0.001). Commercial EEG monitors can capture changes in the brain state associated with the RASS score during dexmedetomidine sedation. PSI and Entropy were highly correlated and may be better suited for assessing deeper levels of sedation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. Naaz S, Ozair E. Dexmedetomidine in current anaesthesia practice-a review. J Clin Diagnostic Res. 2014;8:GE01-4.

    Google Scholar 

  2. Capasso R, Rosa T, Tsou DYA, Nekhendzy V, Drover D, Collins J, et al. Variable findings for drug-induced sleep endoscopy in obstructive sleep apnea with propofol versus dexmedetomidine. Otolaryngol—head neck surg (United States). 2016;154:765–70.

    Article  Google Scholar 

  3. Zhao LL, Liu H, Zhang YY, Wei JQ, Han Y, Han L, et al. A comparative study on efficacy and safety of propofol versus dexmedetomidine in sleep apnea patients undergoing drug-induced sleep endoscopy: a consort-prospective, randomized, controlled clinical trial. Biomed Res Int Hindawi. 2018;2018:10–4.

    Google Scholar 

  4. Chang ET, Certal V, Song SA, Zaghi S, Carrasco-Llatas M, Torre C, et al. Dexmedetomidine versus propofol during drug-induced sleep endoscopy and sedation: a systematic review. Sleep Breath. 2017;21:727–35.

    Article  PubMed  Google Scholar 

  5. Padiyara TV, Bansal S, Jain D, Arora S, Gandhi K. Dexmedetomidine versus propofol at different sedation depths during drug-induced sleep endoscopy: a randomized trial. Laryngoscope. 2020;130:257–62.

    Article  CAS  PubMed  Google Scholar 

  6. Lodenius A, Maddison KJ, Lawther BK, Scheinin M, Eriksson LI, Eastwood PR, et al. Upper airway collapsibility during dexmedetomidine and propofol sedation in healthy volunteers: a nonblinded randomized crossover study. Anesthesiology. 2019;131:962–73.

    Article  CAS  PubMed  Google Scholar 

  7. Kirkham EM, Hoi K, Melendez JB, Henderson LM, Leis AM, Puglia MP, et al. Propofol versus dexmedetomidine during drug-induced sleep endoscopy (DISE) for pediatric obstructive sleep apnea. Sleep Breath. 2021;25:757–65.

    Article  PubMed  Google Scholar 

  8. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O’Neal PV, Keane KA, et al. The Richmond agitation-sedation scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166:1338–44.

    Article  PubMed  Google Scholar 

  9. Musizza B, Ribaric S. Monitoring the depth of anaesthesia. Sensors. 2010;10:10896–935.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Rampil IJ. A primer for EEG signal processing in anesthesia. Anesthesiology. 1998;89:980–1002.

    Article  CAS  PubMed  Google Scholar 

  11. Bruhn J, Röpcke H, Hoeft A. Approximate entropy as an electroencephalographic measure of anesthetic drug effect during desflurane anesthesia. Anesthesiology. 2000;92:715–26.

    Article  CAS  PubMed  Google Scholar 

  12. Drover DR, Lemmens HJ, Pierce ET, Plourde G, Loyd G, Ornstein E, et al. Patient State Index. Anesthesiology. 2002;97:82–9.

    Article  PubMed  Google Scholar 

  13. Balci C, Karabekir HS, Kahraman F, Sivaci RG. Comparison of entropy and bispectral index during propofol and fentanyl sedation in monitored anaesthesia care. J Int Med Res. 2009;37:1336–42.

    Article  CAS  PubMed  Google Scholar 

  14. Chen X, Tang J, White PF, Wender RH, Ma H, Sloninsky A, et al. A comparison of patient state index and bispectral index values during the perioperative period. anesth analg [Internet]. 2002; 95:1669–74. Available from: https://journals.lww.com/00000539-200212000-00036. Accessed 2 Sep 2022

  15. Ji S, Kim E, Lee J, Kim J, Kim H. Comparison of bispectral index and patient state index during sevoflurane anesthesia in children : a prospective observational study. 2020; 1–13.

  16. Kim D, Ahn JH, Heo G, Jeong JS. Comparison of bispectral index and patient state index values according to recovery from moderate neuromuscular block under steady-state total intravenous anesthesia. Sci Rep. 2021;11:1–7.

    Google Scholar 

  17. Soehle M, Kuech M, Grube M, Wirz S, Kreuer S, Hoeft A, et al. Patient state index vs bispectral index as measures of the electroencephalographic effects of propofol. Br J Anaesth. 2010;105:172–8.

    Article  CAS  PubMed  Google Scholar 

  18. Ki S, Lee D, Lee W, Cho K, Han Y, Lee J. Verification of the performance of the Bispectral Index as a hypnotic depth indicator during dexmedetomidine sedation. Anesth Pain Med. 2022;17:44–51.

    Article  Google Scholar 

  19. Absalom AR, Menon DK. BIS and spectral entropy monitoring during sedation with midazolam/remifentanil and dexmedetomidine/remifentanil. Crit Care. 2009;13:137.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Eagleman SL, Drover CM, Li X, MacIver MB, Drover DR. Offline comparison of processed electroencephalogram monitors for anaesthetic-induced electroencephalogram changes in older adults. Br J Anaesth. 2021;126:975–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Kim D, Ahn JH, Jung H, Choi KY, Jeong JS. Effects of neuromuscular blockade reversal on bispectral index and frontal electromyogram during steady-state desflurane anesthesia: a randomized trial. Sci Rep. 2019;9:1–7.

    Google Scholar 

  22. Renna M, Wigmore T, Mofeez A, Gillbe C. Biasing effect of the electromyogram on BIS: a controlled study during high-dose fentanyl induction. J Clin Monit Comput. 2002;17:377–81.

    Article  PubMed  Google Scholar 

  23. Schuller PJ, Newell S, Strickland PA, Barry JJ. Response of bispectral index to neuromuscular block in awake volunteers. Br J Anaesth. 2015;115:i95-103.

    Article  PubMed  Google Scholar 

  24. Messner M, Beese U, Romstöck J, Dinkel M, Tschaikowsky K. The bispectral index declines during neuromuscular block in fully awake persons. Anesth Analg. 2003;97:488–91.

    Article  CAS  PubMed  Google Scholar 

  25. Balci C, Karabekir H, Sivaci R. Determining entropy values equivalent to the bispectral index values during sevoflurane anaesthesia. Arch Med Sci. 2010;6:370–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Xing Y, Xu D, Xu Y, Chen L, Wang H, Li S. Effects of neuromuscular blockages on entropy monitoring during sevoflurane anesthesia. Med Sci Monit. 2019;25:8610–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank Jeffrey Xiong for his assistance with the data playback system.

Funding

This work received support from Masimo, National Institutes of Health (Grant No. 1K99GM140215)

Author information

Authors and Affiliations

Authors

Contributions

LH: created all the figures, performed the data analysis, and wrote the manuscript. MCC, ARS, RC, DRD, VN, and SLE: helped collect data for this study. MCC, VN, MCC, RC: helped develop the protocol for this study. DRD. SLE, and RC: advised methods and analysis. All authors reviewed the manuscript.

Corresponding author

Correspondence to Lichy Han.

Ethics declarations

Conflict of interest

DRD is a consultant for Masimo Inc. RC is a consultant for SAB – Bryte LLC and Invicta Medical. The rest of the authors declare no competing interests.

Ethical approval

The study was approved by the Stanford institutional review board.

Statement of human rights

All procedures performed in this work involving human participants were in accordance with the ethical standards of Stanford University, guided by the principles set forth by the Belmont Report.

Informed consent

All subjects provided written informed consent prior to study enrollment.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Han, L., Drover, D.R., Chen, M.C. et al. Evaluation of patient state index, bispectral index, and entropy during drug induced sleep endoscopy with dexmedetomidine. J Clin Monit Comput 37, 727–734 (2023). https://doi.org/10.1007/s10877-022-00952-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10877-022-00952-9

Keywords

Navigation