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An unexpected increase of entropy in a sleepwalking disorder patient during propofol and remifentanil anesthesia: a case report.

Choi YJ, Kwon K, Bae GE, Yoon SZ, Lee HW, Lim HJ - Korean J Anesthesiol (2014)

Bottom Line: The target effect-site concentrations of anesthetics increased from 4 to 7 µg/ml propofol and 4 ng/ml remifentanil, at which point values fell back to adequate anesthesia levels.Episodes of recall or of explicit memories did not occur during the anesthesia.In conclusion, sleepwalking patients with long-term use medications may need increment of anesthetic dose caused by the anesthetic drug metabolism activation or impairment or immaturity of inhibitory circuits in brain.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik Hospital, Seoul, Korea.

ABSTRACT
We report a case of increased values of entropy parameters Response Entropy (RE) and State Entropy (SE) during intravenous general anesthesia in a sleepwalking patient. An ASA class II, 64-year-old woman with stress incontinence underwent mid-urethral sling surgery. Prior to surgery, the patient had been administered paroxetine, valproic acid and clonazepam for the treatment of sleepwalking disorder. After 10 min of target-controlled infusion of propofol and remifentanil, entropy values increased up to 94 (RE) and 88 (SE) for 10 min. The target effect-site concentrations of anesthetics increased from 4 to 7 µg/ml propofol and 4 ng/ml remifentanil, at which point values fell back to adequate anesthesia levels. Episodes of recall or of explicit memories did not occur during the anesthesia. In conclusion, sleepwalking patients with long-term use medications may need increment of anesthetic dose caused by the anesthetic drug metabolism activation or impairment or immaturity of inhibitory circuits in brain.

No MeSH data available.


Related in: MedlinePlus

Mean arterial blood pressure and EEG response entropy (RE) and state entropy (SE) (A) and target controlled infusion rate of propofol and remifentanil (B) during general anesthesia.
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Figure 1: Mean arterial blood pressure and EEG response entropy (RE) and state entropy (SE) (A) and target controlled infusion rate of propofol and remifentanil (B) during general anesthesia.

Mentions: After induction of anesthesia, RE and SE were maintained within the range of the anesthetic (Fig. 1). The laryngeal mask airway was introduced 3 min after the start of anesthetic drug infusion. Mechanical ventilation was maintained using oxygen with air (FiO2 0.5) at a constant tidal volume (10 ml/kg) and frequency (10 breaths/min). There was a sudden increase of RE from 32 up to 94 and SE from 32 up to 88, 10 min after the start of anesthetic drug infusion. Target effect-site propofol concentration was increased from 3.5 to 7 µg/ml for 5 min, and then decreased to 5 µg/ml. Target effect-site remifentanil concentration was increased from 3.5 to 4 ng/ml. We suspected that the sudden increase in entropy may have been due to blockage of the intravenous line. Drug infusion line was connected using 3 way stopcock directly to the angio-cath; However, we failed to find a blockade in the intravenous line and concluded that propofol and remifentanil were being infused in a satisfactory manner. In addition, there were no nociceptive stimuli at this time because surgeons were in the process of preparing the surgical procedure. There were no signs of patient movement or arousal. Both RE and SE were maintained at approximately 90 for 10 min. After this time, RE and SE both suddenly decreased from 94 and 88 to below 10, and the operation started.


An unexpected increase of entropy in a sleepwalking disorder patient during propofol and remifentanil anesthesia: a case report.

Choi YJ, Kwon K, Bae GE, Yoon SZ, Lee HW, Lim HJ - Korean J Anesthesiol (2014)

Mean arterial blood pressure and EEG response entropy (RE) and state entropy (SE) (A) and target controlled infusion rate of propofol and remifentanil (B) during general anesthesia.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4216790&req=5

Figure 1: Mean arterial blood pressure and EEG response entropy (RE) and state entropy (SE) (A) and target controlled infusion rate of propofol and remifentanil (B) during general anesthesia.
Mentions: After induction of anesthesia, RE and SE were maintained within the range of the anesthetic (Fig. 1). The laryngeal mask airway was introduced 3 min after the start of anesthetic drug infusion. Mechanical ventilation was maintained using oxygen with air (FiO2 0.5) at a constant tidal volume (10 ml/kg) and frequency (10 breaths/min). There was a sudden increase of RE from 32 up to 94 and SE from 32 up to 88, 10 min after the start of anesthetic drug infusion. Target effect-site propofol concentration was increased from 3.5 to 7 µg/ml for 5 min, and then decreased to 5 µg/ml. Target effect-site remifentanil concentration was increased from 3.5 to 4 ng/ml. We suspected that the sudden increase in entropy may have been due to blockage of the intravenous line. Drug infusion line was connected using 3 way stopcock directly to the angio-cath; However, we failed to find a blockade in the intravenous line and concluded that propofol and remifentanil were being infused in a satisfactory manner. In addition, there were no nociceptive stimuli at this time because surgeons were in the process of preparing the surgical procedure. There were no signs of patient movement or arousal. Both RE and SE were maintained at approximately 90 for 10 min. After this time, RE and SE both suddenly decreased from 94 and 88 to below 10, and the operation started.

Bottom Line: The target effect-site concentrations of anesthetics increased from 4 to 7 µg/ml propofol and 4 ng/ml remifentanil, at which point values fell back to adequate anesthesia levels.Episodes of recall or of explicit memories did not occur during the anesthesia.In conclusion, sleepwalking patients with long-term use medications may need increment of anesthetic dose caused by the anesthetic drug metabolism activation or impairment or immaturity of inhibitory circuits in brain.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik Hospital, Seoul, Korea.

ABSTRACT
We report a case of increased values of entropy parameters Response Entropy (RE) and State Entropy (SE) during intravenous general anesthesia in a sleepwalking patient. An ASA class II, 64-year-old woman with stress incontinence underwent mid-urethral sling surgery. Prior to surgery, the patient had been administered paroxetine, valproic acid and clonazepam for the treatment of sleepwalking disorder. After 10 min of target-controlled infusion of propofol and remifentanil, entropy values increased up to 94 (RE) and 88 (SE) for 10 min. The target effect-site concentrations of anesthetics increased from 4 to 7 µg/ml propofol and 4 ng/ml remifentanil, at which point values fell back to adequate anesthesia levels. Episodes of recall or of explicit memories did not occur during the anesthesia. In conclusion, sleepwalking patients with long-term use medications may need increment of anesthetic dose caused by the anesthetic drug metabolism activation or impairment or immaturity of inhibitory circuits in brain.

No MeSH data available.


Related in: MedlinePlus