Impact of General Anesthesia Guided by State Entropy (SE) and Response Entropy (RE) on Perioperative Stability in Elective Laparoscopic Cholecystectomy Patients-A Prospective Observational Randomized Monocentric Study.

Anca Dinu ,Bettina Buzzi,Alexandru Florin Rogobete,Samir Rimawi,Lavinia Ioana Trache,Ovidiu Horea Bedreag,Sonia Elena Popovici,Madalin Marian Vaduva,Loredana Luca,Paul Manuel Luminosu,Lavinia Melania Bratu,Corina Maria Dumbuleu,Raluca Ramona Velovan,Andra Maghiar,Claudiu Barsac,Corina Maria Georgescu,Daiana Toma,Mihai Sandesc ,Marius Păpurică ,Dorel Săndesc

doi:10.3390/e22030356

Abstract

Laparoscopic cholecystectomy is one of the most frequently performed interventions in general surgery departments. Some of the most important aims in achieving perioperative stability in these patients is diminishing the impact of general anesthesia on the hemodynamic stability and the optimization of anesthetic drug doses based on the individual clinical profile of each patient. The objective of this study is the evaluation of the impact, as monitored through entropy (both state entropy (SE) and response entropy (RE)), that the depth of anesthesia has on the hemodynamic stability, as well as the doses of volatile anesthetic. A prospective, observational, randomized, and monocentric study was carried out between January and December 2019 in the Clinic of Anesthesia and Intensive Care of the “Pius Brînzeu” Emergency County Hospital in Timișoara, Romania. The patients included in the study were divided in two study groups: patients in Group A (target group) received multimodal monitoring, which included monitoring of standard parameters and of entropy (SE and RE); while the patients in Group B (control group) only received standard monitoring. The anesthetic dose in group A was optimized to achieve a target entropy of 40–60. A total of 68 patients met the inclusion criteria and were allocated to one of the two study groups: group A (N = 43) or group B (N = 25). There were no statistically significant differences identified between the two groups for both demographical and clinical characteristics (p > 0.05). Statistically significant differences were identified for the number of hypotensive episodes (p = 0.011, 95% CI: [0.1851, 0.7042]) and for the number of episodes of bradycardia (p < 0.0001, 95% CI: [0.3296, 0.7923]). Moreover, there was a significant difference in the Sevoflurane consumption between the two study groups (p = 0.0498, 95% CI: [−0.3942, 0.9047]). The implementation of the multimodal monitoring protocol, including the standard parameters and the measurement of entropy for determining the depth of anesthesia (SE and RE) led to a considerable improvement in perioperative hemodynamic stability. Furthermore, optimizing the doses of anesthetic drugs based on the individual clinical profile of each patient led to a considerable decrease in drug consumption, as well as to a lower incidence of hemodynamic side-effects.

Highlights

Laparoscopic cholecystectomy is considered to be the most frequently performed intervention in the field of general and abdominal surgery [1]
The included patients were randomized in two study groups: the multimodal monitoring protocol was implemented in patient group A, or the target group (heart rate (HR), bpm; blood pressure (BP), mmHg; peripheral oxygen saturation, SpO2, %; capnography, EtCO2, mmHg; state entropy (SE); response entropy (RE); inspired oxygen fraction, FiO2 ; minimum alveolar concentration (MAC)); in group B, or the control group, general anesthesia was guided based on standard procedure
We can say that multimodal monitoring which includes both classical parameters and monitoring of the depth of anesthesia through entropy improved perioperative hemodynamic stability

Summary

Introduction

Laparoscopic cholecystectomy is considered to be the most frequently performed intervention in the field of general and abdominal surgery [1]. The number of patients admitted for specific laparoscopic interventions has increased significantly, leading to an increase in the number of post-operative complications. These are reflected both in the clinical evolution, with increased length of stay and decreased patient satisfaction, as well as in the economic segment of healthcare [1,2]. A series of recent guidelines recommend multimodal monitoring of general anesthesia in order to increase patient safety. Recent recommendations have focused on the introduction in the daily routine of certain additional parameters, such as degree of hypnosis monitoring (depth of anesthesia), the evaluation of nociception–antinociception balance, and neuromuscular transmission monitoring. Depending on the clinical profile of each patient, advanced monitoring can be further extended by introducing special parameters for the evaluation of hemodynamic status

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