Application Of Anesthesia Consciousness Index Based On Electroencephalogram Information Sample Entropy In Pediatric Patients Underwent Tonsil Adenoidectomy

【Background】Children are in a critical period of central nervous system development.Anesthesia of extensive depth or insufficiency may cause nervous system damage,resulting in postoperative cognitive dysfunction.In clinical practice,anesthesiologists often evaluate the depth of anesthesia by the vital signs of children(such as blood pressure,heart rate,etc.).However,due to individual differences among different children,as well as differences in the experience and level of anesthesiologists,the judgment of the depth of anesthesia is often in risk of error,resulting in insufficient or excessive anesthetics,which directly affects the children’s postoperative recovery.Electroencephalography(EEG)is often used to assess the brain’s state of consciousness and level of sedation because it displays the electrical activity of nerve cells in the brain in real time.In pediatric general anesthesia,it is important to select appropriate anesthesia depth monitoring tools to reduce the occurrence of anesthesia related adverse events.Con View monitor is an anesthesia depth monitoring device designed and produced specifically for EEG monitoring of Asian patients.Depth of anesthesia index(AI)provided by Conview monitor is an index reflecting anesthesia depth after sample entropy calculation based on EEG information.Previous studies on adults have found that AI values are of good correlation with the traditional Bispectral index(BIS)and Narcotrend index(NI),and that AI values are more sensitive than BIS values in the progress of consciousness change.Therefore,this study intends to observe the application of Conview anesthesia depth index AI in total intravenous anesthesia of pediatric patients and compare it with routine clinical monitoring,so as to provide a basis for its application in pediatric anesthesia.【Objective】The aim of this study is to investigate the feasibility of utilizing the depth of anesthesia index(AI)that is based on EEG sample entropy calculations of Conview in children receiving intravenous anesthesia.【Methods】One hundred and twenty four continuous children aged between 3 and 12 years old who were planned for elective tonsillectomy and adenoidectomy were included.They were randomly divided into two groups: an experimental group(n=62)and a control group(n=62).Both groups were monitored for anesthesia depth using the Con View monitor and received propofol-remifentanil combined anesthesia.In the experimental group,the drug infusion speed was adjusted based on the depth of anesthesia index AI value to maintain it between 40 and 60.In the control group,the Con View monitor was covered by a black cloth,unseen by and the anesthesiologist,who can only judge the anesthesia depth based on vital signs.Drug infusion speed were adjusted in order to maintain mean arterial pressure(MAP)and heart rate(HR)fluctuation within ±30% of the baseline values.We monitored mean arterial pressure(MAP),heart rate(HR),and AI value at 12 time points,including entry into the operating room(T1),before induction(T2),before intubation(T3),1 minute(T4),3 minutes(T5),and 5 minutes(T6)after intubation,the start of surgery(T7),tonsillectomy(T8),adenoidectomy(T9),end of surgery(T10),emergence from anesthesia(T11),and extubation(T12).We also recorded the recovery time,extubating time,propofol and remifentanil doses.The Richmond Agitation-Sedation Scale(RASS)score,Wong-Baker facial expression pain score,Pediatric Anesthesia Emergence Delirium(PAED)score,and post-anesthesia care unit(PACU)stay time were recorded when leaving PACU.Adverse events occurring during surgery and in PACU were recorded and dealt with.We followed up with both groups of patients for 24 hours after surgery to observe whether adverse events such as pain,nausea,and vomiting occurred.We used the modified Brice questionnaire to follow up with the patients at 24 hours,1week,and 1 month after surgery to observe whether patients had intraoperative awareness.【Results】1.Both the experimental and control groups exhibited similar baseline variables.2.The experimental group demonstrated a statistically significant decrease in recovery time,extubating time,and propofol dose in comparison to the control group(P<0.05).3.No statistically significant differences were observed in remifentanil dose,RASS score,Wong-Baker facial expression pain score,PAED score,PACU stay time,and incidence of adverse events between the two groups(P>0.05).Moreover,neither group displayed intraoperative awareness.【Conclusions】The application of the depth of anesthesia index AI based on EEG sample entropy calculations in pediatric intravenous anesthesia is feasible.Utilization of AI resulted in significant decreases in the amount of propofol required for tonsillectomy and adenoidectomy in children,resulting in shorter recovery and extubating time.Moreover,AI can be safely implemented in pediatric anesthesia.Therefore,selecting appropriate anesthesia depth monitoring tools for children during general anesthesia is of great value for it help reduce the occurrence of anesthesia-related adverse events.Based on the results,the use of AI is an effective and safe approach for pediatric anesthesia.