Entropy Monitoring

Question 1

What is Entropy?

Answer 1

It uses EEG and FEMG signals to determine the CNS state during anesthesia.

Question 2

How is entropy measured?

Answer 2

It measures the cortical electrical activity via EEG which becomes more regular with deeper anesthesia and FEMG quiets down as anesthetic is deepened.

Question 3

FEMG stands for?

Answer 3

Frontalis Electromyography

Question 4

BIS monitoring does what?

Answer 4

Monitors the effect of anesthetics in the brain

Question 5

Do you have to calibrate the BIS monitor?

Answer 5

NO

Question 6

Do the drugs given effect the patient and how they are monitored?

Answer 6

No they are independent of each other

Question 7

What are the 3 parts to the anesthesia triad?

Answer 7

Consciousness/Hipnosis, Analgesia, Muscle Realxation

Question 8

How do we measure how well we are managing analgesia for our patients?

Answer 8

Autonomic and Somatic Responses

Question 9

How do we evaluate how well our patients are muscle relaxed?

Answer 9

Train of 4

Question 10

How can we monitor our patients Consciousness?

Answer 10

BIS monitor

Question 11

BIS Range Guidelines: 0 - 39?

Answer 11

Deep hypnotic state, EEG supression

Question 12

BIS Range Guidelines: 40 - 60?

Answer 12

Moderate Hypnotic State

Question 13

BIS Range Guidelines: 61 - 70?

Answer 13

Light Hypnotic State

Question 14

BIS Range Guidelines: 71 - 100?

Answer 14

Awake, Light to Moderate Sedation

Question 15

BIS numbers less then what have a low probability of consciousness?

Answer 15

60

Question 16

BIS numbers less then what have a low probability of recall?

Answer 16

70

Question 17

Benefits of entropy monitoring?

Answer 17

Less drug utilization, faster wake up and extubation, More alert in PACU, Reduced PONV

Question 18

Estimated population aware during anesthesia?

Answer 18

1:1000

Question 19

Optimal Depth of Unconsciousness?

Answer 19

40-60 on the BIS

Question 20

Most important Reason to use a BIS monitor?

Answer 20

Effective monitoring for risk of awareness

Question 21

Can you use the BIS on the Left, RIght or both sides of the head?

Answer 21

Both

Question 22

Placement of the BIS

Answer 22

Circle 1- centered above the nose 2 inches Circle 4- Above and adjacent to eyebrow Circle 3 - At the temple between the the corner of the eye and hairline

Question 23

The SQI number from 0-100 is an ________ of _________ obtained in the last 60 seconds.

Answer 23

Average of information

Question 24

The EMG may bias the BIS to a HIgher or Lower value?

Answer 24

Higher value

Question 25

Name two categories of drugs that lower the EMG (muscle tone)?

Answer 25

Analgesics and Hypnotics

Question 26

Name the 2 major sites that anesthetics work?

Answer 26

Brain and spinal cord

Question 27

Is BIS an anesthetic depth measurement?

Answer 27

NO, it's just one more piece of info on your patient to make a decision

Question 28

Answer 28

Know The RANGES

Question 29

BIS response to Ketamine administrtion is

Answer 29

Atypical

Question 30

BIS response to anelgesia administration is dependent on

Answer 30

Level of stimulation

Question 31

BIS monitoring derives brain status from the EEG not?

Answer 31

The concerntation of a particular drug

Question 32

The BIS index valuse is calculated over how many seconds

Answer 32

15 -30 seconds

Question 33

BIS values may lag behind observed clinical changes by how long?

Answer 33

5-10 seconds

Question 34

EMG (forehead muscle tone) may increase or decrease BIS?

Answer 34

Increase

Question 35

During stable anesthesia without EMG artifact, Neuro muscular Blockers have little or no effect on the BIS?? True or False

Answer 35

True

Question 36

Ketamine may transiently increase BIS values due to EEG activation?? True or False

Answer 36

True

Question 37

Etomidate may transiently increase BIS?? True or False

Answer 37

True related to the drug induce myoclonus

Question 38

Which druge will increase the BIS value Phenelphrine or Ephedrine

Answer 38

Ephedrine Phenelephrine dose not

Question 39

Beta blockers and Alpha ₂ Blockerswill cause and increase in the BIS value?? True or False

Answer 39

False they will cause a decrease in the BIS value

Question 40

If excessive EMG was noted on your patient prior to induction and a neuromuscular blocker was administered will ou have a steep incline or decline in the BIS value?

Answer 40

Steep decline because the BIS takes into account the EMG

Question 41

On what types of patients should a BIS monitor be used on?

Answer 41

Previous episodes of awareness High opoid sedative tolerance Anticipated difficult airways Known to be hemodynamically unstable Surgical procedures with an increase risk of awareness

Question 42

There has been shown an 80% reduction in incidents of awarness when using the BIS monitor True or False

Answer 42

True

Question 43

Is Entropy different then BIS

Answer 43

Yes Bis measures mainly EEG giving you one number while Entropy measures Frontalis electromyography and EEG changes

Question 44

EEG patterns change from irrgeular to regular with anesthetic depth?? Ture or False

Answer 44

True

Question 45

FEMG patterns increase with anesthetic depth True or Flase

Answer 45

False the Frontalis electromyography quiets down as the brain is saturated with anesthetic

Question 46

What does entropy measure?

Answer 46

The irregularity of the EEG and FEMG signals

Question 47

There are 2 entropy parameters what are they?

Answer 47

Response Entropy and State Entropy

Question 48

Response Entropy (RE) is sensitive to what?

Answer 48

facial muscle activation with in 2 seconds

Question 49

State Entropy (SE) is always less than or equal to what?

Answer 49

Response Entropy (RE)

Question 50

State Entropy is base on what?

Answer 50

The EEG signal

Question 51

Do NMB effect the EEG?

Answer 51

NO

Question 52

Are the BIS and Entorpy guidline ranges the same for conciousness?

Answer 52

YES 40-60 is where you want to be for no recall

Question 53

Entropy and BIS will help the CRNA with what?

Answer 53

Ensuring faster and more predictable wake ups Improving drug management Avoid unnecessary deep anesthesia prevent unexpected recovery

Question 54

What infulences the probability of awarness druing surgery?

Answer 54

ASA class 3-5 High opoid tolerence

Question 55

What is the % of awake anesthetics in the US?

Answer 55

1-2 per 1000

Question 56

BIS reduces PONV by how much in ambulatory surgery

Answer 56

50%

Question 57

Does BIS reduce PACU stay?

Answer 57

Yes by 16%

Question 58

Less then 40 on the concious guidlines for BIS or Entropy means what

Answer 58

Deep Hypnotic State EEG suppression

Question 59

What is the most critical component of the BIS / Entropy System

Answer 59

Dual position versitility or right or left application

Question 60

EMG may bias the BIS to a higher value True or False

Answer 60

True

Question 61

Reliance on the BIS for intraoperative anesthetic managment alnoe is recommended?

Answer 61

HELL NO !!!!!