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Technology > Entropy Monitoring > Flashcards

Entropy Monitoring Flashcards

1
Q

What is Entropy?

A

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

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2
Q

How is entropy measured?

A

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

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3
Q

FEMG stands for?

A

Frontalis Electromyography

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4
Q

BIS monitoring does what?

A

Monitors the effect of anesthetics in the brain

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5
Q

Do you have to calibrate the BIS monitor?

A

NO

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6
Q

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

A

No they are independent of each other

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7
Q

What are the 3 parts to the anesthesia triad?

A

Consciousness/Hipnosis, Analgesia, Muscle Realxation

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8
Q

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

A

Autonomic and Somatic Responses

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9
Q

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

A

Train of 4

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10
Q

How can we monitor our patients Consciousness?

A

BIS monitor

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11
Q

BIS Range Guidelines: 0 - 39?

A

Deep hypnotic state, EEG supression

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12
Q

BIS Range Guidelines: 40 - 60?

A

Moderate Hypnotic State

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13
Q

BIS Range Guidelines: 61 - 70?

A

Light Hypnotic State

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14
Q

BIS Range Guidelines: 71 - 100?

A

Awake, Light to Moderate Sedation

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15
Q

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

A

60

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16
Q

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

A

70

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17
Q

Benefits of entropy monitoring?

A

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

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18
Q

Estimated population aware during anesthesia?

A

1:1000

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19
Q

Optimal Depth of Unconsciousness?

A

40-60 on the BIS

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20
Q

Most important Reason to use a BIS monitor?

A

Effective monitoring for risk of awareness

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21
Q

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

A

Both

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22
Q

Placement of the BIS

A

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

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23
Q

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

A

Average of information

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24
Q

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

A

Higher value

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25
Q

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

A

Analgesics and Hypnotics

26
Q

Name the 2 major sites that anesthetics work?

A

Brain and spinal cord

27
Q

Is BIS an anesthetic depth measurement?

A

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

28
Q
A

Know The RANGES

29
Q

BIS response to Ketamine administrtion is

A

Atypical

30
Q

BIS response to anelgesia administration is dependent on

A

Level of stimulation

31
Q

BIS monitoring derives brain status from the EEG not?

A

The concerntation of a particular drug

32
Q

The BIS index valuse is calculated over how many seconds

A

15 -30 seconds

33
Q

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

A

5-10 seconds

34
Q

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

A

Increase

35
Q

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

True or False

A

True

36
Q

Ketamine may transiently increase BIS values due to EEG activation??

True or False

A

True

37
Q

Etomidate may transiently increase BIS??

True or False

A

True related to the drug induce myoclonus

38
Q

Which druge will increase the BIS value

Phenelphrine or Ephedrine

A

Ephedrine

Phenelephrine dose not

39
Q

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

True or False

A

False they will cause a decrease in the BIS value

40
Q

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?

A

Steep decline because the BIS takes into account the EMG

41
Q

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

A

Previous episodes of awareness

High opoid sedative tolerance

Anticipated difficult airways

Known to be hemodynamically unstable

Surgical procedures with an increase risk of awareness

42
Q

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

True or False

A

True

43
Q

Is Entropy different then BIS

A

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

44
Q

EEG patterns change from irrgeular to regular with anesthetic depth??

Ture or False

A

True

45
Q

FEMG patterns increase with anesthetic depth

True or Flase

A

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

46
Q

What does entropy measure?

A

The irregularity of the EEG and FEMG signals

47
Q

There are 2 entropy parameters what are they?

A

Response Entropy

and

State Entropy

48
Q

Response Entropy (RE) is sensitive to what?

A

facial muscle activation with in 2 seconds

49
Q

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

A

Response Entropy (RE)

50
Q

State Entropy is base on what?

A

The EEG signal

51
Q

Do NMB effect the EEG?

A

NO

52
Q

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

A

YES

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

53
Q

Entropy and BIS will help the CRNA with what?

A

Ensuring faster and more predictable wake ups

Improving drug management

Avoid unnecessary deep anesthesia

prevent unexpected recovery

54
Q

What infulences the probability of awarness druing surgery?

A

ASA class 3-5

High opoid tolerence

55
Q

What is the % of awake anesthetics in the US?

A

1-2 per 1000

56
Q

BIS reduces PONV by how much in ambulatory surgery

A

50%

57
Q

Does BIS reduce PACU stay?

A

Yes by 16%

58
Q

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

A

Deep Hypnotic State

EEG suppression

59
Q

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

A

Dual position versitility or

right or left application

60
Q

EMG may bias the BIS to a higher value

True or False

A

True

61
Q

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

A

HELL NO !!!!!

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