An Entropy-Based Prospective Randomized Controlled Trial to Evaluate the Analgesic and Hypnotic Effects of Equipotent Doses of Sevoflurane and Isoflurane in Patients Presenting for Spine Surgeries

Abstract

Abstract Objectives Minimal alveolar concentration (MAC) of anesthetic agents has been considered a suitable measure of the potency of inhalational anesthetics. Furthermore, it is assumed that equi-MAC concentrations of different anesthetic agents have a similar potency in suppressing responses to painful stimuli. Isoflurane and sevoflurane are two commonly used volatile anesthetic agents in spine surgeries. Therefore, these agents' hypnotic and analgesic potencies should be distinguished and comprehended for the optimal administration of anesthesia. Consequently, we undertook this study to compare the analgesic and hypnotic potencies between these agents at equi-MAC concentrations, using the entropy monitor. Materials and Methods Forty patients undergoing lumbar spine surgery were randomly assigned to two groups receiving either isoflurane (n = 20) or sevoflurane (n = 20). After induction, maintenance of anesthesia was done with age-corrected 1.0 MAC of either isoflurane or sevoflurane. A standardized noxious stimulus was provided to all the patients after achieving a steady state of 1.0 MAC. The state entropy (SE), response entropy (RE), and RE–SE were recorded at baseline, prestimulus, and poststimulus time points in both groups. Statistical Analyses Data are presented as frequency and percentages for categorical variables and mean ± standard deviation for continuous variables. The comparison of categorical variables between the two groups was made using the Fisher's exact test, and the Student's t-test was used for continuous variables. A p-value of < 0.05 was considered to be statistically significant. Results At age-corrected 1.0 MAC, there was no significant difference in the SE, RE, and RE–SE in both the groups at any time point. Conclusion Our study shows that during a steady state of age-corrected 1.0 MAC single-agent anesthesia, sevoflurane and isoflurane have comparable analgesic and hypnotic potencies as measured by entropy indices when a standardized nociceptive stimulus is provided.