Korean J Anesthesiol.  2014 Oct;67(4):270-274. 10.4097/kjae.2014.67.4.270.

An unexpected increase of entropy in a sleepwalking disorder patient during propofol and remifentanil anesthesia: a case report

• Choi YJ
• Kwon K
• Bae GE
• Yoon SZ
• Lee HW
• Lim HJ

• KMID: 1937687
• DOI: http://doi.org/10.4097/kjae.2014.67.4.270

Abstract

We report a case of increased values of entropy parameters Response Entropy (RE) and State Entropy (SE) during intravenous general anesthesia in a sleepwalking patient. An ASA class II, 64-year-old woman with stress incontinence underwent mid-urethral sling surgery. Prior to surgery, the patient had been administered paroxetine, valproic acid and clonazepam for the treatment of sleepwalking disorder. After 10 min of target-controlled infusion of propofol and remifentanil, entropy values increased up to 94 (RE) and 88 (SE) for 10 min. The target effect-site concentrations of anesthetics increased from 4 to 7 microg/ml propofol and 4 ng/ml remifentanil, at which point values fell back to adequate anesthesia levels. Episodes of recall or of explicit memories did not occur during the anesthesia. In conclusion, sleepwalking patients with long-term use medications may need increment of anesthetic dose caused by the anesthetic drug metabolism activation or impairment or immaturity of inhibitory circuits in brain.

Keyword

Anesthetics; Entropy; Somnambulism

MeSH Terms

Anesthesia*
Anesthesia, General
Anesthetics
Brain
Clonazepam
Entropy*
Female
Humans
Metabolism
Middle Aged
Paroxetine
Propofol*
Somnambulism*
Suburethral Slings
Valproic Acid
Anesthetics
Clonazepam
Paroxetine
Propofol
Valproic Acid