Introduction: The Entropy module has been designed to be used alongside current haemodynamic and neuromuscular monitoring parameters

to monitor the delivery and associated effects of anaesthesia (the adequacy of anaesthesia). Three sensors attached to the patients head provide electroencephalography (EEG) and frontal electromyogram (FEMG) readings which are analysed to produce a score of 0-100 for response entropy (RE: response to stimuli; includes higher frequencies upto 47 Hz; reflects both EEG and Frontal EMG activities), a score of 0-91 for state entropy (SE: depth of anaesthesia; calculated over the frequencies ranging from 0.8 to 32 Hz;reflects the patients cortical activity ) and 0100% for burst suppression indication(an isolectric state). This analysis notes the irregularity, complexity, or unpredictability characteristics of a signal. A regular signal where the wavelength and amplitude are constant over time, would have a low entropy value and a signal with an irregular wavelength and amplitude, a higher entropy value. The lower the patient s entropy value the more sedated they are. In clinical practice the Entropy module has the capacity to produce continuous data which can be stored and printed off. The difference between RE and SE (RE-SE) mainly reflects EMG activation. RE and (RE-SE) mainly increase in response to noxious stimulation and are thought to be indicators of the adequacy of antinociception. Neuromuscular Blocking Drugs (NMBDs) which decrease the stretch receptor activity in the muscles and suppress stimulation input to the arousal centres in the brain having a suppressive effect on EEG-derived indices . EMG activation by noxious stimulation, however, contaminates the EEG power spectrum and increase the RE, SE and RE-SE index. NMBDS decrease the EMG activation and suppress the entropy response to noxious stimulation. Although facial muscles are more resistant than other skeletal muscles to neuromuscular block higher doses of NMBDs will also suppress facial muscle activity. Use of the entropy module provides the anaesthetist with a method of directly monitoring neural activity in sedated patients that may reduce the amount of anaesthetic delivered and may also reduce recovery time.

AIMS & OBJECTIVE : To study Rocuronium dose dependent suppression of Entropy levels (RE, SE & RE-SE) to tracheal intubation during induction with Propofol & Sevoflurane . To investigate the dose effect of Rocuronium on the RE-SE response to tracheal intubation. 1. With this study we would like to conclude the optimum Dose of Rocuronium required to suppress the tracheal intubation induced increase in the RE-SE with Sevoflurane and propofol used as induction agent. 2. We also would be able to correlate the TOF and entropy states to tracheal intubation performed at particular Rocuronium dose and entropy levels.

Material & Methods : 1. This study is Approved by the ethics committee of the Sant parmanand Hospital, New delhi. 2. Informed consent will be obtained from all patients 3. a) b) c) Inclusion criteria of patients for the study : ASA physical status I-II Age 20 to 50 yrs of age Lap cholecystectomy under GA

4. Exclusion criteria : a) Patients with surgery of Brain, head or neck b) Disease or injury affecting CNS (Stroke, dementia, carotid stenosis or any organic brain pathology) c) Recently used Psychoactive or analgesic medication d) Neurological disorders, alcohol or drug abuse e) BMI <18.5 or > 25 kg/m2 f) Difficult intubation or time taken for intubation is more than 1 min. 5. Parameters to be recorded for the Study . Demographic parameters : a) Age b) Sex c) Weight d) Height e) BMI Clinical Monitoring parameters : a) MAP b) HR c) SE d) RE e) RE-SE f) Patient movement g) TOF

Progress in the case will be done under following Steps : 1. Fulfill the patients inclusion criteria. 2. Total 80 patients will be taken into consideration. 20 patients under each Rocuronium doses of 0.3, 0.6, 0.9, 1.2 mg/kg body weight

3. All monitoring will be performed with a Datex-Ohmeda S/5TM anaesthesia monitor (GE Healthcare, Helinski, Finland) 4. No premedication will be given to the patient. 5. In the operation theatre perform the following : a) ECG b) Non-invasive Arterial pressure c) Heart rate monitoring d) Pulse oximetry 6. Entropy electrodes will be applied on the left side of the forehead in all patients for keeping the consistency. 7. Two minutes of preoxygenation will be given 8. Anaesthesia induction with Propofol (1.5 to 2 mg/kg) in a dose sufficient to abolish the eye lash reflex. 9. Sevoflurane inhalational induction agent maintained at 1% end tidal Sevoflurane. the MAC-awake value for sevoflurane in unpremedicated children was 0.78%. This value is greater than the range previously reported for adults (0.60% 0.67%) 10. Quantified neuromuscular function by stimulation of the ulnar nerve at 0.1 Hz to produce contraction of the adductor pollicis muscle using accelerometry. 11. Ventilation will be controlled to maintain the End tidal CO2 at 35-40 mm Hg with a fresh gas flow of 6L/min 12. Rocuronium (0 .3, 0 .6 , 0 .9 , or 1.2 mg kg1) will then be administered 2 minutes after induction. 13. Intubation conditions will be assessed 7 min after test drug injection. The optimal Rocuronium dose usually defined as the lowest dose, which allows acceptable intubation conditions in 95% of subjects(ED91 TI). When thumb acceleration is depressed by 50 % or more, intubating conditions are considered acceptable in 97% of patients. 14. Fentanyl or any other analgesic is not given to preserve the sympathetic response to laryngoscopy and intubation.(This is the noxious stimulation in our study) 15. All the defined parameters readings will be recorded Just before intubation 16. Tracheal intubation will be done within 1 minutes (Tracheal intubation is defined as the time at which cuff is inflated) any patient that could not be intubated within 1 min will be excluded from the study. 17. All the defined parameter readings will be recorded within five min. of tracheal intubation only the maximum values will be recorded. 18. Patient movement during or after tracheal intubation is also recorded .

Study Proforma : MAP HR RE SE RE-SE Patient movement TOF

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