Monotonicity of approximate entropy during transition from awareness to unresponsiveness due to propofol anesthetic induction

The ability to monitor the physiological effects of sedative medication accurately is of interest in clinical practice. During the anesthetic agent driven transition to unresponsiveness, nonstationary changes such as signal amplitude variations appear in electroencephalography. In this paper, it is studied whether the application of the approximate entropy (ApEn) method to electroencephalographic (EEG) signal produces a monotonic response curve during the transition from awareness to unresponsiveness. Data from fourteen patients, undergoing propofol anesthetic induction were studied. To optimize the ApEn performance, different parameter choices were carefully evaluated. It was assumed with our protocol, that the level of anesthesia changes monotonically with the elapsed induction time. The monotonicity of the ApEn change was assessed with the prediction probability statistic (P_K). The monotonicity of the ApEn time-series depends on the parameters employed in the algorithm and the varying signal amplitude. Depending on the parameter values, the median P_K value ranged from 0.886 to 0.527. Thus, a good directionality and concordance was observed, but the nonstationarity of the signal affected the results. In conclusion, EEG-based ApEn measure shows a nonlinear response during propofol induction. With a judicious choice of parameters, a monotonic response is confirmed using P_K statistic.