{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T07:19:43Z","timestamp":1789629583998,"version":"build-2803163510"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T00:00:00Z","timestamp":1631577600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003052","name":"Ministry of Trade, Industry and Energy","doi-asserted-by":"publisher","award":["N10047988,2013"],"award-info":[{"award-number":["N10047988,2013"]}],"id":[{"id":"10.13039\/501100003052","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>The aim of this study is to compare the effects of neuromuscular blockade (NMB) on phase lag entropy (PLE) and the bispectral index (BIS). We recorded the BIS, electromyograph (EMG) activity on a BIS monitor (EMG_BIS), PLE, and EMG activity on a PLE monitor (EMG_PLE) in 40 patients receiving general anesthesia. During the awake state, we analyzed the changes in parameters before and 2 min after the eyes were closed. During sedation, we compared the changes in the parameters before and at 4 min after injecting rocuronium (group R) or normal saline (group C) between the two groups. During anesthesia, we compared the changes in parameters before and at 4 min after injecting sugammadex (group B) or normal saline (group D) between the two groups. During the awake state, the BIS, EMG_BIS, and EMG_PLE, but not PLE, decreased significantly with closed eyes. An effect of EMG on the BIS was evident, but not on PLE. During sedation, the BIS decreased with the decrease in EMG_BIS regardless of NMB caused by rocuronium, but NMB decreased PLE, although the degree of the decrease in EMG_PLE after NMB was similar to that after placebo. To determine the effect of NMB on electroencephalograms (EEGs) in groups R and C, we plotted the power spectra before and at 4 min after injecting rocuronium or normal saline. Changes in slow and delta frequency bands were observed at 4 min after injecting rocuronium relative to before injecting rocuronium. There was no effect of EMG on either the BIS or PLE during anesthesia. In conclusion, the effect of electromyograph activity and\/or neuromuscular blockade on BIS or PLE depends on the level of consciousness.<\/jats:p>","DOI":"10.1371\/journal.pone.0257467","type":"journal-article","created":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T17:29:56Z","timestamp":1631640596000},"page":"e0257467","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["The influence of neuromuscular blockade on phase lag entropy and bispectral index: A randomized, controlled trial"],"prefix":"10.1371","volume":"16","author":[{"given":"Sohee","family":"Jin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8877-0274","authenticated-orcid":true,"given":"Hee Jung","family":"Baik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0232-766X","authenticated-orcid":true,"given":"Sooyoung","family":"Cho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rack Kyung","family":"Chung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyoung Ae","family":"Kong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youn Jin","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,9,14]]},"reference":[{"key":"pone.0257467.ref001","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1097\/00000542-199810000-00023","article-title":"A primer for EEG signal processing in anesthesia","volume":"89","author":"IJ Rampil","year":"1998","journal-title":"Anesthesiology"},{"key":"pone.0257467.ref002","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1097\/00000542-200011000-00029","article-title":"Development and clinical application of electroencephalographic bispectrum monitoring","volume":"93","author":"JW Johansen","year":"2000","journal-title":"Anesthesiology"},{"key":"pone.0257467.ref003","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1213\/01.ANE.0000184038.49429.8F","article-title":"The influence of a muscle relaxant bolus on bispectral and datex-ohmeda entropy values during propofol-remifentanil induced loss of consciousness.","volume":"101","author":"N Liu","year":"2005","journal-title":"Anesth Analg"},{"key":"pone.0257467.ref004","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1097\/00000539-200203000-00023","article-title":"Muscle relaxation does not alter hypnotic level during propofol anesthesia.","volume":"94","author":"R Greif","year":"2002","journal-title":"Anesth Analg"},{"key":"pone.0257467.ref005","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1097\/00000542-199402000-00019","article-title":"The cerebral and systemic effects of movement in response to a noxious stimulus in lightly anesthetised dogs","volume":"80","author":"WL Lanier","year":"1994","journal-title":"Anesthesiology"},{"key":"pone.0257467.ref006","doi-asserted-by":"crossref","first-page":"4980","DOI":"10.1002\/hbm.23708","article-title":"Diversity of functional connectivity patterns is reduced in propofol-induced unconsciousness","volume":"38","author":"H Lee","year":"2017","journal-title":"Hum Brain Mapp"},{"key":"pone.0257467.ref007","first-page":"121","article-title":"Eye blink artifact rejection in single-channel electroencephalographic signals by complete ensemble empirical mode decomposition and independent component analysis. 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values in a series of patients undergoing cardiac surgery using forced-air-warming therapy of the head","volume":"95","author":"TM Hemmerling","year":"2002","journal-title":"Anesth Analg"},{"key":"pone.0257467.ref013","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1097\/00000542-200005000-00042","article-title":"Electromyographic activity falsely elevates the bispectral index","volume":"92","author":"J Bruhn","year":"2000","journal-title":"Anesthesiology"},{"key":"pone.0257467.ref014","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1097\/ALN.0b013e31829103f5","article-title":"Disruption of frontal-parietal communication by ketamine, propofol, and sevoflurane","volume":"118","author":"UC Lee","year":"2013","journal-title":"Anesthesiology"},{"key":"pone.0257467.ref015","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1213\/01.ANE.0000072741.78244.C0","article-title":"The bispectral index declines during neuromuscular block in fully awake persons.","volume":"97","author":"M Messner","year":"2003","journal-title":"Anesth Analg"},{"key":"pone.0257467.ref016","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1097\/ALN.0000000000000436","article-title":"Effects of sevoflurane and propofol on frontal electroencephalogram power and coherence","volume":"121","author":"O Akeju","year":"2014","journal-title":"Anesthesiology"},{"key":"pone.0257467.ref017","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1097\/ALN.0000000000000841","article-title":"Clinical Electroencephalography for Anesthesiologists: Part I: Background and Basic Signatures.","volume":"123","author":"PL Purdon","year":"2015","journal-title":"Anesthesiology"},{"key":"pone.0257467.ref018","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1213\/00000539-197911000-00011","article-title":"Pancuronium reduces halothane requirement in man.","volume":"58","author":"AR Forbes","year":"1979","journal-title":"Anesth 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Fahey","year":"1989","journal-title":"Anesthesiology"},{"key":"pone.0257467.ref022","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1093\/bja\/76.3.446","article-title":"Effect of neuromuscular block on depth of anesthesia as measured by the auditory evoked response","volume":"76","author":"CE Richmond","year":"1996","journal-title":"Br J Anaesth"},{"key":"pone.0257467.ref023","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.jclinane.2016.11.005","article-title":"Intraoperative aberrant bispectral index values due to facial nerve monitoring","volume":"37","author":"D Chakrabarti","year":"2017","journal-title":"J Clin Anesth"},{"key":"pone.0257467.ref024","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1213\/00000539-198806000-00005","article-title":"Continuous electromyography for monitoring depth of anesthesia.","volume":"67","author":"T Chang","year":"1988","journal-title":"Anesth 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