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Herzog M, Rudzki M, Plößl S, Plontke S, Kellner P. Depth of sedation during drug induced sedation endoscopy monitored by BiSpectral Index® and Cerebral State Index®. Sleep Breath 2020; 25:1029-1035. [PMID: 32857320 DOI: 10.1007/s11325-020-02180-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Drug induced sedation endoscopy (DISE) is performed to investigate patterns and sites of obstruction in patients with sleep-disordered breathing (SDB). During DISE the patients are sedated to obtain a muscular relaxation of the upper airway which mimics the relaxation during natural sleep. Different sleep stages are intended to be simulated by drug induced sedation, and it is helpful to measure the depth of sedation. The BiSpectral Index® (BIS) is often used for this procedure. Besides the BIS, other means of sedation depth monitoring exist in anaesthesiology but have not yet been investigated with respect to DISE. Monitoring of the Cerebral State Index® (CSI) is one of these methods. The aim of the study was to compare the BIS and CSI for sedation depth monitoring during DISE. METHODS Sixty patients underwent DISE monitored by the BIS and CSI in parallel. The BIS and CSI values were compared using the Bland-Altman analysis. RESULTS The BIS and CSI values differed during the course of sedation during DISE by a mean of - 6.07. At light sedation (BIS 60-80), lower values by 10 scale points of CSI compared with BIS were detectable. At deeper sedation levels (BIS 40-50), the CSI turned to present equal and even higher values compared with the BIS. CONCLUSION Sedation depth measurement during DISE can be performed by the BIS or CSI, but the differences should be interpreted carefully as comparable data for sleep stages in natural sleep are available only for BIS.
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Affiliation(s)
- Michael Herzog
- Department of Otorhinolaryngology, Head and Neck Surgery, Carl-Thiem-Klinikum gGmbH, Carl-Thiem-Str. 111, 03048, Cottbus, Germany. .,Department of Otorhinolaryngology, Head and Neck Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.
| | - Mathias Rudzki
- Emergency Department, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 01620, Halle (Saale), Germany.,Department of Anesthesiology and Surgical Intensive Care, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 01620, Halle (Saale), Germany
| | - Sebastian Plößl
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
| | - Stefan Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
| | - Patrick Kellner
- Department of Anesthesiology and Surgical Intensive Care, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 01620, Halle (Saale), Germany.,Department of Anesthesiology and Intensive Care, University of Lübeck, University Medical Center Schleswig-Holstein, Ratzeburger Allee 16, 23538, Lübeck, Germany
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De Vito A, Carrasco Llatas M, Ravesloot MJ, Kotecha B, De Vries N, Hamans E, Maurer J, Bosi M, Blumen M, Heiser C, Herzog M, Montevecchi F, Corso RM, Braghiroli A, Gobbi R, Vroegop A, Vonk PE, Hohenhorst W, Piccin O, Sorrenti G, Vanderveken OM, Vicini C. European position paper on drug-induced sleep endoscopy: 2017 Update. Clin Otolaryngol 2018; 43:1541-1552. [PMID: 30133943 DOI: 10.1111/coa.13213] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/14/2018] [Accepted: 08/20/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The first edition of the European position paper (EPP) on drug-induced sleep endoscopy (DISE) was published in 2014 with the aim to standardise the procedure, to provide an in-depth insight into the main aspects of this technique and to have a basis for future research. Since 2014, new studies have been published concerning new sedative agents or new insights into the pattern/levels of the obstruction depending on the depth of sedation. Therefore, an enlarged group of European experts in the field of sleep breathing disorders (SBD), including the most of the first DISE EPP main authors, has decided to publish an update of the European position paper on DISE, in order to include new evidence and to find a common language useful for reporting the findings of this endoscopic evaluation in adult population affected by SBD. METHODS The authors have evaluated all the available evidence reported in the literature and have compared experience among various departments in leading European centres in order to provide an update regarding the standardisation of the DISE procedure and an in-depth insight into the main aspects of this technique. RESULTS After the first European Position Consensus Meeting on DISE and its update, consensus was confirmed for indications, required preliminary examinations, where to perform DISE, technical equipment required, staffing, local anaesthesia, nasal decongestion, other medications, patient positioning, basics and special diagnostic manoeuvres, drugs and observation windows. So far, no consensus could be reached on a scoring and classification system. However, regarding this aim, the idea of an essential classification, such as VOTE with the possibility of its graded implementation of information and descriptions, seems to be the best way to reach a universal consensus on DISE classification at this stage. A common DISE language is mandatory, and attempts to come to a generally accepted system should be pursued.
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Affiliation(s)
- Andrea De Vito
- Head and Neck Department, ENT & Oral Surgery Unit, Morgagni-Pierantoni Hospital, Forlì, Italy.,ENT Unit, Santa Maria delle Croci Hospital, Ravenna AUSL of Romagna, Romagna, Italy
| | | | - Madeline J Ravesloot
- Department of Otorhinolaryngology and Head and Neck Surgery, OLVG, Amsterdam, The Netherlands.,Medisch Centrum Jan van Goyen, Amsterdam, The Netherlands
| | - Bhik Kotecha
- Royal National Throat Nose & Ear Hospital, UCLH, London, UK
| | - Nico De Vries
- Department of Otolaryngology, OLVG Hospital and ACTA, Amsterdam, Netherlands.,Department of Otorhinolaryngology and Head and Neck Surgery, Multidisciplinary Sleep Disorders Center, University of Antwerp, Antwerp, Belgium.,Department of Oral Kinesiology, Academic Centre for Dentistry, MOVE Inst., Amsterdam, The Netherlands
| | - Evert Hamans
- Department of Otorhinolaryngology, Head and Neck Surgery, Jan Palfijn Hospital, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerpen, Belgium
| | - Joachim Maurer
- Sleep Disorders Centre, Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Mannheim, Mannheim, Germany
| | - Marcello Bosi
- Pulmonary Operative Unit, Department of Thoracic Diseases, Morgagni-Pierantoni Hospital, AUSL of Romagna, Forlì, Italy
| | - Marc Blumen
- Service ORL, Hopital Foch, Suresnes France and Centre Medical Veille Sommeil, Paris, France
| | - Clemens Heiser
- Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universitat Munchen, Munich, Germany
| | - Michael Herzog
- Department of Otorhinolaryngology, Head and Neck Surgery, Carl Thiem Klinikum, Cottbus, Germany
| | - Filippo Montevecchi
- Head and Neck Department, ENT & Oral Surgery Unit, Morgagni-Pierantoni Hospital, AUSL of Romagna, Forlì, Italy
| | | | - Alberto Braghiroli
- Sleep Lab. Pulmonary Rehabilitation Dept. Istituti Clinici Scientifici Maugeri, SPA SB, IRCCS, Veruno, Italy
| | - Riccardo Gobbi
- Head and Neck Department, ENT & Oral Surgery Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Anneclaire Vroegop
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Patty Elisabeth Vonk
- Department of Otorhinolaryngology and Head and Neck Surgery, OLVG, Amsterdam, The Netherlands
| | | | - Ottavio Piccin
- Department of Otolaryngology, Head and Neck Surgery, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giovanni Sorrenti
- Department of Otolaryngology, Head and Neck Surgery, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Olivier M Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp- Department ENT, Head and Neck Surgery, Antwerp University Hospital - Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Antwerp, Belgium
| | - Claudio Vicini
- Head and Neck Department, AUSL of Romagna, ENT & Oral Surgery Unit, Morgagni-Pierantoni Hospital, Forlì, Italy.,ENT Unit, Infermi Hospital, AUSL of Romagna, Faenza, Italy.,ENT Unit, Santa Maria delle Croci Hospital, Ravenna, Italy.,AUSL of Romagna, Romagna, Italy.,ENT Clinic, University of Ferrara, Ferrara, Italy
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3
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Cho SH, Kim SS, Hyun DM, Yoon HS, Han JW, Kim JS. Comparison between cerebral state index and bispectral index during desflurane anesthesia. Korean J Anesthesiol 2018; 71:447-452. [PMID: 29739183 PMCID: PMC6283714 DOI: 10.4097/kja.d.17.00084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/11/2018] [Indexed: 11/13/2022] Open
Abstract
Background Cerebral state index (CSI) is an anesthesia depth monitor alternative to bispectral index (BIS). Published comparative studies have used propofol or sevoflurane. However, studies using desflurane have not been reported yet. Different volatile anesthetics have different electroencephalography signatures. The performance of CSI may be different in desflurane anesthesia. Therefore, the objective of this study was to compare CSI and BIS during desflurane anesthesia. Methods Thirty-three patients were recruited. Desflurane and remifentanil were used to maintain general anesthesia. BIS and CSI were recorded simultaneously every minute. End-tidal concentration of desflurane was maintained at 4% from the beginning of surgery for 5 minutes. Pairwise data of CSI and BIS were obtained five times at one-minute intervals. This process was repeated in the order of 6%, 8%, and 10%. Results BIS and CSI were negatively correlated with the end-tidal concentration of desflurane with a similar degree of correlation (correlation coefficient BIS: –0.847, CSI: –0.844). The relationship between CSI and BIS had a good linearity with a slope close to 1 (R2 = 0.905, slope = 1.01). For the relationship between CSI and BIS at each end-tidal concentration of desflurane, CSI and BIS showed good linearity in 4% and 10% (R2 = 0.559, 0.540). However, the linearity and slope were decreased in 6% and 8% (R2 = 0.163, 0.014). Conclusions CSI showed an equivalent degree of overall performance compared to BIS in desflurane anesthesia. Accounting for previous literature, CSI can be used as a good substitute for BIS regardless of the kind of anesthetics used.
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Affiliation(s)
- Sang-Hyeon Cho
- Department of Anesthesiology and Pain Medicine, GangNeung Asan Hospital, Gangneung, Korea
| | - Sung-Su Kim
- Department of Anesthesiology and Pain Medicine, GangNeung Asan Hospital, Gangneung, Korea
| | - Dong-Min Hyun
- Department of Anesthesiology and Pain Medicine, GangNeung Asan Hospital, Gangneung, Korea
| | - Hyeong-Suk Yoon
- Department of Anesthesiology and Pain Medicine, GangNeung Asan Hospital, Gangneung, Korea
| | - Jung-Woo Han
- Department of Anesthesiology and Pain Medicine, GangNeung Asan Hospital, Gangneung, Korea
| | - Jin Sun Kim
- Department of Anesthesiology and Pain Medicine, GangNeung Asan Hospital, Gangneung, Korea
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Bergese SD, Uribe AA, Puente EG, Marcus RJL, Krohn RJ, Docsa S, Soto RG, Candiotti KA. A Prospective, Multicenter, Single-Blind Study Assessing Indices of SNAP II Versus BIS VISTA on Surgical Patients Undergoing General Anesthesia. JMIR Res Protoc 2017; 6:e15. [PMID: 28159731 PMCID: PMC5315767 DOI: 10.2196/resprot.6741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 12/29/2022] Open
Abstract
Background Traditionally, anesthesiologists have relied on nonspecific subjective and objective physical signs to assess patients’ comfort level and depth of anesthesia. Commercial development of electrical monitors, which use low- and high-frequency electroencephalogram (EEG) signals, have been developed to enhance the assessment of patients’ level of consciousness. Multiple studies have shown that monitoring patients’ consciousness levels can help in reducing drug consumption, anesthesia-related adverse events, and recovery time. This clinical study will provide information by simultaneously comparing the performance of the SNAP II (a single-channel EEG device) and the bispectral index (BIS) VISTA (a dual-channel EEG device) by assessing their efficacy in monitoring different anesthetic states in patients undergoing general anesthesia. Objective The primary objective of this study is to establish the range of index values for the SNAP II corresponding to each anesthetic state (preinduction, loss of response, maintenance, first purposeful response, and extubation). The secondary objectives will assess the range of index values for BIS VISTA corresponding to each anesthetic state compared to published BIS VISTA range information, and estimate the area under the curve, sensitivity, and specificity for both devices. Methods This is a multicenter, prospective, double-arm, parallel assignment, single-blind study involving patients undergoing elective surgery that requires general anesthesia. The study will include 40 patients and will be conducted at the following sites: The Ohio State University Medical Center (Columbus, OH); Northwestern University Prentice Women's Hospital (Chicago, IL); and University of Miami Jackson Memorial Hospital (Miami, FL). The study will assess the predictive value of SNAP II versus BIS VISTA indices at various anesthetic states in patients undergoing general anesthesia (preinduction, loss of response, maintenance, first purposeful response, and extubation). The SNAP II and BIS VISTA electrode arrays will be placed on the patient’s forehead on opposite sides. The hemisphere location for both devices’ electrodes will be equally alternated among the patient population. The index values for both devices will be recorded and correlated with the scorings received by performing the Modified Observer’s Assessment of Alertness and Sedation and the American Society of Anesthesiologists Continuum of Depth of Sedation, at different stages of anesthesia. Results Enrollment for this study has been completed and statistical data analyses are currently underway. Conclusions The results of this trial will provide information that will simultaneously compare the performance of SNAP II and BIS VISTA devices, with regards to monitoring different anesthesia states among patients. ClinicalTrial Clinicaltrials.gov NCT00829803; https://clinicaltrials.gov/ct2/show/NCT00829803 (Archived by WebCite at http://www.webcitation.org/6nmyi8YKO)
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Affiliation(s)
- Sergio D Bergese
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States.,Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Alberto A Uribe
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Erika G Puente
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - R-Jay L Marcus
- Department of Anesthesiology, Northwestern University Prentice Women's Hospital, Chicago, IL, United States
| | | | - Steven Docsa
- Stryker Corporation, Kalamazoo, MI, United States
| | - Roy G Soto
- Department of Anesthesiology, William Beaumont Hospital, Royal Oak, MI, United States
| | - Keith A Candiotti
- Department of Anesthesiology, University of Miami/Jackson Memorial Hospital, Miami, FL, United States
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Sharma A, Singh PM, Trikha A, Rewari V. Entropy correlates with Richmond Agitation Sedation Scale in mechanically ventilated critically ill patients. J Clin Monit Comput 2014; 28:193-201. [PMID: 24122077 DOI: 10.1007/s10877-013-9517-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 10/04/2013] [Indexed: 11/26/2022]
Abstract
Sedation is routinely used in intensive care units. However due to absence of objective scoring systems like Bispectral Index and entropy our ability to regulate the degree of sedation is limited. This deficiency is further highlighted by the fact that agitation scores used in intensive care units (ICU) have no role in paralyzed patients. The present study compares entropy as a sedation scoring modality with Richmond Agitation Sedation Scale (RASS) in mechanically ventilated, critically ill patients in an ICU. Twenty-seven, mechanically ventilated, critically ill patients of either sex, 16-65 years of age, were studied over a period of 24 h. They received a standard sedation regimen consisting of a bolus dose of propofol 0.5 mg/kg and fentanyl 1 lg/kg followed by infusions of propofol and fentanyl ranging from 1.5 to 5 mg/kg/h and 0.5 to 2.0 lg/kg/h, respectively. Clinically relevant values of RASS for optimal ICU sedation (between 0 and -3) in non-paralyzed patients were compared to corresponding entropy values, to find if any significant correlation exists between the two. These entropy measurements were obtained using the Datex-Ohmeda-M-EntropyTM module. This module is presently not approved by Food and Drug Administration (FDA) for monitoring sedation in ICU. A total of 527 readings were obtained. There was a statistically significant correlation between the state entropy (SE) and RASS [Spearman's rho/rs = 0.334, p\0.0001]; response entropy (RE) and RASS [Spearman's rho/rs = 0.341, p\0.0001]). For adequate sedation as judged by a RASS value of 0 to -3, the mean SE was 57.86 ± 16.50 and RE was 67.75 ± 15.65. The present study illustrates that entropy correlates with RASS (between scores 0 and -3) when assessing the level of sedation in mechanically ventilated critically ill patients.
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De Vito A, Carrasco Llatas M, Vanni A, Bosi M, Braghiroli A, Campanini A, de Vries N, Hamans E, Hohenhorst W, Kotecha BT, Maurer J, Montevecchi F, Piccin O, Sorrenti G, Vanderveken OM, Vicini C. European position paper on drug-induced sedation endoscopy (DISE). Sleep Breath 2014; 18:453-65. [PMID: 24859484 DOI: 10.1007/s11325-014-0989-6] [Citation(s) in RCA: 188] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 04/04/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although drug-induced sedation endoscopy (DISE) represents the most widespread diagnostic tool for upper airway endoscopic evaluation of snoring and obstructive sleep apnea hypopnea syndrome (OSAHS), many controversies exist about how to perform the sedation, the indications for DISE, and how to report DISE findings. The present position paper reports on a consensus as proposed by a group of European experts in the field of DISE after discussion during a recent dedicated meeting. METHODS The authors have evaluated all the available evidence reported in the literature and have compared experience among various departments in leading European centers in order to provide a standardization of the DISE procedure and an in-depth insight in the main aspects of this technique. RESULTS A proposal of the DISE procedure standardization has been achieved with a general agreement concerning the terminology, indications, contraindications, required preliminary examinations, setting, technical equipment required, staffing, local anesthesia and nasal decongestion, patient positioning, basis and special diagnostic maneuvers, and the applied sedation drugs and observation windows. Otherwise, no consensus has been reached on a scoring and classification system. CONCLUSIONS Although consensus has been reached on several aspects of the DISE procedure, some topics remain open to future research, such as a better analysis of the importance of positional aspects during DISE and a further comparison of the differences in degree, level and pattern of upper airway collapse observed during DISE versus during natural sleep and awake endoscopy. Finally, a universally accepted scoring and classification system is lacking.
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Affiliation(s)
- Andrea De Vito
- Special Surgery Department, Ear-Nose-Throat Unit, Morgagni-Pierantoni Hospital, Via Forlanini 34, 47121, Forlì, Italy
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Lenkin AI, Zaharov VI, Lenkin PI, Smetkin AA, Bjertnaes LJ, Kirov MY. Monitoring of anesthetic depth during surgical correction of acquired valvular disorders: single center, randomized trial. J Cardiothorac Vasc Anesth 2013; 28:301-7. [PMID: 24094565 DOI: 10.1053/j.jvca.2013.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The authors' primary objective was to test the hypothesis that Cerebral State Index (CSI)-guided control of anesthetic depth might reduce the consumption of anesthetics and shorten the duration of ICU and hospital stays after surgical correction of combined valve disorders. DESIGN Single center, randomized trial. SETTING City Hospital Number 1 of Arkhangelsk, Russian Federation. PARTICIPANTS Fifty adult patients with combined valve disorders requiring surgical correction. INTERVENTIONS The patients were randomized into 2 groups. In the CSI group, anesthetic depth was monitored, and the rate of infusion of propofol was titrated to maintain the depth of anesthesia corresponding to a CSI of 40-60. In the control group, the depth of anesthesia was monitored clinically, and the dosage of propofol was administered according to the recommendations of the manufacturer. MEASUREMENTS AND MAIN RESULTS All patients received standard perioperative monitoring. Consumption of anesthetics and length of ICU and hospital stays were recorded. Preoperative patient characteristics did not differ significantly between the groups. In the CSI group, average intraoperative doses of midazolam and propofol were reduced by 41% and 19%, respectively (p<0.01). Maintenance of anesthesia guided by CSI shortened the time until fit for ICU discharge by 50% and reduced the lengths of ICU and postoperative hospital stays by 35% and 25%, respectively (p< 0.05). CONCLUSIONS Monitoring of anesthetic depth reduces the requirements for midazolam and propofol, resulting in a faster recovery and a shorter postoperative ICU and hospital stay after surgical correction of combined valve disorders.
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Affiliation(s)
- Andrey I Lenkin
- Department of Anesthesiology and Intensive Care Medicine, City Hospital #1 of Arkhangelsk, Arkhangelsk, Russian Federation.
| | - Viktor I Zaharov
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russian Federation
| | - Pavel I Lenkin
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russian Federation
| | - Alexey A Smetkin
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russian Federation
| | - Lars J Bjertnaes
- Department of Clinical Medicine (Anesthesiology), Faculty of Health Sciences, University of Tromsoe, Tromsoe, Norway
| | - Mikhail Y Kirov
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russian Federation; Department of Clinical Medicine (Anesthesiology), Faculty of Health Sciences, University of Tromsoe, Tromsoe, Norway
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Shi L, Li X, Wan H. A Predictive Model of Anesthesia Depth Based on SVM in the Primary Visual Cortex. Open Biomed Eng J 2013; 7:71-80. [PMID: 24044024 PMCID: PMC3772573 DOI: 10.2174/1874120720130701002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 04/26/2013] [Accepted: 05/23/2013] [Indexed: 11/22/2022] Open
Abstract
In this paper, a novel model for predicting anesthesia depth is put forward based on local field potentials (LFPs) in the primary visual cortex (V1 area) of rats. The model is constructed using a Support Vector Machine (SVM) to realize anesthesia depth online prediction and classification. The raw LFP signal was first decomposed into some special scaling components. Among these components, those containing higher frequency information were well suited for more precise analysis of the performance of the anesthetic depth by wavelet transform. Secondly, the characteristics of anesthetized states were extracted by complexity analysis. In addition, two frequency domain parameters were selected. The above extracted features were used as the input vector of the predicting model. Finally, we collected the anesthesia samples from the LFP recordings under the visual stimulus experiments of Long Evans rats. Our results indicate that the predictive model is accurate and computationally fast, and that it is also well suited for online predicting.
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Affiliation(s)
| | - Xiaoyuan Li
- School of Electrical Engineering, Zhengzhou University, Zhengzhou, Henan, China
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Al-Kadi MI, Reaz MBI, Ali MAM. Evolution of electroencephalogram signal analysis techniques during anesthesia. SENSORS 2013; 13:6605-35. [PMID: 23686141 PMCID: PMC3690072 DOI: 10.3390/s130506605] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 05/06/2013] [Accepted: 05/07/2013] [Indexed: 12/25/2022]
Abstract
Biosignal analysis is one of the most important topics that researchers have tried to develop during the last century to understand numerous human diseases. Electroencephalograms (EEGs) are one of the techniques which provides an electrical representation of biosignals that reflect changes in the activity of the human brain. Monitoring the levels of anesthesia is a very important subject, which has been proposed to avoid both patient awareness caused by inadequate dosage of anesthetic drugs and excessive use of anesthesia during surgery. This article reviews the bases of these techniques and their development within the last decades and provides a synopsis of the relevant methodologies and algorithms that are used to analyze EEG signals. In addition, it aims to present some of the physiological background of the EEG signal, developments in EEG signal processing, and the effective methods used to remove various types of noise. This review will hopefully increase efforts to develop methods that use EEG signals for determining and classifying the depth of anesthesia with a high data rate to produce a flexible and reliable detection device.
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Affiliation(s)
- Mahmoud I. Al-Kadi
- Department of Electrical, Electronic & Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, UKM Bangi Selangor 43600, Malaysia; E-Mails: (M.B.I.R.); (M.A.M.A.)
- Department of Biomedical Engineering, Al-Khwarizmi College of Engineering, Baghdad University, Baghdad 47146, Iraq
- Authors to whom correspondence should be addressed; E-Mail: ; Tel.: +60-1-7991-7098
| | - Mamun Bin Ibne Reaz
- Department of Electrical, Electronic & Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, UKM Bangi Selangor 43600, Malaysia; E-Mails: (M.B.I.R.); (M.A.M.A.)
| | - Mohd Alauddin Mohd Ali
- Department of Electrical, Electronic & Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, UKM Bangi Selangor 43600, Malaysia; E-Mails: (M.B.I.R.); (M.A.M.A.)
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10
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Nitzschke R, Schmidt GN. Electroencephalography during out-of-hospital cardiopulmonary resuscitation. J Emerg Med 2012; 43:659-662. [PMID: 20828974 DOI: 10.1016/j.jemermed.2010.05.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Revised: 04/14/2010] [Accepted: 05/30/2010] [Indexed: 05/29/2023]
Abstract
BACKGROUND At the present time there is no parameter that can estimate the quality of cerebral perfusion and possible success of cerebral resuscitation during advanced cardiac life support (ACLS) efforts. In recent years, various attempts have been made to use electroencephalography (EEG)-based cerebral neuromonitoring to assess the effectiveness of cardiopulmonary resuscitation (CPR). OBJECTIVES The Cerebral State Monitor M3 (Danmeter A/S, Odense, Denmark) is a portable, single-channel EEG monitor that provides the user with different EEG-based parameters and the raw waveform EEG to measure cerebral activity. CASE REPORT We report two cases of out-of-hospital CPR with single-channel EEG monitoring conducted parallel to ACLS with external chest compressions. We demonstrate an artifact in waveform EEG recordings that is caused by the external chest compressions, and that leads to a miscalculation of the Burst Suppression Ratio and Cerebral State Index. CONCLUSION These cases suggest that digitally processed EEG-monitoring is not a useful tool during CPR.
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Affiliation(s)
- Rainer Nitzschke
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Molnár C, Kovács Z, Simon E, Gál J, Mikos B, Fülesdi B. Comparison of two depth of anaesthesia monitors during general anaesthesia: electrophysiological and clinical assessment. ACTA PHYSIOLOGICA HUNGARICA 2012; 99:111-7. [PMID: 22849834 DOI: 10.1556/aphysiol.99.2012.2.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED Cerebral state monitor (CSM) is a recently developed anaesthesia depth monitor based on EEG measurement. Medline search confirmed that the accuracy of this monitor has already been compared with BIS monitoring; however, we did not find any studies comparing CSM monitor with AEP monitoring. Therefore, the aim of our study was to investigate the correlation between AAI using AEP monitor and CSI (cerebral state index) using CSM monitor. METHODS Prospective, observational study involving 39 ASA I-III patients undergoing lumbar discuss hernia operation. Simultaneous registration of CSI and AAI was performed during general anaesthesia. The identical values were off-line analysed. Additionally in 20 patients parallel registration of CSI and AAI was undertaken while anaesthesia was guided based on routine clinical signs. RESULTS While analysing the data in the superficial, ideal and deep anaesthesia zones, we found that a relationship between CSI and AAI is weak. Our patients spent roughly the half of the clinical anaesthesia in the ideal zone based on the AAI index and less than 50% based on CSI. Almost one fifth of clinical anaesthesia based on AAI and nearly 40% based on CSI was spent in the deep anaesthesia zones. A superficial anaesthesia has been detected in 27% of time based on AAI and 17% based on CSI. CONCLUSIONS CSI and AAI weakly correlated to each other. Depth of anaesthesia monitors may be useful in detecting patients who spend valuable time within the deep anaesthetic zone.
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Affiliation(s)
- Cs Molnár
- University of Debrecen, Department of Anaesthesiology and Intensive Care, Debrecen, Hungary
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Pilge S, Blum J, Kochs EF, Schöniger SA, Kreuzer M, Schneider G. Does the Cerebral State Index Separate Consciousness from Unconsciousness? Anesth Analg 2011; 113:1403-10. [DOI: 10.1213/ane.0b013e31823007cd] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Comparison between cerebral state index and bispectral index as measures of electroencephalographic effects of sevoflurane using combined sigmoidal E(max) model. Acta Pharmacol Sin 2011; 32:1208-14. [PMID: 21892201 DOI: 10.1038/aps.2011.99] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIM The cerebral state index (CSI) was recently introduced as an electroencephalographic monitor for measuring the depth of anesthesia. We compared the performance of CSI to the bispectral index (BIS) as electroencephalographic measures of sevoflurane effect using two combined sigmoidal E(max) models. METHODS Twenty adult patients scheduled for laparotomy were studied. After induction of general anesthesia, sevoflurane concentrations were progressively increased and then decreased over 70 min. An analysis of the BIS and CSI with the sevoflurane effect-site concentration was conducted using two combined sigmoidal E(max) models. RESULTS The BIS and CSI decreased over the initial concentration range of sevoflurane and then reached a plateau in most patients. A further increase in sevoflurane concentration produced a secondary plateau in the pharmacodynamic response. The CSI was more strongly correlated with effect-site sevoflurane concentration (R(2)=0.95±0.04) than the BIS was (R(2)=0.87±0.07) (P<0.05). The individual E(max) and C(eff50) (effect-site concentration associated with 50% decrease from baseline to plateau) values for the upper and lower plateaus were significantly greater for BIS (12.7±7.3, 1.6±0.4, and 4.2±0.5, respectively) than for CSI (3.4±2.2, 1.2±0.4, and 3.8±0.5, respectively) (P<0.05). The remaining pharmacodynamic parameters for the BIS and CSI were similar. CONCLUSION The overall performance of the BIS and CSI during sevoflurane anesthesia was similar despite major differences in their algorithms. However, the CSI was more consistent and more sensitive to changes in sevoflurane concentration, whereas the measured BIS seemed to respond faster. The newly developed combined E(max) model adequately described the clinical data, including the pharmacodynamic plateau.
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Springman SR, Andrei AC, Willmann K, Rusy DA, Warren ME, Han S, Lee M. A comparison of SNAP II and bispectral index monitoring in patients undergoing sedation. Anaesthesia 2010; 65:815-9. [PMID: 20586747 DOI: 10.1111/j.1365-2044.2010.06408.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Clinical signs and patients' verbal responses have traditionally been used to assess patients' comfort and the depth of sedation. Recently, level-of-consciousness monitors have been used to guide sedation. The SNAP II(c) is a single-lead electroencephalogram device that displays a SNAP(c) Index - a derived value based on both high and low frequency electroencephalogram signals. Much of the current clinical research on monitoring during sedation involves the bispectral index monitor. We compared simultaneous readings recorded by the SNAP II and bispectral index during sedation in 51 consecutive patients undergoing surgery. The anaesthesia team was blinded to the SNAP II and bispectal index values. Concurrent SNAP II and bispectral index readings displayed similarly-shaped trajectories during sedation, but further studies are needed to establish the routine clinical utility of both these monitors.
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Affiliation(s)
- S R Springman
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Abstract
BACKGROUND There has been a breakthrough in the understanding of anaesthetic drug effects during the last two decades, and new monitors aimed at quantifying such effects have been developed. MATERIAL AND METHODS This review is based on publications from the last 15 years, oral presentations, and rewritten parts of the author's PhD thesis. RESULTS General anaesthesia can be regarded as a combination of hypnosis (sleep), analgesia and muscle relaxation. Modern anaesthetic drugs aim at each of these effects separately. Pharmacological variation makes it impossible to find one dose suitable for all, so tools for measuring drug effects in the individual patient are warranted. Monitors for measuring depth-of-hypnosis and partly analgesic effect are commercially available. Among these, BIS (bispectral index), based on EEG, is by far the best documented. BIS is proven useful for preventing undesired awareness and overdosing, but there are major limitations. Use of such technology in clinical practice is under constant debate. INTERPRETATION Even though the BIS technology is promising and used widely, no health authorities have so far recommended that such monitors should be compulsory during general anaesthesia, but rather that it should be considered on an individual basis. So far, it seems like this is a sensible approach in Norway as well.
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Affiliation(s)
- Siv Cathrine Høymork
- Anestesi- og intensivavdelingen, Vestre Viken, Sykehuset Asker og Baerum 1309 Rud, Norway.
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Cerebral state index versus bispectral index during propofol-fentanyl-nitrous oxide anesthesia. J Anesth 2010; 24:380-5. [PMID: 20339885 DOI: 10.1007/s00540-010-0906-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Accepted: 01/14/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to compare the cerebral state index (CSI) and bispectral index (BIS) during propofol-fentanyl-nitrous oxide anesthesia. METHODS Thirty patients scheduled for abdominal surgery, with a mean age of 30-70 years, were enrolled. Anesthesia was induced with propofol and fentanyl and was maintained with propofol, fentanyl, epidural mepivacaine, and nitrous oxide in oxygen. During surgery, the propofol infusion rate was adjusted to try to keep BIS at 40 + or - 3 for 10 min and then decreased to keep the BIS at 60 + or - 3 for 10 min. RESULTS The BIS had a larger value for the time between switching on the apparatus and starting to measure at a signal quality index >75%. The recovery time from disturbance by an electric cautery event was 41 + or - 14 s for the BIS and 3 + or - 1 s for the CSI (P < 0.05). The absolute values of the BIS and CSI were not significantly different and they showed a good correlation. The bias (mean of the differences, BIS - CSI) was negative at all measurement points, but the limits of agreement and percentage error were small. CONCLUSIONS The absolute values of the BIS and CSI were not significantly different during propofol-fentanyl-nitrous oxide anesthesia. The start of the measurement was faster with the CSI than with the BIS after switch-on, and measurement was less disturbed by electric cautery with the CSI.
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Steinmetz J, Funder KS, Dahl BT, Rasmussen LS. Depth of anaesthesia and post-operative cognitive dysfunction. Acta Anaesthesiol Scand 2010; 54:162-8. [PMID: 19764909 DOI: 10.1111/j.1399-6576.2009.02098.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND A deep level of anaesthesia measured by the bispectral index has been found to improve processing speed as one aspect of cognitive function after surgery. The purpose of the present study was to assess the possible effect of the level of anaesthesia on post-operative cognitive dysfunction (POCD) 1 week after surgery, as assessed by a neuropsychological test battery. METHODS We included 70 patients >60 years of age scheduled for elective non-cardiac surgery with general anaesthesia. The depth of anaesthesia was monitored using the cerebral state monitor, which provided a cerebral state index (CSI) value. Cognitive function was assessed by the ISPOCD neuropsychological test battery before and at 1 week (or hospital discharge) after surgery and POCD was defined as a Z score above 1.96. RESULTS Five patients were not assessed after surgery. The mean CSI was 40 and 43 in patients with (N=9) and without POCD (N=56), respectively (P=0.41). The cumulated time of both deep anaesthesia (CSI<40) and light anaesthesia (CSI>60) did not differ significantly, and no significant correlation was found between the mean CSI and the Z score. CONCLUSION We were unable to detect a significant association between the depth of anaesthesia and the presence of POCD 1 week after the surgery.
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Affiliation(s)
- J Steinmetz
- Department of Anaesthesia, Centre of Head and Orthopaedics, University Hospital of Copenhagen, Copenhagen, Denmark.
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Zanner R, Pilge S, Kochs E, Kreuzer M, Schneider G. Time delay of electroencephalogram index calculation: analysis of cerebral state, bispectral, and Narcotrend indices using perioperatively recorded electroencephalographic signals. Br J Anaesth 2009; 103:394-9. [DOI: 10.1093/bja/aep198] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cerebral state index vs. bispectral index during sevoflurane–nitrous oxide anaesthesia. Eur J Anaesthesiol 2009; 26:638-42. [DOI: 10.1097/eja.0b013e328324e946] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Meyhoff CS, Henneberg SW, Jørgensen BG, Gätke MR, Rasmussen LS. Depth of anaesthesia monitoring in obese patients: a randomized study of propofol-remifentanil. Acta Anaesthesiol Scand 2009; 53:369-75. [PMID: 19173688 DOI: 10.1111/j.1399-6576.2008.01872.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In obese patients, depth of anaesthesia monitoring could be useful in titrating intravenous anaesthetics. We hypothesized that depth of anaesthesia monitoring would reduce recovery time and use of anaesthetics in obese patients receiving propofol and remifentanil. METHODS We investigated 38 patients with a body mass index >or=30 kg/m(2) scheduled for an abdominal hysterectomy. Patients were randomized to either titration of propofol and remifentanil according to a cerebral state monitor (CSM group) or according to usual clinical criteria (control group). The primary end point was time to eye opening and this was assessed by a blinded observer. RESULTS Time to eye opening was 11.8 min in the CSM group vs. 13.4 min in the control group (P=0.58). The average infusion rate for propofol was a median of 516 vs. 617 mg/h (P=0.24) and for remifentanil 2393 vs. 2708 microg/h (P=0.04). During surgery, when the cerebral state index was continuously between 40 and 60, the corresponding optimal propofol infusion rate was 10 mg/kg/h based on ideal body weight. CONCLUSION No significant reduction in time to eye opening could be demonstrated when a CSM was used to titrate propofol and remifentanil in obese patients undergoing a hysterectomy. A significant reduction in remifentanil consumption was found.
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Affiliation(s)
- C S Meyhoff
- Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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Sevoflurane requirement during elective ankle day surgery: the effects of etirocoxib premedication, a prospective randomised study. J Orthop Surg Res 2008; 3:40. [PMID: 18786254 PMCID: PMC2546393 DOI: 10.1186/1749-799x-3-40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Accepted: 09/11/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anti-inflammatory drugs, NSAIDs, have become an important part of the pain management in day surgery. The aim of the present study was to evaluate the effect of Coxib premedication on the intra-operative anaesthetic requirements in patients undergoing elective ankle surgery in general anaesthesia. TYPE OF STUDY Prospective, randomized study of the intra-operative anaesthetic-sparing effects of etoricoxib premedication as compared to no NSAID preoperatively. METHODS The intra-operative requirement of sevoflurane was studied in forty-four ASA 1-2 patients undergoing elective ankle day surgical in balanced general anaesthesia. Primary study endpoint was end-tidal sevoflurane concentration to maintain Cerebral State Index of 40-50 during surgery. RESULTS All anaesthesia and surgery was uneventful, no complications or adverse events were noticed. The mean end-tidal sevoflurane concentration intra-operatively was 1.25 (SD 0.2) and 0.91 (SD 0.2) for the pre and post-operative administered group of patients respectively (p < 0.0001). No other intra-operative differences could be noted. Emergence and recovery was rapid and no difference was noticed in time to discharge-eligible mean 52 minutes in both groups studied. In all 6 patients, 5 in the group receiving etoricoxib post-operatively, after surgery, and one in the pre-operative group required rescue analgesia before discharge from hospital. No difference was seen in pain or need for rescue analgesia, nausea or patients satisfaction during the first 24 postoperative hours. CONCLUSION Coxib premedication before elective day surgery has an anaesthetic sparing potential.
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Current World Literature. Curr Opin Anaesthesiol 2007; 20:284-6. [PMID: 17479036 DOI: 10.1097/aco.0b013e3281e3380b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Disma N, Lauretta D, Palermo F, Sapienza D, Ingelmo PM, Astuto M. Level of sedation evaluation with Cerebral State Index and A-Line Arx in children undergoing diagnostic procedures. Paediatr Anaesth 2007; 17:445-51. [PMID: 17474951 DOI: 10.1111/j.1460-9592.2006.02146.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Monitoring of anesthesia depth is difficult clinically, particularly in children. The aim of this study was to assess the correlation existing between CSI (Cerebral State Index), or AAI (A-line ARX) and a clinical sedation scale such as UMSS (University of Michigan Sedation Scale), during deep sedation with propofol in children undergoing diagnostic procedures. METHODS Twenty ASA I and II children, scheduled to undergo deep sedation for magnetic resonance imaging (MRI) or Esophagogastroduodenoscopy (EGDS), were enrolled. The patients were randomly assigned to receive depth of anesthesia monitoring with CSI or AAI. The anesthetist administered repeated doses of propofol every 10 s to a UMSS score of 3-4. An attending anesthetist, not involved in drug administration, recorded time and doses of sedation medications, vital signs, UMSS score and CSI or AAI score. All the evaluations were recorded at awake state (baseline), every 10 s until an UMSS score of 3-4 and every 3 min until the children were awake. RESULTS We enrolled 13 males and seven females ranging in age from 8 months to 7 years. After induction of anesthesia CSI and AAI scores decreased and from the end of the procedure to emergence the two scores increased. The CSI data showed a strong correlation with the UMSS scores (r = -0.861; P < 0.0001); we found a similar correlation between the AAI data and the UMSS scores (r = -0.823; P < 0.0001). CONCLUSIONS Our study suggests that CSI and AAI may be two, real-time and objective tools to assess induction and emergence during propofol sedation in children undergoing EGDS and MRI.
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Affiliation(s)
- Nicola Disma
- Department of Anesthesia and Intensive Care (Director Prof. A. Gullo), Policlinico University Hospital, Catania, Italy.
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Anderson RE, Sartipy U, Jakobsson JG. Use of conventional ECG electrodes for depth of anaesthesia monitoring using the cerebral state index: a clinical study in day surgery. Br J Anaesth 2007; 98:645-8. [PMID: 17371776 DOI: 10.1093/bja/aem061] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The cost-benefit relationship for depth of anaesthesia monitors is complicated by the high cost of specially designed EEG electrodes. The cerebral state index (CSI) monitor will accept regular ECG electrodes with snap connectors. The purpose of this study was to determine if generic ECG electrodes could replace the more expensive proprietary EEG electrodes for the CSI monitor. METHODS Two identical cerebral state monitors were used simultaneously during sevoflurane anaesthesia for knee arthroscopy in 14 ASA I-II patients. One monitor used proprietary (Danmeter) EEG electrodes and the other used ECG electrodes (3M Red Dot Diagnostic ECG Electrodes). Paired CSI values were recorded every other minute. Anaesthetic depth was titrated clinically. Sedation depth was scored according to the Observer's Assessment of Alertness/Sedation (OAAS) scale. RESULTS The agreement between the two measures was found to be high, mean difference--0.23, and the overall repeatability mean bias was 6.6 and 153/163 pairs (94%) were located within the 95% limits of agreement. No major difference was noted in impedance, noise, or artifacts. A large overlap in CSI was noted for each level of the OAAS scale; patients with CSI values as low as 40-50 responded whereas patients not responding to surgical stimulation had CSI values as high as 75. The direct cost of disposables decreased from 4euro to 0.50euro per patient by using ordinary ECG electrodes. CONCLUSIONS Switching from proprietary EEG electrodes to ordinary generic ECG electrodes maintains the same accuracy at about a 10th of the cost when measuring CSI during day surgery with sevoflurane anaesthesia.
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Affiliation(s)
- R E Anderson
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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Cortínez LI, Delfino AE, Fuentes R, Muñoz HR. Performance of the Cerebral State Index During Increasing Levels of Propofol Anesthesia: A Comparison with the Bispectral Index. Anesth Analg 2007; 104:605-10. [PMID: 17312217 DOI: 10.1213/01.ane.0000255152.96354.17] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The cerebral state monitor is a new device to measure depth of anesthesia. In this study we compared the cerebral state monitor with the bispectral index (BIS) monitor during propofol anesthesia. METHODS Fifteen healthy patients received a continuous infusion of propofol (300 mL/h). The cerebral state index (CSI) and the BIS values were recorded until burst suppression ratio > or =60%. Baseline variability, prediction probability, and agreement analysis between indices were evaluated. Clinical markers of loss of consciousness were also assessed. RESULTS Mean awake BIS and CSI values were 95.6 and 91.6, respectively (P = 0.01). BIS and CSI prediction probability values (mean +/- sd) were estimated to be 0.87 +/- 0.08 and 0.86 +/- 0.08, respectively (NS). The CSI tended to stabilize at values of 60-40 when estimated propofol concentrations at the effect site increased from 5 to 8 mug/mL. The BIS stabilized at values of 40-20 when the propofol concentrations at the effect site increased from 7 to 10 mug/mL. The mean BIS-CSI difference was -7.4 with 95% limits of agreement of 22.2 and -36.9. The BIS and CSI correlation with the burst suppression ratio was -0.60 and -0.97, respectively (P < 0.01). Predicted BIS and CSI values for loss of eyelash reflex in 50% and 95% of the patients were different (P < 0.05). CONCLUSION The overall performance of both monitors during propofol induction was similar. However, the different dynamic profiles of these monitors indicate that BIS may be a more useful index for evaluating intermediate anesthetic levels, whereas CSI may be better for evaluating deeper anesthetic levels.
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Affiliation(s)
- Luis I Cortínez
- Departamento de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Hoymork SC, Hval K, Jensen EW, Raeder J. Can the cerebral state monitor replace the bispectral index in monitoring hypnotic effect during propofol/remifentanil anaesthesia? Acta Anaesthesiol Scand 2007; 51:210-6. [PMID: 17330331 DOI: 10.1111/j.1399-6576.2006.01213.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In 2004, the cerebral state monitor, CSM, was launched as a low-cost alternative to the bispectral index, BIS, for monitoring depth of sleep during anaesthesia. We tested whether the two monitors would reflect hypnosis equally during propofol/remifentanil anaesthesia. METHODS During laparoscopy or breast/surface surgery, 55 non-paralyzed patients were monitored simultaneously with the BIS and the CSM. Trend curves for the indexes [BIS and cerebral state index (CSI)] were compared for congruence. The difference between the two indexes for the entire course was quantified, and the ability of the two monitors to separate awake from asleep during induction was described. RESULTS In the majority of the patients, 87%, there was a good fit between the indexes. There were major deviations in seven patients, in whom CSI indicated that the patients were awake during parts of the course despite clinical sleep, correctly identified with the BIS. Both indexes separated awake from asleep during induction in the individual patient, but the overlap in values between patients was more pronounced for CSI. CONCLUSION CSM and BIS show some important differences in measuring hypnotic state during clinical propofol/remifentanil anaesthesia.
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Affiliation(s)
- S C Hoymork
- Department of Anaesthesia, Ullevaal University Hospital and University of Oslo, Faculty Division of Ullevaal University Hospital, Oslo, Norway.
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Abstract
Depth-of-anesthesia monitoring with EEG or EEG combined with mLAER is becoming widely used in anesthesia practice. Evidence shows that this monitoring improves outcome by reducing the incidence of intra-operative awareness while reducing the average amount of anesthesia that is administered, resulting in faster wake-up and recovery, and perhaps reduced nausea and vomiting. As with any monitoring device, there are limitations in the use of the monitors and the anesthesiologist must be able to interpret the data accordingly. The limitations include the following. The currently available monitoring algorithms do not account for all anesthetic drugs, including ketamine, nitrous oxide and halothane. EMG and other high-frequency electrical artifacts are common and interfere with EEG interpretation. Data processing time produces a lag in the computation of the depth-of-anesthesia monitoring index. Frequently the EEG effects of anesthetic drugs are not good predictors of movement in response to a surgical stimulus because the main site of action for anesthetic drugs to prevent movement is the spinal cord. The use of depth-of-anesthesia monitoring in children is not as well understood as in adults. Several monitoring devices are commercially available. The BIS monitor is the most thoroughly studied and most widely used, but the amount of information about other monitors is growing. In the future, depth-of-anesthesia monitoring will probably help in further refining and better understanding the process of administering anesthesia.
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Affiliation(s)
- T Andrew Bowdle
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Mail Stop 356540, Room AA-117C, University of Washington, Seattle, WA 98195, USA.
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