1
|
Cheriyan T, Bai K, Bayyapureddy S, Dua A, Singh P, Sun Z, Patel C, Kumar V. Effect of bispectral index on intra-operative awareness: A meta-analysis of randomized controlled studies. Saudi J Anaesth 2024; 18:360-370. [PMID: 39149744 PMCID: PMC11323923 DOI: 10.4103/sja.sja_74_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 08/17/2024] Open
Abstract
Background Randomized controlled trials (RCTs) investigating the efficacy of bispectral index (BIS) to reduce intra-operative awareness (IOA) have reported conflicting results. The purpose of this meta-analysis is to consolidate results from RCTs to assess the efficacy of BIS in reducing IOA when compared to controls. Secondary outcomes included time to extubation, time to spontaneous and/or verbal eye opening, PACU discharge time, and utilization of inhaled anesthetics. Methods RCTs which reported on one of the primary and/or secondary outcomes were included. Literature search utilized keywords "randomized control trial" and "intraoperative awareness." Meta-analysis was performed using RevMan 5. Results Twenty-seven RCTs were included in the study with a total of 35,585 patients, with 18,146 patients in the BIS and 17,439 in the control group. Eighteen of 14,062 patients (0.12%) and 42 of 16,765 (0.25%) reported definite IOA in the BIS and control group, respectively, with no statistically significant difference. BIS was effective in reducing the time to spontaneous eye opening by an average of 1.3 minutes and the time to extubation by an average of 1.97 minutes. There was no difference in PACU discharge times among the groups. There was a significant decrease in consumption of sevoflurane but no difference in desflurane and propofol compared to the control group. Conclusion While BIS monitoring results in decreased incidence of intra-operative awareness by half, it was not statistically significant. BIS provides modest benefits with regard to reducing the time to extubation, the time to spontaneous eye opening, and consumption of sevoflurane.Level of evidence: I.
Collapse
Affiliation(s)
- Thomas Cheriyan
- Department of Anesthesiology, University of California Davis, Sacramento, California, USA
- Department of Anesthesiology, St Josephs Medical Centre at Dignity Health, Stockton, California, USA
- Department of Anesthesiology, Piedmont Medical Center, Columbus, Georgia, USA
| | - Kevin Bai
- Department of Anesthesiology, Medical College of Georgia, Atlanta, USA
| | | | - Anterpreet Dua
- Department of Anesthesiology, Medical College of Georgia, Atlanta, USA
| | - Paramvir Singh
- Department of Anesthesiology, Medical College of Georgia, Atlanta, USA
| | - Zhuo Sun
- Department of Anesthesiology, Medical College of Georgia, Atlanta, USA
| | - Chhaya Patel
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, USA
| | - Vikas Kumar
- Department of Anesthesiology, Medical College of Georgia, Atlanta, USA
| |
Collapse
|
2
|
Katerenchuk V, Calçada A, Batista AC, Cordeiro L. Unreported Source of Interference with the Bispectral Index During Liposuction: A Case Report. A A Pract 2024; 18:e01797. [PMID: 38828981 DOI: 10.1213/xaa.0000000000001797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Incorrect bispectral index (BIS) values have been reported due to interference with this monitoring system. We report a case of a 46-year-old woman who underwent liposuction and breast lipofilling, where we observed a misinterpretation by the BIS algorithm that has not yet been reported. Concurrently with abdominal and thigh liposuction, an increase in the BIS value was observed. The importance of examining electroencephalogram (EEG) and density spectral array (DSA) readings during liposuction procedures is highlighted in this case report, extending our observations beyond just the numerical BIS value, which is not always reliable.
Collapse
Affiliation(s)
- Vasyl Katerenchuk
- From the Department of Anaesthesiology, Unidade Local de Saúde da Arrábida, E.P.E., Hospital São Bernardo, Setúbal, Portugal
| | | | | | | |
Collapse
|
3
|
Xin Y, Ma L, Xie T, Liang Y, Ma M, Chu T, Liu C, Xu A. Comparative analysis of the effect of electromyogram to bispectral index and 95% spectral edge frequency under remimazolam and propofol anesthesia: a prospective, randomized, controlled clinical trial. Front Med (Lausanne) 2023; 10:1128030. [PMID: 37608826 PMCID: PMC10442164 DOI: 10.3389/fmed.2023.1128030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 07/25/2023] [Indexed: 08/24/2023] Open
Abstract
Background Bispectral index (BIS), an index used to monitor the depth of anesthesia, can be interfered with by the electromyogram (EMG) signal. The 95% spectral edge frequency (SEF95) also can reflect the sedation depth. Remimazolam in monitored anesthesia care results in higher BIS values than propofol, though in the same sedation level assessed by Modified Observers Assessment of Alertness and Sedation (MOAA/S). Our study aims to illustrate whether EMG is involved in remimazolam causing higher BIS value than propofol preliminarily and to explore the correlations among BIS, EMG, and SEF95 under propofol and remimazolam anesthesia. Patients and methods Twenty-eight patients were randomly divided into propofol (P) and remimazolam (RM) groups. Patients in the two groups received alfentanil 10 μg/kg, followed by propofol 2 mg/kg and remimazolam 0.15 mg/kg. Blood pressure (BP), heart rate (HR), and oxygen saturation (SpO2) were routinely monitored. The BIS, EMG, and SEF95 were obtained through BIS VISTATM. The primary outcomes were BIS, EMG, and the correlation between BIS and EMG in both groups. Other outcomes were SEF95, the correlation between BIS and SEF95, and the correlation between EMG and SEF95. And all the statistical and comparative analysis between these signals was conducted with SPSS 26.0 and GraphPad Prism 8. Results BIS values, EMG, and SEF95 were significantly higher in the RM group than in the P group (all p < 0.001). There was a strong positive correlation between BIS and EMG in the RM group (r = 0.416). Nevertheless, the BIS in the P group showed a weak negative correlation with EMG (r = -0.219). Both P (r = 0.787) and RM group (r = 0.559) had a reasonably significant correlation coefficient between BIS and SEF95. SEF95 almost did not correlate with EMG in the RM group (r = 0.101). Conclusion Bispectral index can be interfered with high EMG intensity under remimazolam anesthesia. However, EMG can hardly affect the accuracy of BIS under propofol anesthesia due to low EMG intensity and a weak negative correlation between EMG and BIS. Moreover, SEF95 may have a great application prospect in predicting the sedation condition of remimazolam.
Collapse
Affiliation(s)
- Yueyang Xin
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Li Ma
- School of Information Engineering, Wuhan University of Technology, Wuhan, Hubei, China
| | - Tianli Xie
- School of Information Engineering, Wuhan University of Technology, Wuhan, Hubei, China
| | - Yuhui Liang
- School of Information Engineering, Wuhan University of Technology, Wuhan, Hubei, China
| | - Miao Ma
- School of Information Engineering, Wuhan University of Technology, Wuhan, Hubei, China
| | - Tiantian Chu
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Cheng Liu
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Aijun Xu
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| |
Collapse
|
4
|
Stimulation artefact on EEG trace with BIS monitoring during D-wave recording. J Clin Monit Comput 2022; 37:929-931. [PMID: 36508115 DOI: 10.1007/s10877-022-00951-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/13/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022]
Abstract
The D-wave reflects the corticospinal fibre potentials and is frequently recorded intraoperatively for intramedullary spinal tumours to ensure maximum safe resection. A 38-year-old male had an intramedullary spinal cord tumour surgically removed while being monitored with D-wave from a single distal electrode technique. Total intravenous anaesthesia (TIVA) with propofol (without a muscle relaxant and with intermittent intravenous fentanyl boluses) was used for the maintenance of anaesthesia guided by processed electroencephalography (EEG) using a bispectral index (BIS®) monitor. Regular spike artefacts were observed in the EEG signal recorded by the BIS® monitor during the application of the single-pulse transcranial electrical stimulus and were used as a visual indicator of stimulus delivery. Finally, we propose a novel method of confirming stimulus delivery during D-wave recording based on stimulation artefacts in the EEG signal recorded by the BIS® monitor.
Collapse
|
5
|
Arora P, R Karim HM, Neema PK. Episodes of Sudden and Transient Drops of Bi-Spectral Index during the Maintenance Phase of Neuroanesthesia: A Potential Useful Hint Beyond the Sedative-Hypnotic Status. Neurol India 2022; 70:2256-2257. [PMID: 36352666 DOI: 10.4103/0028-3886.359204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Prateek Arora
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Habib M R Karim
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Praveen K Neema
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| |
Collapse
|
6
|
Evaluation of Prognosis of Coma Patients With Acute Brain Injury by Electroencephalogram Bispectral Index Monitoring. J Trauma Nurs 2021; 28:298-303. [PMID: 34491945 DOI: 10.1097/jtn.0000000000000607] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The high mortality rate of comatose patients with traumatic brain injury is a prominent public health issue that negatively impacts patients and their families. Objective, reliable tools are needed to guide treatment decisions and prioritize resources. OBJECTIVE This study aimed to evaluate the prognostic value of the bispectral index (BIS) in comatose patients with severe brain injury. METHODS This was a retrospective cohort study of 84 patients with severe brain injury and Glasgow Coma Scale (GCS) scores of 8 and less treated from January 2015 to June 2017. Sedatives were withheld at least 24 hr before BIS scoring. The BIS value, GCS scores, and Full Outline of UnResponsiveness (FOUR) were monitored hourly for 48 hr. Based on the Glasgow Outcome Scale (GOS) score, the patients were divided into poor (GOS score: 1-2) and good prognosis groups (GOS score: 3-5). The correlation between BIS and prognosis was analyzed by logistic regression, and the receiver operating characteristic curves were plotted. RESULTS The mean (SD) of the BIS value: 54.63 (11.76), p = .000; and GCS score: 5.76 (1.87), p = .000, were higher in the good prognosis group than in the poor prognosis group. Lower BIS values and GCS scores were correlated with poorer prognosis. Based on the area under the curve of receiver operating characteristic curves, the optimal diagnostic cutoff value of the BIS was 43.6, and the associated sensitivity and specificity were 85.4% and 74.4%, respectively. CONCLUSION Taken together, our study indicates that BIS had good predictive value on prognosis. These findings suggested that BIS could be used to evaluate the severity and prognosis of severe brain injury.
Collapse
|
7
|
Zeeni C, Karam CJ, Kaddoum RN, Aouad MT. Propofol use in children: updates and controversies. Minerva Anestesiol 2020; 86:433-444. [DOI: 10.23736/s0375-9393.19.14022-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
8
|
Comparison of the Effects of Target-Controlled Infusion of Propofol and Sevoflurane as Maintenance of Anesthesia on Hemodynamic Profile in Kidney Transplantation. Anesthesiol Res Pract 2019; 2019:5629371. [PMID: 31885551 PMCID: PMC6925739 DOI: 10.1155/2019/5629371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/23/2019] [Accepted: 10/03/2019] [Indexed: 11/17/2022] Open
Abstract
Background Target-controlled infusion (TCI) propofol and sevoflurane are common agents for general anesthesia, including for kidney transplantation procedure. This study compared the effect of TCI propofol and sevoflurane on intraoperative hemodynamic profile in kidney transplant patients. Methods A single-blinded prospective study was performed in 46 kidney transplant recipients who were randomized into receiving TCI propofol or sevoflurane as anesthetics maintenance. Hemodynamic parameters such as mean arterial pressure (MAP), cardiac index (CI), stroke volume index (SVI), and systemic vascular resistance index (SVRI) were measured at baseline before induction, postintubation, first surgical incision, every 15 minutes after the first incision, reperfusion, and 15 minutes after reperfusion. Data were analyzed using unpaired t-test, paired t-test, and general linear model. Results Intraoperative MAP, CI, SVI, and SVRI changes were similar in both groups (p = 0.480, 0.216, 0.086, and 0.054). In comparison to the baseline value, TCI propofol and sevoflurane groups showed significant reductions of MAP at postintubation (p=0.010; p < 0.001) and during the first surgical incision (p=0.009; p < 0.001); significant reduction of CI at postintubation (p=0.003; p < 0.001) and during the first surgical incision (p < 0.001; p < 0.001); significant reduction of SVI at postintubation (p=0.013; p=0.008), during the first surgical incision (p=0.008; p=0.003), and 15 minutes after reperfusion (p=0.010; p=0.005); and significant increasing of SVRI during the first surgical incision (p=0.007; p=0.005). The TCI propofol group showed significantly lower SVRI compared to the sevoflurane group postintubation (p=0.029) and during the first surgical incision (p=0.026). Conclusion Intraoperative hemodynamic profile was similar between the TCI propofol and sevoflurane group during kidney transplant surgery. The TCI propofol group had higher CI and SVI but showed significantly lower SVRI as compared to the sevoflurane group. The incidence of postanesthesia agitation, postoperative outcome, and complication were not significantly different between the two groups.
Collapse
|
9
|
Iwata S, Sanuki M, Ozaki M. Falsely high patient state index during cardiopulmonary bypass with intra-aortic balloon pumping: a case report. JA Clin Rep 2019; 5:80. [PMID: 32026977 PMCID: PMC6967226 DOI: 10.1186/s40981-019-0299-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/15/2019] [Indexed: 11/13/2022] Open
Abstract
Background The patient state index (PSI) is a parameter of a four-channel electroencephalography (EEG)-derived variable used to assess the depth of anesthesia. A PSI value of 25–50 indicates adequate state of hypnosis, and a value of 100 indicates a fully awake state. Due to reduced interference from electronic devices like electrocautery, falsely high intraoperative PSI values are rarely reported. However, this case report cautions about falsely high PSI during cardiopulmonary bypass (CPB) with intra-aortic balloon pumping (IABP). Case presentation A 68-year-old man was scheduled for coronary artery bypass graft surgery with IABP. General anesthesia was maintained using sevoflurane. Initial PSI was between 30 and 50 before CPB. Propofol was administered during CPB, and IABP provided pulsatile flow. IABP was stopped soon after the initiation of CPB, and the ascending aorta was partially clamped to anastomose the saphenous vein graft to the ascending aorta. The PSI value decreased drastically, but with resumption of IABP, the value increased to approximately 80, despite increasing the dose of anesthetics. Meanwhile, the EEG waveform was nearly flat. After discontinuing CPB, the PSI value returned to being extremely low. There was no evidence of intraoperative awareness or instrument trouble. After reviewing the anesthesia record, the high PSI value was almost consistent with ongoing IABP during CPB. We suspect that the oscillation noise created by IABP during CPB erroneously influences the PSI algorithm, resulting in a falsely high PSI. Conclusions Anesthesiologists should note that adherence to pEEG-derived values without discretion may cause errors when monitoring the depth of anesthesia.
Collapse
Affiliation(s)
- Shihoko Iwata
- Department of Anesthesiology, Tokyo Women's Medical University Hospital, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Michiyoshi Sanuki
- Department of Anesthesiology, Critical Care and Pain Medicine, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-cho, Kure, Hiroshima, 737-0023, Japan
| | - Makoto Ozaki
- Department of Anesthesiology, Tokyo Women's Medical University Hospital, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| |
Collapse
|
10
|
Hernaiz Alonso C, Tanner JJ, Wiggins ME, Sinha P, Parvataneni HK, Ding M, Seubert CN, Rice MJ, Garvan CW, Price CC. Proof of principle: Preoperative cognitive reserve and brain integrity predicts intra-individual variability in processed EEG (Bispectral Index Monitor) during general anesthesia. PLoS One 2019; 14:e0216209. [PMID: 31120896 PMCID: PMC6532861 DOI: 10.1371/journal.pone.0216209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 04/16/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Preoperative cognitive reserve and brain integrity may explain commonly observed intraoperative fluctuations seen on a standard anesthesia depth monitor used ubiquitously in operating rooms throughout the nation. Neurophysiological variability indicates compromised regulation and organization of neural networks. Based on theories of neuronal integrity changes that accompany aging, we assessed the relative contribution of: 1) premorbid cognitive reserve, 2) current brain integrity (gray and white matter markers of neurodegenerative disease), and 3) current cognition (specifically domains of processing speed/working memory, episodic memory, and motor function) on intraoperative neurophysiological variability as measured from a common intraoperative tool, the Bispectral Index Monitor (BIS). METHODS This sub-study included participants from a parent study of non-demented older adults electing unilateral Total Knee Arthroplasty (TKA) with the same surgeon and anesthesia protocol, who also completed a preoperative neuropsychological assessment and preoperative 3T brain magnetic resonance imaging scan. Left frontal two-channel derived EEG via the BIS was acquired preoperatively (un-medicated and awake) and continuously intraoperatively with time from tourniquet up to tourniquet down. Data analyses used correlation and regression modeling. RESULTS Fifty-four participants met inclusion criteria for the sub-study. The mean (SD) age was 69.5 (7.4) years, 54% were male, 89% were white, and the mean (SD) American Society of Anesthesiologists score was 2.76 (0.47). We confirmed that brain integrity positively and significantly associated with each of the cognitive domains of interest. EEG intra-individual variability (squared deviation from the mean BIS value between tourniquet up and down) was significantly correlated with cognitive reserve (r = -.40, p = .003), brain integrity (r = -.37, p = .007), and a domain of processing speed/working memory (termed cognitive efficiency; r = -.31, p = .021). Hierarchical regression models that sequentially included age, propofol bolus dose, cognitive reserve, brain integrity, and cognitive efficiency found that intraoperative propofol bolus dose (p = .001), premorbid cognitive reserve (p = .008), and current brain integrity (p = .004) explained a significant portion of intraoperative intra-individual variability from the BIS monitor. CONCLUSIONS Older adults with higher premorbid reserve and less brain disease were more stable intraoperatively on a depth of anesthesia monitor. Researchers need to replicate findings within larger cohorts and other surgery types.
Collapse
Affiliation(s)
- Carlos Hernaiz Alonso
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida, United States of America
| | - Jared J. Tanner
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida, United States of America
| | - Margaret E. Wiggins
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida, United States of America
| | - Preeti Sinha
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida, United States of America
| | - Hari K. Parvataneni
- Department of Orthopedic Surgery, University of Florida College of Medicine; Gainesville, Florida, United States of America
| | - Mingzhou Ding
- Department of Biomedical Engineering, University of Florida Herbert Wertheim College of Engineering, Gainesville, Florida, United States of America
| | - Christoph N. Seubert
- Department of Anesthesiology, University of Florida, Gainesville, Florida, United States of America
| | - Mark J. Rice
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Cynthia W. Garvan
- Department of Anesthesiology, University of Florida, Gainesville, Florida, United States of America
| | - Catherine C. Price
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida, United States of America
- Department of Anesthesiology, University of Florida, Gainesville, Florida, United States of America
| |
Collapse
|
11
|
Gupta DS, Kapoor I, Mahajan C, Prabhakar H. Erroneous high entropy values in a patient undergoing brachial plexus repair. J Clin Anesth 2019; 58:29-30. [PMID: 31055198 DOI: 10.1016/j.jclinane.2019.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022]
|
12
|
Makkar JK, Dwivedi D, Kuberan A, Kumar B, Bala I. Minimum Alveolar Concentration of Desflurane for Maintaining BIS Below 50 in Children and Effect of Caudal Analgesia on it. Anesth Essays Res 2018; 12:512-516. [PMID: 29962626 PMCID: PMC6020569 DOI: 10.4103/aer.aer_51_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Context: Neuraxial techniques have sedative properties secondary to decreased inputs from sensory and motor afferents. We hypothesized that caudal analgesia decreases the requirement of desflurane as measured by bispectral index (BIS). Aims: This study aims to determine the minimum alveolar concentration (MAC) of desflurane for maintaining BIS below 50 (MACBIS50) in children undergoing infraumbilical surgeries with laryngeal mask airway (LMA) and study the effect of caudal analgesia on the same. Settings and Design: This is prospective and observational study. Subjects and Methods: Thirty-nine American Society of Anesthesiologists physical status Classes I and II children in between 1 and 8 years of age undergoing elective infraumbilical surgery under general anesthesia were allocated randomly into two groups (Group C and Group D) after induction with sevoflurane and LMA insertion. In Group C, caudal block was performed with 0.75 mL/kg of 0.25% bupivacaine and BIS values were recorded after 10 min for 1 min at 10 s intervals. In Group D, BIS was recorded for desflurane for 1 min at 10 s intervals followed by a caudal block with the same dose. Statistical Analysis Used: Dixon up-down method with a step size of 0.5%, and probit analysis were used for analysis. Results: A total of 39 patients were enrolled. MAC of desflurane for maintaining MACBIS50 was 5.57 (95% confidence interval [CI] 5.22–5.95) in Group D and 4.31 (95% CI 3.12–5.08) in Group C. The use of caudal anesthesia lowered the MAC of desflurane for maintaining MACBIS50 in children by 22.36% (P < 0.001). Conclusions: The use of caudal analgesia significantly reduced MAC of desflurane for maintaining MACBIS50 in children undergoing infraumbilical surgeries using LMA.
Collapse
Affiliation(s)
- Jeetinder Kaur Makkar
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research Institute, Chandigarh, India
| | - Deepak Dwivedi
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research Institute, Chandigarh, India
| | - Aswini Kuberan
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research Institute, Chandigarh, India
| | - Balbir Kumar
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research Institute, Chandigarh, India
| | - Indu Bala
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research Institute, Chandigarh, India
| |
Collapse
|
13
|
Nguyen PT, Meeks D, Liotiri D. Anaesthesia and orphan disease: airway and anaesthetic management in Huntington's disease. BMJ Case Rep 2017; 2017:bcr-2017-221354. [PMID: 29054944 PMCID: PMC5665358 DOI: 10.1136/bcr-2017-221354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 11/04/2022] Open
Abstract
We present a case that highlights the issues surrounding the delivery of a safe general anaesthetic to a patient with Huntington's disease (HD) and bulbar dysfunction. In the case of a 46-year-old patient undergoing laparoscopic percutaneous endoscopic gastrostomy tube insertion, we discuss the rationale behind our chosen method and anaesthetic agents as well as airway issues specific to HD. In a patient whose condition would not allow for an awake fibreoptic intubation, we opted for a modified rapid sequence induction. Special considerations were made with regard to muscle relaxation given the complications associated with inadequate paralysis and reversal in patients with HD. The technique we describe may also apply to other patient categories, such as patients with movement disorders, bulbar dysfunction and dementia.
Collapse
Affiliation(s)
- Phuong Thao Nguyen
- Department of Anaesthesia, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Daveena Meeks
- Department of Anaesthesia, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Despoina Liotiri
- Department of Anaesthesia, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| |
Collapse
|
14
|
Ramírez MIG, Rodríguez-Arias LR, Santiago AO, Pizano AL, Zamora RL, Gregorio RV, Trenado C, Sánchez HMG, San-Juan D. Correlation Between Bispectral Index and Electrocorticographic Features During Epilepsy Surgery. Clin EEG Neurosci 2017; 48:272-279. [PMID: 27325591 DOI: 10.1177/1550059416654850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Surgical resection guided by intraoperative electrocorticography (iECoG) has been in clinical use for many decades. The use of the bispectral index (BIS) for monitoring depth of anesthesia during different types of surgery, including epilepsy surgery, is increasing nowadays. The BIS is an EEG-derived variable indicating cortical electrical activity. However, the correlation between the BIS score and the iECoG score, with the purpose of optimizing the quality and time of the iECoG recordings in epilepsy surgery is unknown. The goal of this study was to evaluate the correlation between BIS values and iECoG parameters during the epilepsy surgery under anesthesia with propofol and fentanyl. This is a prospective study that included patients with epilepsy who underwent epilepsy surgery guided by BIS and iECoG (September 2008 to October 2013). Clinical, physiological, and sociodemographic characteristics are shown. We correlated the iECoG parameters (presence of burst suppressions [BS], suppression time [seconds], background frequency [Hz], and type of iECoG score by Mathern et al) with BIS values. We included 28 patients, 15/28 (53.5%) female, general mean age of 30.5 years (range 13-56 years). Patients underwent epilepsy surgery: 22/28 (79%) temporal and 6/28 (21%) extratemporal. We found a nonlinear polynomial cubic relationship between the mentioned variables noting that a BIS range of 40 to 60 gave the following results: iECoG BS periods <5 seconds, background frequency 10 to 17 Hz, and iECoG score 2 characterized by lack of >20-Hz background frequencies. No BS were observed with a BIS > 60. In conclusion BIS values and iECoG parameters during the epilepsy surgery under anesthesia with propofol and fentanyl have a nonlinear correlation. BS patterns were not found with a BIS > 60. These findings show that BIS is a nonlinear multidimensional measure, which possesses high variability with the iECoG parameters. BS patterns are not found with BIS > 60.
Collapse
Affiliation(s)
| | | | - Areli O Santiago
- 1 Neuroanesthesiology Department. National Institute of Neurology, Mexico City, Mexico
| | | | | | - Rafael V Gregorio
- 3 Clinical Neurophysiology Department, National Institute of Neurology, Mexico City, Mexico
| | - Carlos Trenado
- 4 Institute of Clinical Neuroscience and Medical Psychology, University Hospital Düsseldorf, Dusseldorf, Germany
| | - Héctor Manuel G Sánchez
- 5 Faculty of Medicine of the Autonomous University of Baja California, Campus of Mexicali, Mexicali, Baja California, Mexico
| | - Daniel San-Juan
- 3 Clinical Neurophysiology Department, National Institute of Neurology, Mexico City, Mexico
| |
Collapse
|
15
|
Abstract
The anesthetic-electroconvulsive therapy (ECT) time interval (time interval elapsed from the beginning of anesthesia injection to the beginning of ECT stimulus) has been reported to have an important impact on seizure quality outcomes, because it is an indirect measure of the anesthetic plasma concentration when the ECT electrical stimulus is administered. We report the importance of the routine monitoring of this time interval in clinical settings, as an additional measure to interpret seizure quality outcomes at each ECT session, to further assist on ECT dosing decisions during the treatment course.
Collapse
|
16
|
Chen SJ, Peng CJ, Chen YC, Hwang YR, Lai YS, Fan SZ, Jen KK. Comparison of FFT and marginal spectra of EEG using empirical mode decomposition to monitor anesthesia. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 137:77-85. [PMID: 28110742 DOI: 10.1016/j.cmpb.2016.08.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 07/20/2016] [Accepted: 08/31/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Intraoperative awareness refers that patients can recall aspects of their surgery after being put under general anesthesia. This distressing complication causes affected patients to be conscious and probably feel pain, leading to emotional trauma or other sequelae. Monitoring and administrating the depth of anesthesia is necessary to prevent patients from awareness during a medical operation. In this paper, we analyzed the electroencephalograms (EEGs) of patients to characterize their anesthesia. The data set, "awareness" and "anesthesia" groups, each contained 558 samples, including patients who had undergone different types of surgeries. METHODS EEG signals acquired from patients in an aware state or under anesthesia were decomposed into a set of intrinsic mode functions (IMFs) through empirical mode decomposition (EMD). Fast Fourier transform (FFT) and Hilbert transform (HT) analyses were then performed on each IMF to determine the frequency spectra. The probability distributions of expected values of frequencies were generated for the same IMF in the two groups of patients. The corresponding statistical data, including analysis of variance tests, were also calculated. A receiver operating characteristic curve was used to identify optimal frequency value to discriminate between the two states of consciousness. RESULTS The frequencies of the IMFs for aware patients were found to be higher than those for anesthetized patients. The optimal frequency threshold by using FFT (or HT) for IMF 1 was 21.08 (or 25.00) Hz. IMF1 performed the highest with respect to the area under the curve (AUC) of 0.993 for FFT (or 0.989 for HT); hence it can be applied as a useful classifier to distinguish between fully anesthetized patients and aware patients. CONCLUSIONS This paper proposes a method for identifying whether patients' state of consciousness during a range of surgery types is "under anesthesia" or "aware." Our method involves using EEG to characterize the depth of anesthesia through two frequency analysis techniques. On the basis of our analyses, we conclude that the performance of IMF1 is satisfactory in distinguishing between patients' states of consciousness during surgery requiring general anesthesia.
Collapse
Affiliation(s)
- Shih-Jui Chen
- Department of Mechanical Engineering, National Central University, Taoyuan, Taiwan, ROC
| | - Chia-Ju Peng
- Department of Mechanical Engineering, National Central University, Taoyuan, Taiwan, ROC
| | - Yi-Chun Chen
- Department of Optics and Photonics, National Central University, Taoyuan, Taiwan, ROC
| | - Yean-Ren Hwang
- Department of Mechanical Engineering, National Central University, Taoyuan, Taiwan, ROC.
| | - Ying-Sian Lai
- Department of Mechanical Engineering, National Central University, Taoyuan, Taiwan, ROC
| | - Shou-Zen Fan
- Department of Anesthesiology, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC
| | - Kuo-Kuang Jen
- National Chung-Shan Institute of Science and Technology, Taoyuan, Taiwan, ROC
| |
Collapse
|
17
|
Choi DH, Shin TJ, Kim S, Bae J, Cho D, Ham J, Park JY, Kim HI, Jeong S, Lee B, Kim JG. Monitoring cerebral oxygenation and local field potential with a variation of isoflurane concentration in a rat model. BIOMEDICAL OPTICS EXPRESS 2016; 7:4114-4124. [PMID: 27867719 PMCID: PMC5102553 DOI: 10.1364/boe.7.004114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/25/2016] [Accepted: 09/09/2016] [Indexed: 06/06/2023]
Abstract
We aimed to investigate experimentally how anesthetic levels affect cerebral metabolism measured by near-infrared spectroscopy (NIRS) and to identify a robust marker among NIRS parameters to discriminate various stages of anesthetic depth in rats under isoflurane anesthesia. In order to record the hemodynamic changes and local field potential (LFP) in the brain, fiber-optic cannulae and custom-made microelectrodes were implanted in the frontal cortex of the skull. The NIRS and LFP signals were continuously monitored before, during and after isoflurane anesthesia. As isoflurane concentration is reduced, the level of oxyhemoglobin and total hemoglobin concentrations of the frontal cortex decreased gradually, while deoxyhemoglobin increased. The reflectance ratio between 730nm and 850nm and burst suppression ratio (BSR) correspond similarly with the change of oxyhemoglobin during the variation of isoflurane concentration. These results suggest that NIRS signals in addition to EEG may provide a possibility of developing a new anesthetic depth index.
Collapse
Affiliation(s)
- Dong-Hyuk Choi
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju 61005, South Korea; These authors contributed equally to this study
| | - Teo Jeon Shin
- Department of Pediatric Dentistry, School of Dentistry, Seoul National University, Seoul 03080, South Korea; These authors contributed equally to this study
| | - Seonghyun Kim
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju 61005, South Korea
| | - Jayyoung Bae
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju 61005, South Korea
| | - Dongrae Cho
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju 61005, South Korea
| | - Jinsil Ham
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju 61005, South Korea
| | - Ji-Young Park
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju 61005, South Korea
| | - Hyoung-Ihl Kim
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju 61005, South Korea
| | - Seongwook Jeong
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju 61469, South Korea
| | - Boreom Lee
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju 61005, South Korea;
| | - Jae Gwan Kim
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju 61005, South Korea;
| |
Collapse
|
18
|
Tasaka CL, Duby JJ, Pandya K, Wilson MD, A. Hardin K. Inadequate Sedation During Therapeutic Paralysis: Use of Bispectral Index in Critically Ill Patients. Drugs Real World Outcomes 2016; 3:201-208. [PMID: 27398299 PMCID: PMC4914538 DOI: 10.1007/s40801-016-0076-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Patients receiving therapeutic paralysis may experience inadequate sedation due to intrinsic limitations of behavioral sedation assessment. Bispectral index (BIS™) provides an objective measure of sedation; however, the role of BIS™ is not well defined in intensive care unit (ICU) patients on neuromuscular blocking agents (NMBA). Objective The aim of this study was to delineate the relationship between BIS™ and level of sedation for critically ill patients during therapeutic paralysis. Methods This was a retrospective observational study conducted in ICU patients receiving continuous infusion NMBA and BIS™ monitoring. The primary endpoint was the correlation of BIS™ <60 during therapeutic paralysis with a Richmond Agitation Sedation Score (RASS) of −4 to −5 (i.e., deep or unarousable sedation) at the time of emergence from therapeutic paralysis. Results Thirty-one patients were included in the analysis. Three of these patients (9.6 %) were inadequately sedated upon emergence from paralysis; that is, restless or agitated (RASS +1 to +2). We did not observe a correlation between BIS™ and RASS upon emergence from paralysis (r = 0.27, p = 0.14). The sensitivity of BIS™ <60 in predicting deep sedation (RASS −5 to −4) was 100 % (95 % confidence interval [CI] 0–100) with a positive predictive value of 35.7 %. The sensitivity and positive predictive value of BIS™ <60 in predicting light sedation or deeper (RASS −5 to −2) was 92.9 % (95 %CI 83.3–100) and 92.9 %, respectively. Conclusion These results suggest that 1 in 10 critically ill patients receiving therapeutic paralysis may be inadequately sedated. BIS™ monitoring may serve as a useful adjunctive measure of sedation in critically ill patients receiving therapeutic paralysis.
Collapse
Affiliation(s)
- Chelsea L. Tasaka
- Department of Pharmacy, University of California San Francisco Medical Center , 505 Parnassus Avenue, San Francisco, CA 94143 USA
- University of California, San Francisco, School of Pharmacy, San Francisco, CA USA
| | - Jeremiah J. Duby
- University of California, Davis Medical Center, Sacramento, CA USA
- University of California, San Francisco, School of Pharmacy, San Francisco, CA USA
- Touro University, College of Pharmacy, Vallejo, CA USA
| | - Komal Pandya
- University of Kentucky Medical Center, Lexington, KY USA
| | | | | |
Collapse
|
19
|
Cascella M. Mechanisms underlying brain monitoring during anesthesia: limitations, possible improvements, and perspectives. Korean J Anesthesiol 2016; 69:113-20. [PMID: 27066200 PMCID: PMC4823404 DOI: 10.4097/kjae.2016.69.2.113] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 12/13/2015] [Accepted: 12/31/2015] [Indexed: 12/18/2022] Open
Abstract
Currently, anesthesiologists use clinical parameters to directly measure the depth of anesthesia (DoA). This clinical standard of monitoring is often combined with brain monitoring for better assessment of the hypnotic component of anesthesia. Brain monitoring devices provide indices allowing for an immediate assessment of the impact of anesthetics on consciousness. However, questions remain regarding the mechanisms underpinning these indices of hypnosis. By briefly describing current knowledge of the brain's electrical activity during general anesthesia, as well as the operating principles of DoA monitors, the aim of this work is to simplify our understanding of the mathematical processes that allow for translation of complex patterns of brain electrical activity into dimensionless indices. This is a challenging task because mathematical concepts appear remote from clinical practice. Moreover, most DoA algorithms are proprietary algorithms and the difficulty of exploring the inner workings of mathematical models represents an obstacle to accurate simplification. The limitations of current DoA monitors — and the possibility for improvement — as well as perspectives on brain monitoring derived from recent research on corticocortical connectivity and communication are also discussed.
Collapse
Affiliation(s)
- Marco Cascella
- Department of Anesthesia, Endoscopy and Cardiology, National Cancer Institute 'G Pascale' Foundation, Naples, Italy
| |
Collapse
|
20
|
Sun C, Xue FS, Li RP, Liu GP. Rational Study Design is Important for Assessing Myocardial Protection of Anesthetics. Chin Med J (Engl) 2015; 128:3123-4. [PMID: 26609002 PMCID: PMC4795252 DOI: 10.4103/0366-6999.169173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Fu-Shan Xue
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | | | | |
Collapse
|
21
|
Gálvez V, Hadzi-Pavlovic D, Wark H, Harper S, Leyden J, Loo CK. The Anaesthetic-ECT Time Interval in Electroconvulsive Therapy Practice--Is It Time to Time? Brain Stimul 2015; 9:72-7. [PMID: 26452698 DOI: 10.1016/j.brs.2015.09.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/03/2015] [Accepted: 09/08/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Because most common intravenous anaesthetics used in ECT have anticonvulsant properties, their plasma-brain concentration at the time of seizure induction might affect seizure expression. The quality of ECT seizure expression has been repeatedly associated with efficacy outcomes. The time interval between the anaesthetic bolus injection and the ECT stimulus (anaesthetic-ECT time interval) will determine the anaesthetic plasma-brain concentration when the ECT stimulus is administered. OBJECTIVE The aim of this study was to examine the effect of the anaesthetic-ECT time interval on ECT seizure quality and duration. METHODS The anaesthetic-ECT time interval was recorded in 771 ECT sessions (84 patients). Right unilateral brief pulse ECT was applied. Anaesthesia given was propofol (1-2 mg/kg) and succinylcholine (0.5-1.0 mg/kg). Seizure quality indices (slow wave onset, amplitude, regularity, stereotypy and post-ictal suppression) and duration were rated through a structured rating scale by a single blinded trained rater. Linear Mixed Effects Models analysed the effect of the anaesthetic-ECT time interval on seizure quality indices, controlling for propofol dose (mg), ECT charge (mC), ECT session number, days between ECT, age (years), initial seizure threshold (mC) and concurrent medication. RESULTS Longer anaesthetic-ECT time intervals lead to significantly higher quality seizures (p < 0.001 for amplitude, regularity, stereotypy and post-ictal suppression). CONCLUSIONS These results suggest that the anaesthetic-ECT time interval is an important factor to consider in ECT practice. This time interval should be extended to as long as practically possible to facilitate the production of better quality seizures. Close collaboration between the anaesthetist and the psychiatrist is essential.
Collapse
Affiliation(s)
- Verònica Gálvez
- School of Psychiatry, University of New South Wales (UNSW), Hospital Road, Randwick, NSW 2031, Australia; Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia; The Wesley Hospital, 7 Blake St, Kogarah, NSW 2217, Australia
| | - Dusan Hadzi-Pavlovic
- School of Psychiatry, University of New South Wales (UNSW), Hospital Road, Randwick, NSW 2031, Australia; Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
| | - Harry Wark
- School of Psychiatry, University of New South Wales (UNSW), Hospital Road, Randwick, NSW 2031, Australia; The Wesley Hospital, 7 Blake St, Kogarah, NSW 2217, Australia; The Sydney Clinic, 22-24 Murray St, Bronte, NSW 2024, Australia; Children's Hospital Westmead, Hawkesbury Road & Hainsworth Street, Westmead, NSW 2145, Australia
| | - Simon Harper
- The Wesley Hospital, 7 Blake St, Kogarah, NSW 2217, Australia; Faculty of Medicine, University of New South Wales, Samuels Ave, Kensington, NSW 2052, Australia
| | - John Leyden
- The Wesley Hospital, 7 Blake St, Kogarah, NSW 2217, Australia; Department of Anaesthesia and Pain Management, Royal North Shore Hospital, Reserve Rd, St Leonards, NSW 2065, Australia
| | - Colleen K Loo
- School of Psychiatry, University of New South Wales (UNSW), Hospital Road, Randwick, NSW 2031, Australia; Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia; The Wesley Hospital, 7 Blake St, Kogarah, NSW 2217, Australia; St. George Hospital, Gray St, Kogarah, NSW 2217, Australia.
| |
Collapse
|
22
|
Deschk M, Wagatsuma JT, Araújo MA, Santos GGF, Júnior SSR, Abimussi CJX, Siqueira CE, Motta JCL, Perri SHV, Santos PSP. Continuous infusion of propofol in calves: bispectral index and hemodynamic effects. Vet Anaesth Analg 2015; 43:309-15. [PMID: 26362013 DOI: 10.1111/vaa.12302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 07/10/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the bispectral index (BIS) and the hemodynamic effects of propofol administered by continuous infusion at different rates in calves. STUDY DESIGN Experimental crossover study. ANIMALS Eight intact male Dutch calves, aged 6-12 months and weighing 84-124 kg. METHODS The calves were anesthetized with propofol (5 mg kg(-1) ) intravenously (IV), and after endotracheal intubation, positioned in right lateral recumbency and allowed to breathe ambient air. Anesthesia was maintained by continuous infusion of propofol, administered IV with an infusion pump at 0.6 mg kg(-1) minute(-1) (treatment G6) or 0.8 mg kg(-1) minute(-1) IV (treatment G8), for 60 minutes. The eight animals were anesthetized twice, 1 week apart. The following hemodynamic variables and BIS were assessed before the induction of anesthesia (baseline) and 15, 30, 45, and 60 minutes after beginning the infusion of propofol: heart rate, systolic, diastolic and mean arterial pressures, cardiac output, mean pulmonary artery pressure, cardiac index, stroke index, pulmonary vascular resistance index, and systemic vascular resistance index, BIS, electromyography, and signal quality index. RESULTS The continuous infusions of propofol at different rates did not alter BIS variables during the infusion time between dose rates, and no clinically significant hemodynamic changes were observed. CONCLUSIONS AND CLINICAL RELEVANCE A continuous infusion of propofol at 0.6 or 0.8 mg kg(-1) minute(-1) caused minimal hemodynamic changes without clinical relevance in calves. BIS could not be reliably used to discriminate the anesthetic depth during the two propofol infusion rates.
Collapse
Affiliation(s)
- Mauricio Deschk
- Department of Clinical, Surgery and Animal Reproduction, Faculty of Veterinary Medicine, UNESP, São Paulo State University, Araçatuba, SP, Brazil
| | - Juliana T Wagatsuma
- Department of Clinical, Surgery and Animal Reproduction, Faculty of Veterinary Medicine, UNESP, São Paulo State University, Araçatuba, SP, Brazil
| | - Marcelo A Araújo
- Department of Clinical, Surgery and Animal Reproduction, Faculty of Veterinary Medicine, UNESP, São Paulo State University, Araçatuba, SP, Brazil
| | - Guilherme G F Santos
- Department of Clinical, Surgery and Animal Reproduction, Faculty of Veterinary Medicine, UNESP, São Paulo State University, Araçatuba, SP, Brazil
| | - Sergio S R Júnior
- Department of Clinical, Surgery and Animal Reproduction, Faculty of Veterinary Medicine, UNESP, São Paulo State University, Araçatuba, SP, Brazil
| | - Caio J X Abimussi
- Department of Clinical, Surgery and Animal Reproduction, Faculty of Veterinary Medicine, UNESP, São Paulo State University, Araçatuba, SP, Brazil
| | - Carlos E Siqueira
- Department of Clinical, Surgery and Animal Reproduction, Faculty of Veterinary Medicine, UNESP, São Paulo State University, Araçatuba, SP, Brazil
| | - Jéssica C L Motta
- Department of Clinical, Surgery and Animal Reproduction, Faculty of Veterinary Medicine, UNESP, São Paulo State University, Araçatuba, SP, Brazil
| | - Silvia H V Perri
- Department Support, Animal Production and Health (DAPSA), Faculty of Veterinary Medicine, UNESP, São Paulo State University, Araçatuba, SP, Brazil
| | - Paulo S P Santos
- Department of Clinical, Surgery and Animal Reproduction, Faculty of Veterinary Medicine, UNESP, São Paulo State University, Araçatuba, SP, Brazil
| |
Collapse
|
23
|
Prottengeier J, Moritz A, Heinrich S, Gall C, Schmidt J. Sedation assessment in a mobile intensive care unit: a prospective pilot-study on the relation of clinical sedation scales and the bispectral index. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:615. [PMID: 25418521 PMCID: PMC4256754 DOI: 10.1186/s13054-014-0615-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 10/22/2014] [Indexed: 11/30/2022]
Abstract
Introduction The critically-ill undergoing inter-hospital transfers commonly receive sedatives in continuation of their therapeutic regime or to facilitate a safe transfer shielded from external stressors. While sedation assessment is well established in critical care in general, there is only little data available relating to the special conditions during patient transport and their effect on patient sedation levels. The aim of this prospective study was to investigate the feasibility and relationship of clinical sedation assessment (Richmond Agitation-Sedation Scale (RASS)) and objective physiological monitoring (bispectral index (BIS)) during patient transfers in our Mobile-ICU. Methods The levels of sedation of 30 pharmacologically sedated patients were evaluated at 12 to 17 distinct measurement points spread strategically over the course of a transfer by use of the RASS and BIS. To investigate the relation between the RASS and the BIS, Spearman’s squared rank correlation coefficient (ρ2) and the Kendall’s rank correlation coefficient (τ) were calculated. The diagnostic value of the BIS with respect to the RASS was investigated by its sensitivity and positive predictive value for possible patient awakening. Therefore, measurements were dichotomized considering a clinically sensible threshold of 80 for BIS-values and classifying RASS values being nonnegative. Results Spearman’s rank correlation resulted to ρ2 = 0.431 (confidence interval (CI) = 0.341 to 0.513). The Kendall’s correlation coefficient was calculated as τ = 0.522 (CI = 0.459 to 0.576). Awakening of patients (RASS ≥0) was detected by a BIS value of 80 and above with a sensitivity of 0.97 (CI = 0.89 to 1.00) and a positive predictive value of 0.59 (CI = 0.45 to 0.71). Conclusions Our study demonstrates that the BIS-Monitor can be used for the assessment of sedation levels in the intricate environment of a Mobile-ICU, especially when well-established clinical scores as the RASS are impracticable. The use of BIS is highly sensitive in the detection of unwanted awakening of patients during transfers. Electronic supplementary material The online version of this article (doi:10.1186/s13054-014-0615-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Johannes Prottengeier
- Department of Anaesthesiology, Erlangen University Hospital, Krankenhausstrasse 12, 91054, Erlangen, Germany.
| | - Andreas Moritz
- Department of Anaesthesiology, Erlangen University Hospital, Krankenhausstrasse 12, 91054, Erlangen, Germany.
| | - Sebastian Heinrich
- Department of Anaesthesiology, Erlangen University Hospital, Krankenhausstrasse 12, 91054, Erlangen, Germany.
| | - Christine Gall
- Department of Medical Informatics, Biometry and Epidemiology, Waldstrasse 6, 91054, Erlangen, Germany.
| | - Joachim Schmidt
- Department of Anaesthesiology, Erlangen University Hospital, Krankenhausstrasse 12, 91054, Erlangen, Germany.
| |
Collapse
|
24
|
|
25
|
Escallier KE, Nadelson MR, Zhou D, Avidan MS. Monitoring the brain: processed electroencephalogram and peri‐operative outcomes. Anaesthesia 2014; 69:899-910. [DOI: 10.1111/anae.12711] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2014] [Indexed: 11/29/2022]
Affiliation(s)
- K. E. Escallier
- Washington University School of Medicine Saint Louis Missouri USA
| | - M. R. Nadelson
- Washington University School of Medicine Saint Louis Missouri USA
| | - D. Zhou
- Washington University School of Medicine Saint Louis Missouri USA
| | - M. S. Avidan
- Washington University School of Medicine Saint Louis Missouri USA
| |
Collapse
|
26
|
Nadelson MR, Willingham MD, Avidan MS. Bispectral Index Monitoring and Perioperative Outcomes. Anesth Analg 2013. [DOI: 10.1213/ane.0b013e31829c3e0f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
27
|
[Usefulness of Bispectral Index (BIS) monitoring for early detection of cerebral hypoperfusions]. ACTA ACUST UNITED AC 2013; 32:653-8. [PMID: 23953319 DOI: 10.1016/j.annfar.2013.07.802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 07/03/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The goal of the study was to assess whether clinically significant cerebral hypoperfusion in awake patients would be associated with some alterations in the values of the bispectral index (BIS) monitoring. STUDY DESIGN Observational study. POPULATION AND METHODS We monitored the BIS during endovascular carotid artery occlusion testing in awake patients. RESULTS Twenty-eight patients were included. Twenty-one adequately tolerated the procedure. Their BIS value remained stable throughout the procedure. Four patients had poor angiographic tolerance, but no clinical symptoms. Their BIS value slightly decreased during the test (minimal BIS: 83 [79-87]). Three patients had poor clinical and angiographic tolerance of the occlusion. They all experienced an immediate and dramatic decrease in their BIS value (minimal BIS: ipsilateral to clamping: 50 [45-60]; contralateral to clamping: 48 [45-52]). In all patients, the clinical symptoms and the BIS normalized after deflating the occlusion balloon. CONCLUSION In awake patients, the observed values of the BIS monitoring seem to be associated with clinically relevant cerebral hypoperfusion.
Collapse
|
28
|
Kim JH, Kim AN, Kim KW, Lee SI, Kim JY, Kim KT, Park JS, Kim JW, Choe WJ. Interruption of bispectral index monitoring by nerve integrity monitoring during tympanoplasty -A case report-. Korean J Anesthesiol 2013; 64:161-3. [PMID: 23459709 PMCID: PMC3581786 DOI: 10.4097/kjae.2013.64.2.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 03/07/2012] [Accepted: 04/19/2012] [Indexed: 11/30/2022] Open
Abstract
We report that intraoperative NIM-2 monitoring devices can interfere with bispectral index monitoring. A 45-year-old male with chronic otits media underwent tympanolasty under general anesthesia with NIM-2 monitoring and bispectral index monitoring at our institution. And then, bispectral index monitoring was severely interrupted by facial nerve monitoring.
Collapse
Affiliation(s)
- Jun Hyun Kim
- Department of Anesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Kertai MD, Whitlock EL, Avidan MS. Brain monitoring with electroencephalography and the electroencephalogram-derived bispectral index during cardiac surgery. Anesth Analg 2012; 114:533-46. [PMID: 22253267 DOI: 10.1213/ane.0b013e31823ee030] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cardiac surgery presents particular challenges for the anesthesiologist. In addition to standard and advanced monitors typically used during cardiac surgery, anesthesiologists may consider monitoring the brain with raw or processed electroencephalography (EEG). There is strong evidence that a protocol incorporating the processed EEG bispectral index (BIS) decreases the incidence intraoperative awareness in comparison with standard practice. However, there is conflicting evidence that incorporating the BIS into cardiac anesthesia practice improves "fast-tracking," decreases anesthetic drug use, or detects cerebral ischemia. Recent research, including many cardiac surgical patients, shows that a protocol based on BIS monitoring is not superior to a protocol based on end-tidal anesthetic concentration monitoring in preventing awareness. There has been a resurgence of interest in the anesthesia literature in limited montage EEG monitoring, including nonproprietary processed indices. This has been accompanied by research showing that with structured training, anesthesiologists can glean useful information from the raw EEG trace. In this review, we discuss both the hypothesized benefits and limitations of BIS and frontal channel EEG monitoring in the cardiac surgical population.
Collapse
Affiliation(s)
- Miklos D Kertai
- Duke University Medical Center, 2301 Erwin Road, 5693 HAFS Bldg., DUMC 3094 Durham, NC 27710, USA.
| | | | | |
Collapse
|