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Critical care, neurology and analgesia
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Assessment of the electroencephalogram (EEG) offers the potential for continuous, non-invasive measurement of brain function. The bispectral index is derived from the EEG, using a sophisticated algorithm, that uses the advanced signal processing of bispectral and power spectral variables in a multivariate analysis to produce a bispectral index number. The bispectral index monitor uses bispectral indexing to calculate a processed multivariate parameter on a scale from 0 (no brain activity) to 100 (fully awake) and has proved useful in monitoring the depths of anesthesia and sedation in the intensive care unit. Poor skin contact, muscle activity or rigidity, head and body motion, sustained eye movements, improper sensor placement or skin preparation, and unusual or excessive interference may cause potential artefacts. Some drugs also affect the bispectral index number; for any given level of sedation, the administration of ketamine causes an increase in the bispectral index number, whilst the administration of nitrous oxide causes a decrease in the bispectral index number.
Neuropharmacology: Age-related changes
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Katleen Wyatt Chester, Olivia Johnson Morgan, Kruti Shah
Postoperative cognitive dysfunction (POCD) is defined as cognitive decline after surgery and anesthesia (33). Evidence suggests that POCD could develop from amyloid deposition and tau protein. In addition to surgery, other risk factors include age and history of stroke, while cerebral hypoperfusion, duration of anesthesia, and alterations in neurotransmitters increase risk as well. Elderly are more susceptible to POCD, which can present transiently with fluctuating symptoms or follow a more permanent and consistent pattern. Unfortunately, these changes significantly worsen recovery and increase hospital length of stay. Up to 40% of adults will experience some type of POCD postoperatively, with up to 10% of elderly patients having persistent dysfunction after 3 months (53). Preclinical data involving propofol and volatile anesthetics indicate that these agents may cause POCD; however, the evidence is controversial. Bispectral index monitoring is of interest in the elderly population during surgical procedures, as it appears to result in lower total anesthetic doses and less incidence of POCD (33,54).
Posterior fossa tumor
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Manual of Neuroanesthesia, 2017
MonitorsRoutine monitoring: heart rate (HR), electrocardiography (ECG), noninvasive blood pressure (NIBP), pulse oximetry (SpO2), end-tidal carbon dioxide (EtCO2), temperature.Specific monitoring: invasive blood pressure (IBP), central venous pressure (CVP), cranial nerve monitoring (electromyography [EMG]), brain stem auditory evoked responses (BAERs), transesophageal echocardiography (TEE)/precordial Doppler (if sitting position).Bispectral index (BIS) monitoring for depth of anesthesia (in patients in whom no neuromuscular blockers are used).
The maximum value of bispectral index predicts outcome in hypoxic-ischemic encephalopathy after resuscitation, better than minimum or mean value
Published in Brain Injury, 2018
Wenli Miao, Qing Sun, Hongdao Wang, Hailing Li
Bispectral index (BIS) is a non-invasive and real-time measurement of simplified electroencephalographic data and is applied more widely than electroencephalogram (EEG) in critical care because of its objectiveness and practicality. Since BIS has been reported effective in predicting prognostic outcome of patients with brain injury (3–5), evaluating effectiveness on chest compression during CPR (6), the possibility of its application on predicting the severity of brain injury, even the mortality among patients with HIE after CPR, was proposed (7–9), for which, however, the conclusion is not determined (10). Presumably, higher BIS values stand for better neurological outcomes (11); meanwhile, lower BIS values represent the poorer (12). However, which of the BIS values, maximum (BISmax), minimum (BISmin) or mean (BISmean), whatever solely or jointly, should be considered the most dependable in predicting the outcomes among patients with HIE is highly controversial. The study we conducted herein is to provide more clinical evidence in evaluating the practicality of value of BIS on clinical cases with HIE after CPR.
Assessment of sedation level for endoscopic retrograde cholangiopancreatography – a prospective validation study
Published in Scandinavian Journal of Gastroenterology, 2018
Jarno Jokelainen, Harri Mustonen, Leena Kylänpää, Marianne Udd, Outi Lindström, Reino Pöyhiä
Bispectral index (BiS) monitoring is an electroencephalogram (EEG) based-method which analyzes the EEG signal with an algorithm that produces a simple index score that was developed to assess the depth of general anesthesia, but has also been used to monitor the depth of sedation. BiS has been used in studies on ERCP sedation with some success [4–7]. Other methods of assessing the depth of sedation for ERCP have also been used in studies, such as the Richmond Agitation/Sedation Scale (RASS) [8], a modified Ramsay Sedation Scale (mRSS) [9] and modified Observer Assessment of Alertness and Sedation (mOAAS) [4,6]. These are all assessed by clinical evaluation and by verbal, tactile or painful stimuli. Also, these scales are designed to be used in intensive care units and may not be ideal for use during procedural sedation. This study was performed in order to evaluate the usefulness and practicality of the aforementioned methods of assessing the depth of sedation during ERCP.
Sedation in cardiac arrhythmias management
Published in Expert Review of Cardiovascular Therapy, 2018
Federico Guerra, Giulia Stronati, Alessandro Capucci
Deep sedation consists in a depression of the level of consciousness, induced by drugs, during which patients, although not easily aroused, respond purposefully to repeated or painful stimuli. During the procedure, clinical monitoring helps to ensure the adequate level of sedation in order to carry out the DCC. Studies have been performed on the use of the bispectral index (BIS) monitor: a noninvasive device which measures the depth of sedation achieved by sedatives and hypnotics [4]. While the BIS can reduce the waiting time that usually characterizes cardioversions as it makes the clinician less dependent on the anesthesiologist, Kabukcu and colleagues found that conventional clinical data were satisfactory in monitoring deep sedation and that BIS monitoring did not provide additional relevant information during DCC [5]. Commonly used clinical criteria to assess adequate sedation depth include no response to sound and pain and the loss of eyelash and glabellar reflexes.