Abstract
BackgroundThe major difficulty in postoperative care in patients after craniotomy is to distinguish the intracranial deficits from the residual effect of general anesthesia. In present study, we used cerebral state index (CSI) monitoring in patients after craniotomy with delayed recovery, and evaluated the prediction probability of CSI for long-term postoperative unconsciousness.MethodsWe enrolled 57 consecutive adult patients admitted to neurosurgical intensive care unit (NICU) after elective craniotomy with delayed recovery. CSI was continuously monitored for 6 hours after admission. Patient's level of consciousness was followed up for 24 hours. According to whether obeyed verbal command, patients were divided into awaken group and non-awaken group. CSI values were compared between the two groups. Prediction probability (PK) was calculated to determine the probability of CSI in predicting unconsciousness 24 hours after operation.ResultsIn awaken group (n = 51), CSI increased significantly after the 2nd NICU admitted hour (P < 0.05). At each time point, CSI values in awaken group were significantly higher than those in non-awaken group (n = 6) (P < 0.05). The values of PK (SE) for CSI in the first 6 admitted hours ranged from 0.94 (0.06) to 0.99 (0.02).ConclusionsIn patients after craniotomy with delayed recovery, CSI monitoring in early postoperative hours had high prediction probability for long-term unconsciousness. CSI monitoring may be a reliable objective method to predict level of consciousness after elective craniotomy.
Highlights
The major difficulty in postoperative care in patients after craniotomy is to distinguish the intracranial deficits from the residual effect of general anesthesia
During the study period, 487 adult patients after elective craniotomy were admitted in our neurosurgical intensive care unit (NICU) for postoperative care
Inter-patient variability of cerebral state index (CSI) existed in each group, which was demonstrated by a significant difference in random factor of patient in non-repeated-measures of analysis of variance (P < 0.05)
Summary
The major difficulty in postoperative care in patients after craniotomy is to distinguish the intracranial deficits from the residual effect of general anesthesia. We used cerebral state index (CSI) monitoring in patients after craniotomy with delayed recovery, and evaluated the prediction probability of CSI for long-term postoperative unconsciousness. Rapid emergence from general anesthesia is desirable in the majority of neurosurgical patients, in certain cases whose systemic or brain homeostasis is impaired, delayed recovery may be a better choice [1]. One of the main issues in postoperative care in delayed recovery is to distinguish the unresponsive state that is indicative of intracranial reasons from the residual effects of general anesthesia [1]. Clinical studies of CSI monitoring in postoperative care are limited, especially for neurosurgical patients
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