Cerebral State Index Research Articles

Hypnosis measured with monitors of anesthetic depth - EEG changes during the test for Harvard Group Scale of Hypnotic Susceptibility.

Hypnotic trance can be defined as a non-ordinary state of consciousness that is accompanied by a number of neurophysiological changes, including brain electrophysiology. In addition to subjective measures, corresponding objective parameters are needed in experimental and clinical hypnosis research but are complex, impractical, or unspecific. A similar challenge exists for the measurement and monitoring of drug-induced hypnosis, namely general anesthesia. The observation of changes in EEG induced by narcotics has led to the development of monitors for the depth of anesthesia based on EEG parameters. We investigated whether two such monitors react to the induction and maintenance of hypnosis during a highly standardized procedure. A total of 56 volunteers were monitored for the bispectral index (BIS) and cerebral state index (CSI) (range 0-100, >95 considered "awake") during the Harvard Group Scale of Hypnotic Susceptibility test. For this test, trance is induced by a taped text and followed by 12 tasks performed under hypnosis. In contrast to random forms of hypnosis, this represents a standardized, worldwide-established condition. According to the resulting score, participants were classified into suggestibility groups in order to evaluate whether the electrophysiological measurements of BIS and CIS indices differ between high and low suggestible persons. Furthermore, participants were asked to rate their hypnotic depth (HD, 1-10) at every task of the test. Scores dropped significantly from a mean of 97.7 to 86.4 for BIS and from 94.6 to 77.7 for CSI with the induction of hypnosis to stay throughout hypnosis at levels of approximately 88.6 or 82.9, respectively. Results did not differ between high- and low-suggestible participants. The means of the subjective score of hypnotic depth and of the electrophysiological measurements showed a similar course. However, no correlation was found between BIS or CSI values and scores of hypnotic depths. Monitors for depth of anesthesia respond to changes in consciousness, including trance states of hypnosis. However, specificity is unclear. Practically, in hypnosis research with the exclusion of drug effects or sleep, these monitors might be helpful to test and compare the efficacy of induction texts and to detect disturbances of trance state.

Athletes’ State Monitoring under Data Mining and Random Forest

The study aims to train athletes to be in top form and at their best in the competition. Based on the relevant theoretical research, archers are taken as the research subjects, the characteristics of archery are analyzed, and the electroencephalogram (EEG) features of the athletes in different stages of precompetition training are monitored. And the athletes’ competitive state monitoring model based on random forest (RF) is implemented and tested. The experimental results show that the athletes’ dominant frequency of brain band α, EEG entropy, central fatigue index, excitation inhibition index, and cerebral state index in precompetition training is significantly different from those in training ( P < 0.05 ).The monitoring model implemented classifies athletes’ competitive states. Compared with the support vector machine (SVM) classification model, its classification accuracy is higher than 90%. The overall classification accuracy is 89.74%, more significant than SVM. The research provides a reference for monitoring athletes’ competitive states and helps them regulate their states in real time.

Evaluation of Anesthetic Specific EEG Dynamics during State Transitions between Loss and Return of Responsiveness.

Purpose: electroencephalographic (EEG) information is used to monitor the level of cortical depression of a patient undergoing surgical intervention under general anesthesia. The dynamic state transitions into and out of anesthetic-induced loss and return of responsiveness (LOR, ROR) present a possibility to evaluate the dynamics of the EEG induced by different substances. We evaluated changes in the EEG power spectrum during anesthesia emergence for three different anesthetic regimens. We also assessed the possible impact of these changes on processed EEG parameters such as the permutation entropy (PeEn) and the cerebral state index (CSI). Methods: we analyzed the EEG from 45 patients, equally assigned to three groups. All patients were induced with propofol and the groups differed by the maintenance anesthetic regimen, i.e., sevoflurane, isoflurane, or propofol. We evaluated the EEG and parameter dynamics during LOR and ROR. For the emergence period, we focused on possible differences in the EEG dynamics in the different groups. Results: depending on the substance, the EEG emergence patterns showed significant differences that led to a substance-specific early activation of higher frequencies as indicated by the “wake” CSI values that occurred minutes before ROR in the inhalational anesthetic groups. Conclusion: our results highlight substance-specific differences in the emergence from anesthesia that can influence the EEG-based monitoring that probably have to be considered in order to improve neuromonitoring during general anesthesia.

A comparison of sustainable recording between cerebral state index (CSI) and bispectral index (BIS) monitors during total intravenous anaesthesia using target-controlled infusion technique for elective supratentorial craniotomy

A comparison of sustainable recording between cerebral state index (CSI) and bispectral index (BIS) monitors during total intravenous anaesthesia using target-controlled infusion technique for elective supratentorial craniotomy

Magnesium Sulfate and Clonidine; Effects on Hemodynamic Factors and Depth of General Anesthesia in Cesarean Section.

BackgroundMaking stable hemodynamic and also durable unawareness is a daily challenge in the setting of general anesthesia in women who undergo surgical delivery of neonate and have limitations to receive opioids derivatives.ObjectivesWe aimed to evaluate the effects of magnesium sulfate and clonidine on hemodynamic changes and depth of anesthesia and in mentioned mothers and also in neonatal APGAR index.MethodsCurrent randomized, double-blind controlled trial study was conducted among a total of 360 pregnant females (38 - 41 weeks of gestation) who underwent elective cesarean section. Participants were randomly divided into three drug-receiving groups (equal 120 members): magnesium sulfate (30 mg/kg), clonidine (3 µg/kg), and placebo (0.9% NaCl). Patients’ blood pressure, heart rate, cerebral state index (CSI) in specific time zones, and also late 24-hour recall were recorded. The CSI is an electroencephalographic monitoring method helping to assess the depth of anesthesia. Neonatal parameters, including APGAR score and umbilical venous blood sampling, were measured.ResultsMean patients’ age was 28 ± 4.5. A significant decreasing and stabilizing effect of magnesium sulfate and clonidine on hemodynamic parameters (blood pressure and heart rate) was revealed (P < 0.001). Evidence implied on deeper anesthesia (lower CSI) among drug receivers comparing to placebo (P < 0.001). None of the participants experienced a late 24-hour recall postoperatively. All neonates were healthy, and no decrease was reported in APGAR score at minutes 1 and 5. Umbilical blood gas analysis showed no signs of acidosis and/or hypoxemia.ConclusionsAdjuvant administration of either magnesium sulfate or clonidine is associated with hemodynamic stability and favorable unawareness in the setting of elective surgical delivery.

Depth of sedation during drug induced sedation endoscopy monitored by BiSpectral Index® and Cerebral State Index®.

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. Sixty patients underwent DISE monitored by the BIS and CSI in parallel. The BIS and CSI values were compared using the Bland-Altman analysis. 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. 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.

The intra-neuroendoscopic technique (INET): a modified minimally invasive technique for evacuation of brain parenchyma hematomas

BackgroundMinimally invasive endoscopic hematoma evacuation is widely used in the treatment of intracerebral hemorrhage. However, this technique still has room for improvement. The intra-neuroendoscopic technique (INET) is a modified minimally invasive technique, and we report its safety and efficacy in evacuating brain parenchyma hematomas by comparing it with cranial puncture and drainage operation (CPDO).MethodsThe frontal, temporal, or occipital approaches were used according to the site of bleeding. The preoperative and postoperative hematoma volumes, Glasgow Coma Scale (GCS) score, Cerebral State Index (CSI), hematoma evacuation rate, operation time, complications, and 30-day mortality and Glasgow Outcome Scale (GOS) were retrospectively compared between the two groups.ResultsA total of 98 patients were enrolled. The evacuation rate (84 ± 7.1% versus 51.0 ± 8.4%, p = 0.00), 7-day GCS (11.8 ± 1.2 versus 10.4 ± 1.5, p = 0.01), and CSI (87.1 ± 8.7 versus 80.6 ± 10.2, p = 0.02) were higher, and the 30-day mortality rate (1.9% versus 15.6%, p = 0.036) was lower in the INET group. However, the operation time was longer in the INET group than in the control group (65.2 ± 12.5 min versus 45.6 ± 10.9 min, p = 0.000). Multivariable logistic regression showed that a good medium-term outcome (GOS scores 4–5) was significantly associated with INET (odds ratio (OR) 3.514, 95% confidence interval (CI) 1.463–8.440, p = 0.005), age under 65 years (OR 1.402, 95% CI, 1.041–1.888, p = 0.026), and hematoma volume less than 50 ml (OR 1.974, 95% CI 1.302–2.993, p = 0.001).ConclusionsINET surgery for brain parenchyma hematoma evacuation is a safe and efficient modified technique. This technique is minimally invasive, has less complications, and may be helpful in providing optimal outcomes for selected patients.Trial registrationClinicalTrials.gov, NCT02515903. Registered on 5 August 2015.

Processed electroencephalogram and evoked potential techniques for amelioration of postoperative delirium and cognitive dysfunction following non-cardiac and non-neurosurgical procedures in adults.

Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) may complicate a patient's postoperative recovery in several ways. Monitoring of processed electroencephalogram (EEG) or evoked potential (EP) indices may prevent or minimize POD and POCD, probably through optimization of anaesthetic doses. To assess whether the use of processed EEG or auditory evoked potential (AEP) indices (bispectral index (BIS), narcotrend index, cerebral state index, state entropy and response entropy, patient state index, index of consciousness, A-line autoregressive index, and auditory evoked potentials (AEP index)) as guides to anaesthetic delivery can reduce the risk of POD and POCD in non-cardiac surgical or non-neurosurgical adult patients undergoing general anaesthesia compared with standard practice where only clinical signs are used. We searched CENTRAL, MEDLINE, Embase and clinical trial registry databases up to 28 March 2017. We updated this search in February 2018, but these results have not been incorporated in the review. We included randomized or quasi-randomized controlled trials comparing any method of processed EEG or evoked potential techniques (entropy, BIS, AEP etc.) against a control group where clinical signs were used to guide doses of anaesthetics in adults aged 18 years or over undergoing general anaesthesia for non-cardiac or non-neurosurgical elective operations. We used the standard methodological procedures expected by Cochrane. Our primary outcomes were: occurrence of POD; and occurrence of POCD. Secondary outcomes included: all-cause mortality; any postoperative complications; and postoperative length of stay. We used GRADE to assess the quality of evidence for each outcome. We included six randomized controlled trials (RCTs) with 2929 participants comparing processed EEG or EP indices-guided anaesthesia with clinical signs-guided anaesthesia. There are five ongoing studies and one study awaiting classification.Anaesthesia administration guided by the indices from a processed EEG (bispectral index) probably reduces the risk of POD within seven days after surgery with risk ratio (RR) of 0.71 (95% CI 0.59 to 0.85; number needed to treat for an additional beneficial outcome (NNTB) of 17, 95% CI 11 to 34; 2197 participants; 3 RCTs; moderate quality of evidence). Three trials also showed the lower rate of POCD at 12 weeks after surgery (RR 0.71, 95% CI 0.53 to 0.96; NNTB 38, 95% CI 21 to 289; 2051 participants; moderate-quality evidence), but it is uncertain whether processed EEG indices reduce POCD at one week (RR 0.84, 95% CI 0.69 to 1.02; 3 trials; 1989 participants; moderate-quality evidence), and at 52 weeks (RR 0.30, 95% CI 0.05 to 1.80; 1 trial; 59 participants; very low quality of evidence). There may be little or no effect on all-cause mortality (RR 1.01, 95% CI 0.62 to 1.64; 1 trial; 1155 participants; low-quality evidence). One trial suggested a lower risk of any postoperative complications with processed EEG (RR 0.51, 95% CI 0.37 to 0.71; 902 participants, moderate-quality evidence). There may be little or no effect on reduced postoperative length of stay (mean difference -0.2 days, 95% CI -2.02 to 1.62; 1155 participants; low-quality evidence). There is moderate-quality evidence that optimized anaesthesia guided by processed EEG indices could reduce the risk of postoperative delirium in patients aged 60 years or over undergoing non-cardiac surgical and non-neurosurgical procedures. We found moderate-quality evidence that postoperative cognitive dysfunction at three months could be reduced in these patients. The effect on POCD at one week and over one year after surgery is uncertain. There are no data available for patients under 60 years. Further blinded randomized controlled trials are needed to elucidate strategies for the amelioration of postoperative delirium and postoperative cognitive dysfunction, and their consequences such as dementia (including Alzheimer's disease (AD)) in both non-elderly (below 60 years) and elderly (60 years or over) adult patients. The one study awaiting classification and five ongoing studies may alter the conclusions of the review once assessed.

A comparison between nicardipine and urapidil used for management of intracerebral hemorrhage

Objective To compare the efficacy and safety of nicardipine versus urapidil in blood pressure (BP) management during the acute phase of intracerebral hemorrhage (ICH). Methods ICH patients admitted in Emergency Intensive Care Unit of Shenzhen People’s Hospital from March, 2013 through March, 2016 were retrospectively studied. Patients were enrolled as nicardipine group or urapidil group depending on the initial antihypertensive drug given at admission. The differences in rate of patients reached the goal BP within the first 24 h, time required for getting goal BP, blood pressure variability (BPV), rebleeding or hematoma expansion during the first 24 h, cerebral state index (CSI) within 7 days and 28-day mortality were compared between the two groups. The differences in adverse events including bradycardia, tachycardia and hypotension were also compared between two groups. An independent t test and χ2 test were performed to compare different variables. An analysis of variance of repeated measurement was performed to compare CSI within 7 days between two groups. Results Seventy-seven patients were included with 42 in nicardipine group and 55 in urapidil group. Rate of patients getting goal BP in nicardipine group was (94±5)% and (86±11)% in urapidil group (P 0.05). Through analysis of variance of repeated measurement, CSI in nicardipine group improves more rapidly than that in urapidil group (F=1 581.115, P=0.000). Hypotension, bradycardia and tachycardia were also comparable between groups (P>0.05). Conclusion Compared with urapidil, nicardipine produces effect more rapidly with more stable BP and higher rate of patients with ICH getting goal BP. Moreover, the application of nicardipine may be better to improve the CSI of ICH patients. Key words: Urapidil; Nicardipine; Blood pressure; Verebral hemorrhage; Acute phase; Cerebral state index

Effect of sevoflurane-based anesthesia on interventricular synchronization in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass

Objective To evaluate the effect of sevoflurane-based anesthesia on the interventricular synchronization in the patients undergoing coronary artery bypass grafting(CABG)with cardiopulmonary bypass(CPB). Methods Twenty-four American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 52-75 yr, with body mass index of 17-31 kg/m2, with body surface area of 1.7-2.2 m2 , of New York Heart Association Ⅱ or Ⅲ, with left ventricular ejection fraction(LVEF)≥45%, scheduled for elective CABG with CPB, were divided into 2 groups(n=12 each)using a random number table: propofol combined with remifentanil anesthesia group(group C)and sevoflurane combined with propofol and remifentanil anesthesia group(group S). After induction of general anesthesia, the patients were endotracheally intubated and mechanically ventilated.Anesthesia was maintained by IV infusion of propofol, remifentanil and cisatracurium, and the cerebral state index value was maintained at 40-60.In group S, the patients inhaled sevoflurane(the end-tidal concentration was 1.80% for 50-59 yr and 1.60% for 60-75 yr)for 60 min starting from 15 min after termination of CPB.After induction of anesthesia and before splitting of sternum, immediately before inhaling sevoflurane and at 30 and 60 min of sevoflurane inhalation, heart rate, cardiac index, LVEF, right ventricular eject fraction, QRS width and interventricular mechanical delay were recorded, and the occurrence of interventricular dyssynchrony was recorded. Results There were no significant differences between group C and group S in the heart rate, cardiac index, LVEF, right ventricular eject fraction, QRS width, interventricular mechanical delay or incidence of interventricular dyssynchrony(P>0.05). Conclusion Sevoflurane-based anesthesia exerts no marked effect on interventricular synchronization in the patients undergoing CABG with CPB. Key words: Anesthetics, inhalation; Coronary artery bypass; Cardiac pacing, artificial; Heart ventricles

The efficacy of local dexmedetomidine during fiberoptic nasotracheal intubation: A randomized clinical trial.

Background and Aims:The present study was designed and carried out aiming to evaluate the effects of local dexmedetomidine (Dex) on sedation rate and hemodynamic changes in candidate patients for fiberoptic nasotracheal intubation.Material and Methods:Candidate patients for fiberoptic nasotracheal intubation were randomly divided into three groups including intravenous (IV) Dex group, local Dex group, and control group. Local anesthesia using lidocaine was performed in all patients. After performing the intubation, propofol infusion was used to keep the patients on predetermined cerebral state index (CSI). Hemodynamic parameters, arterial blood O2 saturation (SpO2), and CSI were monitored in all patients before, during, and after the procedure. Coughing score, intubation score, and patient tolerance score during and after nasotracheal intubation were assessed. Propofol consumption was also measured.Results:A total of 95 patients with the mean age of 45.4 ± 6.7 years were evaluated (54.2% of females). Hemodynamic parameters and SpO2 were significantly different between the three groups (P < 0.001). The dose of propofol used for reaching proper CSI was significantly higher in the control group compared to IV and local Dex groups (P < 0.001). There is no significant statistical difference in propofol consumption between local and IV Dex groups. The number of patients who were cooperative during intubation was higher in local Dex group compared to IV Dex and control groups; however, the difference was not statistically significant.Conclusion:It is likely that using local Dex during fiberoptic bronchoscopy decreases sudden changes in hemodynamic values and decreases coughing and improves patient tolerance and intubation scores. Local Dex can be useful as IV form with the aim of propofol dose saving.

Comparison of propofol-hydromorphone and propofol-dexmedetomidine in patients with intubation after maxillofacial plastic surgery.

ObjectiveTo compare the sedation and analgesic effects between propofol–hydromorphone and propofol–dexmedetomidine in patients with postoperative intubation after maxillofacial plastic surgery.MethodsForty-two patients undertaking maxillofacial plastic surgery with intubation were randomly assigned into propofol plus hydromorphone (P–H) group or propofol plus dexmedetomidine (P–D) group, receiving intravenous infusion of P–H or P–D, respectively. Cerebral state index, Ramsay sedation score, arterial blood gas analysis, and physiology indices were recorded before admission (T0), 30 minutes (T1), 1 hour (T2), 2 hours (T3), 6 hours (T4), and 12 hours after admission (T5) to intensive care unit, and 10 minutes after extubation (T6). Blood interleukin-6 was measured with enzyme-linked immunosorbent assay.ResultsThere was no significant difference in arterial blood gas analysis, oxygen saturation, mean arterial pressure, and respiratory rate between two groups at all time-points (P>0.05). The changes of heart rate (at T4, T5, and T6), cerebral state index (T1, T2, T3, T4, and T5), and Ramsay score (at T3) in P–H group were significantly different from that in P–D group (P<0.05). The plasma interleukin-6 at T4 in P–H group was significantly lower than that in P–D group (P<0.05).ConclusionThe P–H approach takes advantages over P–D approach in relieving the pain and discomfort, reducing the overstimulation of sympathetic nerve and the stress level, and enhancing the tolerance of postoperative intubation after maxillofacial plastic surgery.

Cerebral state index versus Glasgow coma scale as a predictor for in-hospital mortality in brain-injured patients

ObjectiveTo compare the value of Glasgow coma scale (GCS) and cerebral state index (CSI) on predicting hospital discharge status of acute brain-injured patients. MethodsIn 60 brain-injured patients who did not receive sedatives, GCS and CSI were measured daily during the first 10days of hospitalization. The outcome of prognostic cut-off points was calculated by GCS and CSI using receiver operating characteristic (ROC) curve regarding the time of admission and third day of hospitalization. Sensitivity, specificity and other predictive values for both indices were calculated. ResultsOf the 60 assessed patients, 14 patients had mild, 13 patients had moderate and 33 patients had severe injuries. During the course of the study, 17 patients (28.3%) deteriorated in their situation and died. The mean GCS and CSI in patients who deceased during hospitalization was significantly lower than those who were discharged from the hospital. GCS<4.5 and CSI<64.5 at the time of admission was associated with higher mortality risk in traumatic brain injury patients and GCS was more sensitive than CSI to predict in-hospital death in these patients. For the first day of hospitalization, the area under ROC curve was 0.947 for GCS and 0.732 for CSI. ConclusionGCS score at ICU admission is a good predictor of in-hospital mortality. GCS<4.5 and CSI<64.5 at the time of admission is associated with higher mortality risk in traumatic brain injury patients and GCS is more sensitive than CSI in predicting death in these patients.

El efecto de flumazenil sobre la recuperación de anestesia general con isoflurano: una prueba aleatorizada controlada

Background and objectivesThe inhalational anesthetic isoflurane is widely used in general anesthetics. Its mechanism of action involves interaction with the receptor of gamma-amino butyric acid, which is also the binding site for benzodiazepines. Flumazenil, benzodiazepine antagonist, reverses the effects of these drugs in gamma-amino butyric acid receptors and could therefore also reverse the effect of isoflurane. In anesthesia practice, extubation and early anesthetic recovery reduce morbidity and incidence of complications. The objective of this trial is to determine whether the use of flumazenil may contribute to faster recovery from anesthesia. MethodsForty patients scheduled to undergo general anesthesia with isoflurane were enrolled in this prospective, double-blind, randomized trial. Patients were randomized to receive, at the end of anesthesia, flumazenil or placebo as allocated into 2 groups. The anesthetic technique was standardized. The groups were compared concerning values of Cerebral State Index, heart rate, blood pressure and oxygen saturation from the application of flumazenil or placebo until 30min after injection. Data regarding time to extubation, time to reach 10 points in the Aldrete-Kroulik score and Vigilance score was also collected. ANOVA test was applied to analyze the results, considering P<.05. ResultsPatients receiving flumazenil achieved faster extubation than the control (P=.033). No differences were observed in values of Cerebral State Index, the time until Aldrete-Kroulik=10 and until Vigilance score=10. ConclusionsAdministration of flumazenil at the end of isoflurane general anesthesia resulted in earlier extubation in studied patients.

Effect of flumazenil on recovery from general anesthesia with isoflurane: A randomized controlled trial

Background and objectivesThe inhalational anesthetic isoflurane is widely used in general anesthetics. Its mechanism of action involves interaction with the receptor of gamma-aminobutyric acid (GABA), which is also the binding site for benzodiazepines. Flumazenil, benzodiazepine antagonist, reverses the effects of these drugs in GABA receptors and could therefore also reverse the effect of isoflurane. In anesthesia practice, extubation and early anesthetic recovery reduce morbidity and incidence of complications. The objective of this trial is to determine whether the use of flumazenil may contribute to faster recovery from anesthesia. MethodsForty patients scheduled to undergo general anesthesia with isoflurane were enrolled in this prospective, double-blind, randomized trial. Patients were randomized to receive, at the end of anesthesia, flumazenil or placebo as allocated into two groups. The anesthetic technique was standardized. The groups were compared concerning values of cerebral state index (CSI), heart rate, blood pressure and oxygen saturation from the application of flumazenil or placebo until 30min after injection. Data regarding time to extubation, time to reach 10 points in the Aldrete–Kroulic score (AK=10) and Vigilance score (VS=10) was also collected. ANOVA test was applied to analyze the results, considering p<0.05. ResultsPatients receiving flumazenil achieved faster extubation than the control (p=0.033). No differences were observed in values of CSI, the time until AK=10 and until VS=10. ConclusionsAdministration of flumazenil at the end of isoflurane general anesthesia resulted in earlier extubation in studied patients.

Anesthetic influence on occurrence and treatment of the trigemino-cardiac reflex: a systematic literature review.

Trigeminocardiac reflex (TCR) is defined as sudden onset of parasympathetic dysrhythmia including hypotension, apnea, and gastric hypermotility during stimulation of any branches of the trigeminal nerve. Previous publications imply a relation between TCR and depth of anesthesia. To gain more detailed insights into this hypothesis, we performed a systematic literature review.Literature about occurrence of TCR was systematically identified through searching in Cochrane Central Register of Controlled Trials (CENTRAL), PubMed (MEDLINE), EMBASE (Ovid SP), and the Institute for Scientific Information (ISI Web of Sciences) databases until June 2013, as well as reference lists of articles for risk calculation. In this study, TCR was defined as drop in mean arterial blood pressure and heart rate, both >20% to baseline. We calculated intraoperative cerebral state index (CSI) of each TCR-case using a newly developed method. These data were further divided into 3 subgroups: CSI <40 (deep anesthesia), CSI 40–60 (regular anesthesia), and CSI >60 (slight anesthesia).Including 45 studies with 910 patients, 140 (15%) presented with TCR, and 770 (85%) without TCR during operation. TCR occurrence showed a 1.2-fold higher pooled risk slighter anesthesia (CSI <40: 13%, at CSI 40–60: 21%, and at CSI >60: 27%) compared with deeper anesthesia. In addition, we could discover a 1.3-fold higher pooled risk of higher MABP drop with a strong negative correlation (r = −0.935; r2 = 0.89) and a 4.5-fold higher pooled risk of asystole during TCR under slight anesthesia compared with deeper anesthesia.Our work is the first systematic review about TCR and demonstrates clear evidence for TCR occurrence and a more severe course of the TCR in slight anesthesia underlying the importance of skills in anesthesia management during skull base surgery. Furthermore, we have introduced a new standard method to calculate the depth of anesthesia.

Cerebral state index versus glasgow coma scale as a predictor for in-hospital mortality in brain-injured ICU patients

Cerebral state index versus glasgow coma scale as a predictor for in-hospital mortality in brain-injured ICU patients

Agreement of cerebral state index and glasgow coma scale in brain-injured patients

Agreement of cerebral state index and glasgow coma scale in brain-injured patients

Agreement of cerebral state index and glasgow coma scale in brain-injured patients.

Background:Variables derived from electroencephalogram like cerebral state index (CSI) have been used to monitor the anesthesia depth during general anesthesia. Observed evidences show such variables have also been used as a detector of brain death or outcome predictor in traumatic brain-injured (TBI) patients.Objectives:The current study was designed to determine the correlation between Glasgow coma score (GCS) and CSI among TBI patients.Patients and Methods:In 60 brain-injured patients who did not need and receive sedatives, GCS and CSI were daily measured during the first ten days of their hospital stay. Correlation between GCS and CSI was studied using the Pearson's correlation test. The Gamma agreement coefficient was also calculated between the two variables for the first day of hospitalization.Results:A significant correlation coefficient of 0.611-0.796 was observed between CSI and GCS in a ten-day period of the study (P < 0.001). Gamma agreement coefficient was 0.79 (P < 0.001) for CSI and GCS for the first day of hospitalization. An increased daily correlation was observed in both CSI and GCS values. However, this increase was less significant in CSI compared with the GCS.Conclusions:A statistically significant correlation and agreement was found between GCS and CSI in the brain-injured patients and GCS was also found to be more consistent and reliable compared with CSI.

Intrathecal fentanyl decreases the optimal effect site concentration of propofol during spinal anaesthesia

The aim of this study was to assess the possible difference in the optimal effect site concentration of propofol for conscious sedation during spinal anaesthesia with or without intrathecal fentanyl in patients undergoing urologic surgery. The hypothesis was that intrathecal fentanyl would decrease the effect site concentration of propofol needed for conscious sedation. Among 43 patients, 23 patients received fentanyl 25 mcg and 20 patients received normal saline in addition to hyperbaric bupivacaine 10 mg during spinal anaesthesia. Propofol was infused at a dose determined by a modified Dixon's up-and-down method. The Cerebral State Index was recorded once target effect site concentration was reached to determine the effect of the successfulness of the conscious sedation. The half maximal effective concentration (EC50) of the effect-site concentration of propofol for sedation was 1.67 ± 0.28 mcg/ml in the control group and 0.87 ± 0.15 mcg/ml in the fentanyl group (P = 0.02). The propofol dose for conscious sedation during spinal anaesthesia was decreased by 48% when intrathecal fentanyl 25 mcg was added to local anaesthetics. The EC50 of the effect-site concentration of propofol for sedation decreased from 1.67 ± 0.28 mcg/ml to 0.87 ± 0.15 mcg/ml with the addition of 25 mcg fentanyl to a spinal anaesthetic in patients undergoing urologic surgery.