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Wang H, Zhang Y, Cheng H, Yan F, Song D, Wang Q, Cai S, Wang Y, Huang L. Selective corticocortical connectivity suppression during propofol-induced anesthesia in healthy volunteers. Cogn Neurodyn 2022; 16:1029-1043. [PMID: 36237410 PMCID: PMC9508318 DOI: 10.1007/s11571-021-09775-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/17/2021] [Accepted: 12/13/2021] [Indexed: 11/03/2022] Open
Abstract
We comprehensively studied directional feedback and feedforward connectivity to explore potential connectivity changes that underlie propofol-induced deep sedation. We further investigated the corticocortical connectivity patterns within and between hemispheres. Sixty-channel electroencephalographic data were collected from 19 healthy volunteers in a resting wakefulness state and propofol-induced deep unconsciousness state defined by a bispectral index value of 40. A source analysis was employed to locate cortical activity. The Desikan-Killiany atlas was used to partition cortices, and directional functional connectivity was assessed by normalized symbolic transfer entropy between higher-order (prefrontal and frontal) and lower-order (auditory, sensorimotor and visual) cortices and between hot-spot frontal and parietal cortices. We found that propofol significantly suppressed feedforward connectivity from the left parietal to right frontal cortex and bidirectional connectivity between the left frontal and left parietal cortex, between the frontal and auditory cortex, and between the frontal and sensorimotor cortex. However, there were no significant changes in either feedforward or feedback connectivity between the prefrontal and all the lower-order cortices and between the frontal and visual cortices or in feedback connectivity from the frontal to parietal cortex. Propofol anesthetic selectively decreased the unidirectional interaction between higher-order frontoparietal cortices and bidirectional interactions between the higher-order frontal cortex and lower-order auditory and sensorimotor cortices, which indicated that both feedback and feedforward connectivity were suppressed under propofol-induced deep sedation. Our findings provide critical insights into the connectivity changes underlying the top-down mechanism of propofol anesthesia at deep sedation. Supplementary Information The online version contains supplementary material available at 10.1007/s11571-021-09775-x.
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Affiliation(s)
- Haidong Wang
- School of Life Science and Technology, Xidian University, No. 2 South Taibai Road, Xi’an, 710071 China
| | - Yun Zhang
- School of Life Science and Technology, Xidian University, No. 2 South Taibai Road, Xi’an, 710071 China
| | - Huanhuan Cheng
- School of Life Science and Technology, Xidian University, No. 2 South Taibai Road, Xi’an, 710071 China
| | - Fei Yan
- Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an, 710061 China
| | - Dawei Song
- Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an, 710061 China
| | - Qiang Wang
- Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an, 710061 China
| | - Suping Cai
- School of Life Science and Technology, Xidian University, No. 2 South Taibai Road, Xi’an, 710071 China
| | - Yubo Wang
- School of Life Science and Technology, Xidian University, No. 2 South Taibai Road, Xi’an, 710071 China
| | - Liyu Huang
- School of Life Science and Technology, Xidian University, No. 2 South Taibai Road, Xi’an, 710071 China
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Raue JF, Tünsmeyer J, Kästner SBR. Effects of isoflurane, remifentanil and dexmedetomidine on selected EEG parameters derived from a Narcotrend Monitor before and after nociceptive stimulation at different MAC multiples in cats. BMC Vet Res 2020; 16:332. [PMID: 32928231 PMCID: PMC7489203 DOI: 10.1186/s12917-020-02532-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/19/2020] [Indexed: 11/19/2022] Open
Abstract
Background The aim of this prospective and complete cross-over study was to evaluate the effects of isoflurane, remifentanil and dexmedetomidine on EEG parameters derived from the Narcotrend® Monitor before and after nociceptive stimulation at different isoflurane MAC (minimal alveolar concentration) multiples. Seven adult European Domestic Short Hair cats were used. Each cat went through 3 experimental treatments. Group I received isoflurane, group IR received isoflurane and a constant rate infusion (CRI) of remifentanil (18 μg/kg/h IV), and group ID received isoflurane and a CRI of dexmedetomidine (3 μg/kg/h IV). The isoflurane MAC in each group was determined via supramaximal electrical stimulation. The EEG parameters were derived by a Narcotrend Monitor at specific time points before and after nociceptive stimulation at 0.75, 1.0 and 1.5 MAC. The depth of anaesthesia was also assessed by a clinical score. Results The mean MAC sparing effects in group IR and group ID were 9.8 and 55.2%, respectively. The best correlation of EEG and MAC multiples was found for the Narcotrend Index (NI) in group I (r = − 0.67). The NI was also able to differentiate between 0.75 MAC and 1.5 MAC in group IR. Spectral edge frequency had a lower correlation with MAC multiples in group I (r = − 0.62) but was able to differentiate between 0.75 MAC and 1.5 MAC in groups I and IR, and between 1.0 MAC and 1.5 MAC in group IR. Narcotrend Index, SEF 95 and MF increased significantly after nociceptive stimulation at 1.0 MAC in group I, and SEF 95 increased significantly at 0.75 MAC in group ID. The clinical score correlated closer than any of the EEG parameters with MAC in all groups, with highest correlation values in group I (r = − 0.89). Noxious stimulation led to a significant increase of the clinical score at 0.75 MAC and 1.0 MAC in group I. Conclusions The EEG parameters derived from the Narcotrend Monitor show correlation to isoflurane MAC multiples in cats, but the anaesthetic protocol and especially the addition of dexmedetomidine have great influence on the reliability. The Narcotrend Monitor can be used as an additional tool to assess anesthetic depth in cats.
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Affiliation(s)
- Jonathan F Raue
- Small Animal Clinic, University of Veterinary Medicine Hannover, Foundation, Bünteweg 9, 30559, Hannover, Germany.
| | - Julia Tünsmeyer
- Small Animal Clinic, University of Veterinary Medicine Hannover, Foundation, Bünteweg 9, 30559, Hannover, Germany
| | - Sabine B R Kästner
- Small Animal Clinic, University of Veterinary Medicine Hannover, Foundation, Bünteweg 9, 30559, Hannover, Germany.,Center for Systems Neuroscience Hannover, University of Veterinary Medicine Hannover, Foundation, Bünteweg 9, 30559, Hannover, Germany
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Abstract
PURPOSE OF REVIEW The purpose of this article is to highlight recent advances in the burgeoning field of drug-induced sleep endoscopy (DISE). RECENT FINDINGS One of the first studies to investigate the correlation of DISE findings and natural sleep endoscopy found good agreement in clinically significant obstruction. Previous studies have shown good agreement of DISE findings with the use of different sedative agents implying that the choice of sedative may not be crucial. However, recent studies show variable patterns of collapse, especially at the tongue base, with the use of different sedative agents. A universally accepted classification scheme for drug-induced sleep endoscopy is lacking. A new DISE classification system, termed Palate, Tonsils, Lateral pharyngeal wall, Tongue base, Epiglottis, was introduced this year with the noted advantage of being able to better differentiate between clinically relevant tonsillar and lateral pharyngeal wall collapse. Despite recent advances in the field, there remains no general consensus that DISE findings predict surgical success but may aid in the identification of patients who will respond well to oral appliance therapy. SUMMARY Drug-induced sleep endoscopy is a structure-based evaluation of the upper airway that more closely resembles the natural sleep state compared with awake evaluation.
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Herzog M, Rudzki M, Plößl S, Plontke S, Kellner P. Depth of sedation during drug induced sedation endoscopy monitored by BiSpectral Index® and Cerebral State Index®. Sleep Breath 2020; 25:1029-1035. [PMID: 32857320 DOI: 10.1007/s11325-020-02180-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Drug induced sedation endoscopy (DISE) is performed to investigate patterns and sites of obstruction in patients with sleep-disordered breathing (SDB). During DISE the patients are sedated to obtain a muscular relaxation of the upper airway which mimics the relaxation during natural sleep. Different sleep stages are intended to be simulated by drug induced sedation, and it is helpful to measure the depth of sedation. The BiSpectral Index® (BIS) is often used for this procedure. Besides the BIS, other means of sedation depth monitoring exist in anaesthesiology but have not yet been investigated with respect to DISE. Monitoring of the Cerebral State Index® (CSI) is one of these methods. The aim of the study was to compare the BIS and CSI for sedation depth monitoring during DISE. METHODS Sixty patients underwent DISE monitored by the BIS and CSI in parallel. The BIS and CSI values were compared using the Bland-Altman analysis. RESULTS The BIS and CSI values differed during the course of sedation during DISE by a mean of - 6.07. At light sedation (BIS 60-80), lower values by 10 scale points of CSI compared with BIS were detectable. At deeper sedation levels (BIS 40-50), the CSI turned to present equal and even higher values compared with the BIS. CONCLUSION Sedation depth measurement during DISE can be performed by the BIS or CSI, but the differences should be interpreted carefully as comparable data for sleep stages in natural sleep are available only for BIS.
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Affiliation(s)
- Michael Herzog
- Department of Otorhinolaryngology, Head and Neck Surgery, Carl-Thiem-Klinikum gGmbH, Carl-Thiem-Str. 111, 03048, Cottbus, Germany. .,Department of Otorhinolaryngology, Head and Neck Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.
| | - Mathias Rudzki
- Emergency Department, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 01620, Halle (Saale), Germany.,Department of Anesthesiology and Surgical Intensive Care, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 01620, Halle (Saale), Germany
| | - Sebastian Plößl
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
| | - Stefan Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
| | - Patrick Kellner
- Department of Anesthesiology and Surgical Intensive Care, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 01620, Halle (Saale), Germany.,Department of Anesthesiology and Intensive Care, University of Lübeck, University Medical Center Schleswig-Holstein, Ratzeburger Allee 16, 23538, Lübeck, Germany
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Kumakura Y, Ishiyama T, Matsuoka T, Iijima T, Matsukawa T. Effects of spinal anesthesia and sedation with dexmedetomidine or propofol on cerebral regional oxygen saturation and systemic oxygenation a period after spinal injection. J Anesth 2020; 34:806-13. [PMID: 32556601 DOI: 10.1007/s00540-020-02816-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/12/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate changes in cerebral regional oxygen saturation (rSO2) after spinal anesthesia and compare the changes in rSO2 and systemic oxygenation between dexmedetomidine sedation and propofol sedation. METHODS Thirty-six patients scheduled to undergo transurethral surgery under spinal anesthesia were randomly assigned to the dexmedetomidine (n = 18) and propofol groups (n = 18). We used near-infrared spectroscopy sensors to measure rSO2, and obtained data from each side were averaged. After oxygen insufflation, baseline measurements of mean arterial blood pressure (MAP), heart rate, rSO2, pulse oximetry saturation (SpO2), bispectral index, and body temperature were made. After spinal anesthesia, we measured these parameters every 5 min. Twenty minutes after spinal injection, dexmedetomidine or propofol administration was started. We measured each parameter at 10, 25, and 40 min after the administration of dexmedetomidine or propofol. RESULTS The baseline rSO2 in the dexmedetomidine group was 71.3 ± 7.3%, and that in the propofol group was 71.8 ± 5.6%. After spinal anesthesia, rSO2 in both groups decreased significantly (dexmedetomidine group: 65.4 ± 6.9%; propofol group: 64.3 ± 7.4%). After administering sedatives, rSO2 was equivalent after spinal anesthesia. rSO2 was comparable between the two groups. MAP and SpO2 were significantly higher in the dexmedetomidine group than in the propofol group. CONCLUSION Spinal anesthesia decreased rSO2; however, the decline was not severe. Dexmedetomidine and propofol did not compromise cerebral oxygenation under spinal anesthesia. Nevertheless, MAP and SpO2 were more stable in dexmedetomidine sedation than in propofol sedation. Dexmedetomidine may be suitable for spinal anesthesia.
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Jia L, Hou J, Zheng H, Sun L, Fan Y, Wang X, Hao M, Li Y, Yang T. Study of the rational dose of propofol in elderly patients under bispectral index monitoring during total intravenous anesthesia: A PRISMA-compliant systematic review. Medicine (Baltimore) 2020; 99:e19043. [PMID: 32000452 PMCID: PMC7004673 DOI: 10.1097/md.0000000000019043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Propofol has been used widely as an anesthetic for elderly patients; however, the drug instructions only indicate that the need for maintenance of general anesthesia in elderly patients is reduced, and not the extent of the reduction. This study has summarized the usage of propofol in total intravenous anesthesia under bispectral index (BIS) monitoring and determined the optimum dosage of propofol for elderly patients. METHODS The study comprised 156 patients undergoing elective surgery under general anesthesia divided into 2 groups according to their age: the elderly group (O group) and nonelderly group (Y group). BIS monitoring was used in both groups during the operation, and propofol and remifentanil were used to maintain anesthesia. The preoperative special conditions, intraoperative maintenance of propofol, remifentanil, fentanyl, cis-atracurium, vasoactive drug use, and hemodynamic changes were summarized. RESULTS Propofol maintenance in the O group was 3.372 ± 0.774 mg/(kg h), which was significantly lesser than that in Y group (P < 0.05). The incidence of cardiovascular and cerebrovascular diseases and the use rate of vasoactive drugs in the O group were significantly higher than in the Y group (P < 0.05). CONCLUSION Propofol maintenance in the O group was significantly lower than that in the nonelderly group; this indicates that the anesthetic drug delivery rate for elderly patients should be reduced.
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Affiliation(s)
| | - Jiachen Hou
- Department of Surgery, the Second Hospital of Jilin University, Changchun City, Jilin Province, China
| | | | | | | | - Xu Wang
- Department of Anesthesiology
| | | | - Yue Li
- Department of Anesthesiology
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Dunham CM, Burger AL, Hileman BM, Chance EA, Hutchinson AE, Kohli CM, DeNiro L, Tall JM, Lisko P. Brainwave Self-Regulation During Bispectral Index TM Neurofeedback in Trauma Center Nurses and Physicians After Receiving Mindfulness Instructions. Front Psychol 2019; 10:2153. [PMID: 31616348 PMCID: PMC6775210 DOI: 10.3389/fpsyg.2019.02153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/06/2019] [Indexed: 11/13/2022] Open
Abstract
Fifty-seven level I trauma center nurses/physicians participated in a 4-day intervention to learn relaxed alertness using mindfulness-based instructions and EEG neurofeedback. Neurofeedback was provided by a Bispectral IndexTM (BIS) system that continuously displays a BIS value (0-100) on the monitor screen. Reductions in the BIS value indicate that power in a high-frequency band (30-47 Hz) is decreased and power in an intermediate band (11-20 Hz) is increased. A wellbeing tool with four positive affect and seven negative affect items based on a 5-category Likert scale was used. The wellbeing score is the sum of the positive affect items (positive affect score) and the reverse-scored negative affect items (non-stress score). Of functional concern were four negative affect items rated as moderately, quite a bit, or extremely in a large percent. Of greater concern were all four positive affect items rated as very slightly or none at all, a little, or moderately in over half of the participants. Mean and nadir BIS values were markedly decreased during neurofeedback when compared to baseline values. Post-session relaxation scores were higher than pre-session relaxation scores. Post-session relaxation scores had an inverse relationship with mean and nadir BIS values. Mean and nadir BIS values were inversely associated with NFB cognitive states (i.e., widening the visual field, decreasing effort, attention to space, and relaxed alertness). For all participants, the wellbeing score was higher on day 4 than on day 1. Participants had a higher wellbeing score on day 4 than a larger group of nurses/physicians who did not participate in the BIS neurofeedback trial. Eighty percent of participants demonstrated an improvement in the positive affect or non-stress score on day 4, when compared to day 1; the wellbeing, non-stress, and positive affect scores were substantially higher on day 4 than on day 1. Additionally, for that 80% of participants, the improvements in wellbeing and non-stress were associated with reductions in day 3 BIS values. These findings indicate that trauma center nurses/physicians participating in an EEG neurofeedback trial with mindfulness instructions had improvements in wellbeing. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03152331. Registered May 15, 2017.
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Affiliation(s)
- C Michael Dunham
- Trauma, Critical Care, and General Surgery Services, St. Elizabeth Youngstown Hospital, Youngstown, OH, United States
| | - Amanda L Burger
- Behavioral Medicine, St. Elizabeth Family Medicine Residency, Youngstown, OH, United States
| | - Barbara M Hileman
- Trauma and Neuroscience Research Department, St. Elizabeth Youngstown Hospital, Youngstown, OH, United States
| | - Elisha A Chance
- Trauma and Neuroscience Research Department, St. Elizabeth Youngstown Hospital, Youngstown, OH, United States
| | - Amy E Hutchinson
- Department of Anesthesiology, St. Elizabeth Youngstown Hospital, Youngstown, OH, United States
| | - Chander M Kohli
- Department of Neurosurgery, St. Elizabeth Youngstown Hospital, Youngstown, OH, United States
| | - Lori DeNiro
- Department of Nursing, St. Elizabeth Youngstown Hospital, Youngstown, OH, United States
| | - Jill M Tall
- Department of Biological Sciences, Youngstown State University, Youngstown, OH, United States
| | - Paul Lisko
- Pastoral Services, St. Charles Borromeo Catholic Church, Boardman, OH, United States
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Carrasco-Llatas M, Matarredona-Quiles S, De Vito A, Chong KB, Vicini C. Drug-Induced Sleep Endoscopy: Technique, Indications, Tips and Pitfalls. Healthcare (Basel) 2019; 7:healthcare7030093. [PMID: 31344900 PMCID: PMC6787696 DOI: 10.3390/healthcare7030093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/09/2019] [Accepted: 07/21/2019] [Indexed: 11/16/2022] Open
Abstract
Drug-induced sleep endoscopy (DISE) is a diagnostic tool to assess the upper airway of snorers and obstructive sleep apnea patients in conditions that mimic natural sleep. Although DISE appears simple and similar to awake endoscopy, there are many aspects that need to be standardized in order to obtain reliable and reproducible information. In this article, we will recommend how to reliably perform DISE, its indications, and how to obtain and interpret the information of the upper airway.
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Affiliation(s)
| | | | - Andrea De Vito
- Department of Otolaryngology; Ospedale Morgagni Pierantoni, 47121 Forli, Italy
| | - Khai Beng Chong
- Department of Otolaryngology; Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Claudio Vicini
- Department of Otolaryngology; Ospedale Morgagni Pierantoni, 47121 Forli, Italy
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Ki S, Kim KM, Lee YH, Bang JY, Choi BM, Noh GJ. Phase lag entropy as a hypnotic depth indicator during propofol sedation. Anaesthesia 2019; 74:1033-1040. [PMID: 31106853 DOI: 10.1111/anae.14704] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2019] [Indexed: 11/29/2022]
Abstract
Phase lag entropy, an electro-encephalography-based hypnotic depth indicator, calculates diversity in temporal patterns of phase relationship. We compared the performance of phase lag entropy with the bispectral index™ in 30 patients scheduled for elective surgery. We initiated a target-controlled infusion of propofol using the Schnider model, and assessed sedation levels using the Modified Observer's Assessment of Alertness/Sedation scale every 30 s with each stepwise increase in the effect-site propofol concentration. Phase lag entropy and bispectral index values were recorded. The correlation coefficient and prediction probability between phase lag entropy or bispectral index and the sedation level or effect-site propofol concentration were analysed. We calculated baseline variabilities of phase lag entropy and bispectral index. In addition, we applied a non-linear mixed-effects model to obtain the pharmacodynamic relationships among the effect-site propofol concentration, phase lag entropy or bispectral index and sedation level. As sedation increased, phase lag entropy and bispectral index both decreased. The prediction probability values of phase lag entropy and bispectral index for sedation levels were 0.697 and 0.700 (p = 0.261) and for the effect-site concentration of propofol were 0.646 and 0.630 (p = 0.091), respectively. Baseline variability in phase lag entropy and bispectral index was 3.3 and 5.7, respectively. The predicted propofol concentrations, using the Schnider pharmacokinetic model, producing a 50% probability of moderate and deep sedation were 1.96 and 3.01 μg.ml-1 , respectively. Phase lag entropy was found to be useful as a hypnotic depth indicator in patients receiving propofol sedation.
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Affiliation(s)
- S Ki
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University, Busan, Korea
| | - K M Kim
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Hallym University of College of Medicine, Anyang, Korea
| | - Y H Lee
- Department of Anaesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - J Y Bang
- Department of Anaesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - B M Choi
- Department of Anaesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - G J Noh
- Department of Anaesthesiology and Pain Medicine and Department of Clinical Pharmacology and Therapeutics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Zhou Y, Hu P, Huang Y, Nuoer S, Song K, Wang H, Wen J, Jiang J, Chen X. Population Pharmacokinetic/Pharmacodynamic Model-Guided Dosing Optimization of a Novel Sedative HR7056 in Chinese Healthy Subjects. Front Pharmacol 2018; 9:1316. [PMID: 30510509 PMCID: PMC6252322 DOI: 10.3389/fphar.2018.01316] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/29/2018] [Indexed: 11/13/2022] Open
Abstract
HR7056 is a new benzodiazepine, showing more faster acting onset and recovery than currently available short-acting sedatives. To avoid inadequate anesthesia and predict return of cognition, allowing for immediate neurological evaluation, HR7056 pharmacokinetics and pharmacodynamics were characterized in Chinese healthy subjects. We report on modeling of the data and simulations of dosage regimens for future study. Up to 63 subjects were evaluated, using Bispectral Index (BIS) and Modified Observer's Assessment of Alertness/Sedation (MOAA/S) as pharmacodynamics endpoints. A three-compartment model best described HR7056 pharmacokinetics. Total clearance was 1.49 L min−1, central volume was 2.1 L, inter-compartmental clearances were 0.96 and 0.27 L min−1, respectively. The population mean pharmacodynamic parameters were as follows: BIS, E0: 95.3; IC50: 503 ng mL−1; γ: 1.5; ke0: 0.0855 min−1; Imax: 47.9 and MOAA/S, IC50: 436 ng mL−1; γ: 1.5; ke0: 0.05 min−1; Imax: 27.9. The model simulation will enable maintenance doses to be given more accurately for future study. Clinical Trial Registration: identifier: NCT01970072
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Affiliation(s)
- Ying Zhou
- Clinical Pharmacology Research Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China,Department of Pharmacy, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Pei Hu
- Clinical Pharmacology Research Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Sang Nuoer
- Department of Anesthesiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Kaicheng Song
- Department of Anesthesiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Hongyun Wang
- Clinical Pharmacology Research Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jinhua Wen
- Department of Pharmacy, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ji Jiang
- Clinical Pharmacology Research Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xia Chen
- Clinical Pharmacology Research Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China,Clinical Trial Center, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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De Vito A, Carrasco Llatas M, Ravesloot MJ, Kotecha B, De Vries N, Hamans E, Maurer J, Bosi M, Blumen M, Heiser C, Herzog M, Montevecchi F, Corso RM, Braghiroli A, Gobbi R, Vroegop A, Vonk PE, Hohenhorst W, Piccin O, Sorrenti G, Vanderveken OM, Vicini C. European position paper on drug-induced sleep endoscopy: 2017 Update. Clin Otolaryngol 2018; 43:1541-1552. [PMID: 30133943 DOI: 10.1111/coa.13213] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/14/2018] [Accepted: 08/20/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The first edition of the European position paper (EPP) on drug-induced sleep endoscopy (DISE) was published in 2014 with the aim to standardise the procedure, to provide an in-depth insight into the main aspects of this technique and to have a basis for future research. Since 2014, new studies have been published concerning new sedative agents or new insights into the pattern/levels of the obstruction depending on the depth of sedation. Therefore, an enlarged group of European experts in the field of sleep breathing disorders (SBD), including the most of the first DISE EPP main authors, has decided to publish an update of the European position paper on DISE, in order to include new evidence and to find a common language useful for reporting the findings of this endoscopic evaluation in adult population affected by SBD. METHODS The authors have evaluated all the available evidence reported in the literature and have compared experience among various departments in leading European centres in order to provide an update regarding the standardisation of the DISE procedure and an in-depth insight into the main aspects of this technique. RESULTS After the first European Position Consensus Meeting on DISE and its update, consensus was confirmed for indications, required preliminary examinations, where to perform DISE, technical equipment required, staffing, local anaesthesia, nasal decongestion, other medications, patient positioning, basics and special diagnostic manoeuvres, drugs and observation windows. So far, no consensus could be reached on a scoring and classification system. However, regarding this aim, the idea of an essential classification, such as VOTE with the possibility of its graded implementation of information and descriptions, seems to be the best way to reach a universal consensus on DISE classification at this stage. A common DISE language is mandatory, and attempts to come to a generally accepted system should be pursued.
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Affiliation(s)
- Andrea De Vito
- Head and Neck Department, ENT & Oral Surgery Unit, Morgagni-Pierantoni Hospital, Forlì, Italy.,ENT Unit, Santa Maria delle Croci Hospital, Ravenna AUSL of Romagna, Romagna, Italy
| | | | - Madeline J Ravesloot
- Department of Otorhinolaryngology and Head and Neck Surgery, OLVG, Amsterdam, The Netherlands.,Medisch Centrum Jan van Goyen, Amsterdam, The Netherlands
| | - Bhik Kotecha
- Royal National Throat Nose & Ear Hospital, UCLH, London, UK
| | - Nico De Vries
- Department of Otolaryngology, OLVG Hospital and ACTA, Amsterdam, Netherlands.,Department of Otorhinolaryngology and Head and Neck Surgery, Multidisciplinary Sleep Disorders Center, University of Antwerp, Antwerp, Belgium.,Department of Oral Kinesiology, Academic Centre for Dentistry, MOVE Inst., Amsterdam, The Netherlands
| | - Evert Hamans
- Department of Otorhinolaryngology, Head and Neck Surgery, Jan Palfijn Hospital, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerpen, Belgium
| | - Joachim Maurer
- Sleep Disorders Centre, Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Mannheim, Mannheim, Germany
| | - Marcello Bosi
- Pulmonary Operative Unit, Department of Thoracic Diseases, Morgagni-Pierantoni Hospital, AUSL of Romagna, Forlì, Italy
| | - Marc Blumen
- Service ORL, Hopital Foch, Suresnes France and Centre Medical Veille Sommeil, Paris, France
| | - Clemens Heiser
- Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universitat Munchen, Munich, Germany
| | - Michael Herzog
- Department of Otorhinolaryngology, Head and Neck Surgery, Carl Thiem Klinikum, Cottbus, Germany
| | - Filippo Montevecchi
- Head and Neck Department, ENT & Oral Surgery Unit, Morgagni-Pierantoni Hospital, AUSL of Romagna, Forlì, Italy
| | | | - Alberto Braghiroli
- Sleep Lab. Pulmonary Rehabilitation Dept. Istituti Clinici Scientifici Maugeri, SPA SB, IRCCS, Veruno, Italy
| | - Riccardo Gobbi
- Head and Neck Department, ENT & Oral Surgery Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Anneclaire Vroegop
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Patty Elisabeth Vonk
- Department of Otorhinolaryngology and Head and Neck Surgery, OLVG, Amsterdam, The Netherlands
| | | | - Ottavio Piccin
- Department of Otolaryngology, Head and Neck Surgery, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giovanni Sorrenti
- Department of Otolaryngology, Head and Neck Surgery, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Olivier M Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp- Department ENT, Head and Neck Surgery, Antwerp University Hospital - Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Antwerp, Belgium
| | - Claudio Vicini
- Head and Neck Department, AUSL of Romagna, ENT & Oral Surgery Unit, Morgagni-Pierantoni Hospital, Forlì, Italy.,ENT Unit, Infermi Hospital, AUSL of Romagna, Faenza, Italy.,ENT Unit, Santa Maria delle Croci Hospital, Ravenna, Italy.,AUSL of Romagna, Romagna, Italy.,ENT Clinic, University of Ferrara, Ferrara, Italy
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Dunham CM, Burger AL, Hileman BM, Chance EA. Learning receptive awareness via neurofeedback in stressed healthcare providers: a prospective pilot investigation. BMC Res Notes 2018; 11:645. [PMID: 30180909 PMCID: PMC6123908 DOI: 10.1186/s13104-018-3756-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 08/31/2018] [Indexed: 12/21/2022] Open
Abstract
Objective Because physicians and nurses are commonly stressed, Bispectral Index™ (BIS) neurofeedback, following trainer instructions, was used to learn to lower the electroencephalography-derived BIS value, indicating that a state of receptive awareness (relaxed alertness) had been achieved. Results Ten physicians/nurses participated in 21 learning days with 9 undergoing ≤ 3 days. The BIS-nadir for the 21 days was decreased (88.7) compared to baseline (97.0; p < 0.01). From 21 wellbeing surveys, moderately-to-extremely rated stress responses were a feeling of irritation 38.1%; nervousness 14.3%; over-reacting 28.6%; tension 66.7%; being overwhelmed 38.1%; being drained 38.1%; and people being too demanding 52.4% (57.1% had ≥ 2 stress indicators). Quite a bit-to-extremely rated positive-affect responses were restful sleep 28.6%; energetic 0%; and alert 47.6% (90.5% had ≥ 2 positive-affect responses rated as slightly-to-moderately). For 1 subject who underwent 4 learning days, mean BIS was lower on day 4 (95.1) than on day 1 (96.8; p < 0.01). The wellbeing score increased 23.3% on day 4 (37) compared to day 1 (30). Changes in BIS values provide evidence that brainwave self-regulation can be learned and may manifest with wellbeing. These findings suggest that stress and impairments in positive-affect are common in physicians/nurses. Trial Registration ClinicalTrials.gov NCT03152331. Registered May 15, 2017 Electronic supplementary material The online version of this article (10.1186/s13104-018-3756-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Michael Dunham
- Trauma, Critical Care, and General Surgery Services, St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., Youngstown, OH, 44501, USA.
| | - Amanda L Burger
- Behavioral Medicine, St. Elizabeth Family Medicine Residency, 1053 Belmont Ave., Youngstown, OH, 44504, USA
| | - Barbara M Hileman
- Trauma and Neuroscience Research Department, St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., Youngstown, OH, 44501, USA
| | - Elisha A Chance
- Trauma and Neuroscience Research Department, St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., Youngstown, OH, 44501, USA
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Veer V, Zhang H, Beyers J, Vanderveken O, Kotecha B. The use of drug-induced sleep endoscopy in England and Belgium. Eur Arch Otorhinolaryngol 2018; 275:1335-1342. [PMID: 29556753 PMCID: PMC5893728 DOI: 10.1007/s00405-018-4939-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/14/2018] [Indexed: 11/25/2022]
Abstract
Purpose The purpose of this international survey is to ascertain the current practice of drug-induced sleep endoscopy (DISE) for patients with sleep-disordered breathing (SDB) by Otolaryngologists in the United Kingdom and Belgium. We compare the results with recommendations from the European Position Paper on drug-induced sleep endoscopy. Methods An online questionnaire was circulated to Consultant Otolaryngologists, independent practitioners, and trainees across the two countries. Eleven questions were used in total. Results 181 responses from the UK and 117 responses from Belgium were received, mostly from consultants and independent practitioners. SDB was a common presentation to ENT practice, seen by over 90% of clinicians. The use of DISE varied greatly between the two countries (72.9% Belgium, 26.1% UK). 54.1% of Belgian respondents use DISE on over 50% of their patients, compared to only 32.4% of British clinicians. Attitudes of surgeons towards the diagnostic value of DISE varied; in Belgium, the majority (54%) gave a rating of 3 or more (1 = useless to 5 = essential), with no respondents giving a score of 0 (useless). In the UK only 16% of respondents felt DISE had useful clinical value, with 25 respondents deeming it ’useless’. The majority opt for DISE when non-surgical therapies fail (51.4% UK, 61.3% Belgium). The majority of participants do not use objective measures for depth of sedation (75.7% UK, 66.7% Belgium), with a marked variation on anaesthetic methods. 62.2% of UK clinicians do not use a classification system, whereas in Belgium the majority of clinicians (60.8%) use the VOTE grading system. Conclusions Clinicians in Belgium were more favourable to using DISE than in the UK. Differences in its clinical effectiveness were apparent between the two countries. A consensus on patient selection, method of sedation and an effective classification system seemed to be lacking from both countries. Further education is required to raise awareness for the use of DISE.
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Affiliation(s)
- Vik Veer
- Royal National Throat Nose and Ear Hospital, 330 Gray's Inn Rd, London, WC1X 8DA, UK
| | - Henry Zhang
- Queens Hospital, Rom Valley Way, Romford, RM7 0AG, UK
| | - Jolien Beyers
- Department of ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, and, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Olivier Vanderveken
- Department of ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, and, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Bhik Kotecha
- Royal National Throat Nose and Ear Hospital, 330 Gray's Inn Rd, London, WC1X 8DA, UK.
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Dunham CM, McClain JV, Burger A. Comparison of Bispectral Index™ values during the flotation restricted environmental stimulation technique and results for stage I sleep: a prospective pilot investigation. BMC Res Notes 2017; 10:640. [PMID: 29187246 PMCID: PMC5707909 DOI: 10.1186/s13104-017-2947-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 11/20/2017] [Indexed: 11/18/2022] Open
Abstract
Objective To determine whether Bispectral Index™ values obtained during flotation-restricted environment stimulation technique have a similar profile in a single observation compared to literature-derived results found during sleep and other relaxation-induction interventions. Results Bispectral Index™ values were as follows: awake-state, 96.6; float session-1, 84.3; float session-2, 82.3; relaxation-induction, 82.8; stage I sleep, 86.0; stage II sleep, 66.2; and stages III–IV sleep, 45.1. Awake-state values differed from float session-1 (%difference 12.7%; Cohen’s d = 3.6) and float session-2 (%difference 14.8%; Cohen’s d = 4.6). Relaxation-induction values were similar to float session-1 (%difference 1.8%; Cohen’s d = 0.3) and float session-2 (%difference 0.5%; Cohen’s d = 0.1). Stage I sleep values were similar to float session-1 (%difference 1.9%; Cohen’s d = 0.4) and float session-2 (%difference 4.3%; Cohen’s d = 1.0). Stage II sleep values differed from float session-1 (%difference 21.5%; Cohen’s d = 4.3) and float session-2 (%difference 19.6%; Cohen’s d = 4.0). Stages III–IV sleep values differed from float session-1 (%difference 46.5%; Cohen’s d = 5.6) and float session-2 (%difference 45.2%; Cohen’s d = 5.4). Bispectral Index™ values during flotation were comparable to those found in stage I sleep and nadir values described with other relaxation-induction techniques. Electronic supplementary material The online version of this article (10.1186/s13104-017-2947-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Michael Dunham
- Trauma, Critical Care, and General Surgery Services, St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., Youngstown, OH, 44501, USA.
| | - Jesse V McClain
- Advanced Neurology Associates, Inc, 1340 Belmont Ave., Youngstown, OH, 44504, USA
| | - Amanda Burger
- Behavioral Medicine, St. Elizabeth Family Medicine Residency, 1053 Belmont Ave., Youngstown, OH, 44504, USA
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Lim BG, Lee IO, Kim YS, Won YJ, Kim H, Kong MH. The utility of bispectral index monitoring for prevention of rocuronium-induced withdrawal movement in children: A randomized controlled trial. Medicine (Baltimore) 2017; 96:e5871. [PMID: 28079825 PMCID: PMC5266187 DOI: 10.1097/md.0000000000005871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND This study was designed to determine whether a deep hypnotic state with a bispectral index (BIS) value less than 40 could alleviate withdrawal movement (WM) upon rocuronium injection during anesthesia induction in children. METHODS Finally, 135 healthy children (3-12 years) scheduled for minor elective surgery were studied. Without premedication, anesthesia was induced with thiopental sodium 5 mg/kg. Patients were randomized into 2 groups (control vs experimental) and then by virtue of rocuronium injection time, patients in the experimental group were allocated into 2 groups, as follows: in the control group (group C; n = 45), rocuronium 0.6 mg/kg was administered at the loss of eyelash reflex; in the 1st experimental group, rocuronium 0.6 mg/kg was administered when BIS fell to less than 40 (group T; n = 45); however, if BIS did not fall below 40 after thiopental sodium administration, manual ventilation was provided with oxygen 6 L/minute using sevoflurane 8% and then rocuronium was administered when BIS fell below 40 (the 2nd experimental group, group S; n = 45). Rocuronium-induced WM was evaluated using a 4-point scale (no movement; movement/withdrawal involving the arm only; generalized response, with movement/withdrawal of more than 1 extremity, but no requirement for restraint of the body; and generalized response which required restraint of the body and caused coughing or breath-holding). RESULTS No significant differences were found among the groups for patient characteristics including age, sex, height, and location of venous cannula. However, body weight, height, and body mass index in group S were all smaller than those in group T. The incidence of WM caused by rocuronium was 100% in group C, 95.6% in group T, and 80% in group S, and was significantly lower in group S than in group C. The grade of WM was 3.7 ± 0.6 in group C, 3.2 ± 0.9 in group T, and 2.6 ± 1.0 in group S. It was significantly lower in group T than in group C and significantly lower in group S than in groups C and T. CONCLUSION The confirmation of a deep hypnotic state with BIS values lower than 40 using BIS monitoring can reduce the grade of rocuronium-induced WMs during anesthesia induction using thiopental sodium or sevoflurane in children.
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De Vito A, Carrasco Llatas M, Vanni A, Bosi M, Braghiroli A, Campanini A, de Vries N, Hamans E, Hohenhorst W, Kotecha BT, Maurer J, Montevecchi F, Piccin O, Sorrenti G, Vanderveken OM, Vicini C. European position paper on drug-induced sedation endoscopy (DISE). Sleep Breath 2014; 18:453-65. [PMID: 24859484 DOI: 10.1007/s11325-014-0989-6] [Citation(s) in RCA: 188] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 04/04/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although drug-induced sedation endoscopy (DISE) represents the most widespread diagnostic tool for upper airway endoscopic evaluation of snoring and obstructive sleep apnea hypopnea syndrome (OSAHS), many controversies exist about how to perform the sedation, the indications for DISE, and how to report DISE findings. The present position paper reports on a consensus as proposed by a group of European experts in the field of DISE after discussion during a recent dedicated meeting. METHODS The authors have evaluated all the available evidence reported in the literature and have compared experience among various departments in leading European centers in order to provide a standardization of the DISE procedure and an in-depth insight in the main aspects of this technique. RESULTS A proposal of the DISE procedure standardization has been achieved with a general agreement concerning the terminology, indications, contraindications, required preliminary examinations, setting, technical equipment required, staffing, local anesthesia and nasal decongestion, patient positioning, basis and special diagnostic maneuvers, and the applied sedation drugs and observation windows. Otherwise, no consensus has been reached on a scoring and classification system. CONCLUSIONS Although consensus has been reached on several aspects of the DISE procedure, some topics remain open to future research, such as a better analysis of the importance of positional aspects during DISE and a further comparison of the differences in degree, level and pattern of upper airway collapse observed during DISE versus during natural sleep and awake endoscopy. Finally, a universally accepted scoring and classification system is lacking.
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Affiliation(s)
- Andrea De Vito
- Special Surgery Department, Ear-Nose-Throat Unit, Morgagni-Pierantoni Hospital, Via Forlanini 34, 47121, Forlì, Italy
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LEE JS, KIM JS, KIM MK, KIM SH, KIM JY. Intrathecal fentanyl decreases the optimal effect site concentration of propofol during spinal anaesthesia. Acta Anaesthesiol Scand 2014; 58:597-603. [PMID: 24628076 DOI: 10.1111/aas.12307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- J. S. LEE
- Department of Anesthesiology and Pain Medicine; Anesthesia and Pain Research Institute; Yonsei University College of Medicine; Seoul Korea
| | - J. S. KIM
- Department of Anesthesiology and Pain Medicine; Anesthesia and Pain Research Institute; Yonsei University College of Medicine; Seoul Korea
| | - M. K. KIM
- Department of Anesthesiology and Pain Medicine; Anesthesia and Pain Research Institute; Yonsei University College of Medicine; Seoul Korea
| | - S. H. KIM
- Department of Anesthesiology and Pain Medicine; Anesthesia and Pain Research Institute; Yonsei University College of Medicine; Seoul Korea
| | - J. Y. KIM
- Department of Anesthesiology and Pain Medicine; Anesthesia and Pain Research Institute; Yonsei University College of Medicine; Seoul Korea
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Brás S, Gouveia S, Ribeiro L, Ferreira D, Antunes L, Nunes C. Fuzzy logic model to describe anesthetic effect and muscular influence on EEG Cerebral State Index. Res Vet Sci 2013; 94:735-42. [DOI: 10.1016/j.rvsc.2012.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 12/11/2012] [Accepted: 12/23/2012] [Indexed: 11/17/2022]
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Arefian N, Seddighi AS, Seddighi A, Zali AR. Accuracy of combined EEG parameters in prediction the depth of anesthesia. Iran Red Crescent Med J 2013; 14:833-7. [PMID: 23482427 PMCID: PMC3587877 DOI: 10.5812/ircmj.1502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 05/13/2012] [Accepted: 05/28/2012] [Indexed: 11/22/2022]
Abstract
Background The importance of proper qualitative evaluation of EEG parameters during surgery has been recognized since many years. Although none of the characteristics based on the frequency, entropy, and Bi spectral characteristics have been regarded as a good predictor for detection of the depth of anesthesia alone. So it seems necessary to study multiple characteristics together. Objectives In this study we tried to introduce the best combination of the mentioned characteristics. Materials and Methods EEG data of 64 patients undergoing general anesthesia with the same anesthesia protocol (total intravenous anesthesia) were recorded in all anesthetic stages in Shohada Tajrish Hospital. Quantitative EEG characteristics are classified into 4 categories: time, frequency, bi spectral and entropy based characteristics. Their sensitivity, specificity and accuracy in determination of the depth of anesthesia are yielded by comparison with recorded reference signal in awake, light anesthesia, deep anesthesia and brain death patients. Then, with combining 2, 3, 4 and 5 of characteristics and using coded algorithm we determined the error degree and introduced the combination yielding the least error. Results Fifteen vectors (of dimension two to five) which yielded the best results were introduced. Vectors combined of entropy based characteristics obtained 100% specificity and sensitivity during all 4 stages. Conclusions The combination entropy based characteristics had high accuracy in predicting the depth of anesthesia. Reevaluation of classic indices cortical status index and BIS seems necessary. The next step is to find a system to simplify the evaluation of this information for technicians.
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Affiliation(s)
- Nourmohammad Arefian
- Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Amir Saied Seddighi
- Shohada Tajrish Hospital, Functional Neurosurgery Research Center of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Afsoun Seddighi
- Shohada Tajrish Hospital, Functional Neurosurgery Research Center of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Ali Reza Zali
- Shohada Tajrish Hospital, Functional Neurosurgery Research Center of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Ali Reza Zali, Shohada Tajrish Hospital, Functional Neurosurgery Research Center of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel.: +98-2188265188, Fax: +98-2188265188, E-mail:
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Sulu B, Yildiz BD, Buyukuysal C, Demir E, Gunerhan Y. Comparison of Meperidine Versus Hyoscine During Colonoscopy in the Elderly: A Prospective Randomized Study. J Laparoendosc Adv Surg Tech A 2012; 22:631-4. [DOI: 10.1089/lap.2012.0117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Barlas Sulu
- Department of General Surgery, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Baris Dogu Yildiz
- General Surgery Clinic, Ankara Numune Teaching Hospital, Ankara, Turkey
| | - Cagatay Buyukuysal
- Department of Biostatistics, Zonguldak Karaelmas University Faculty of Medicine, Zonguldak, Turkey
| | - Elif Demir
- Department of General Surgery, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Yusuf Gunerhan
- Department of General Surgery, Kafkas University Faculty of Medicine, Kars, Turkey
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Nguyen-Ky T, Wen P, Li Y, Malan M. Measuring the hypnotic depth of anaesthesia based on the EEG signal using combined wavelet transform, eigenvector and normalisation techniques. Comput Biol Med 2012; 42:680-91. [PMID: 22575174 DOI: 10.1016/j.compbiomed.2012.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Revised: 02/03/2012] [Accepted: 03/14/2012] [Indexed: 11/23/2022]
Abstract
This paper presents a new index to measure the hypnotic depth of anaesthesia (DoA) using EEG signals. This index is derived from applying combined Wavelet transform, eigenvector and normalisation techniques. The eigenvector method is first applied to build a feature function for six levels of coefficients in a discrete wavelet transform (DWT). The best Daubechies wavelet and their ranking value p are optimally determined to identify different states of anaesthesia. A statistic normalisation process is then carried out to re-scale data and compute the hypnotic depth of anaesthesia. Finally, a new function ZDoA is proposed to compute a DoA index which corresponds one of the five depths of anaesthesia states to very deep anaesthesia, deep anaesthesia, moderate anaesthesia, light anaesthesia and awake. Simulation results based on real anaesthetised EEGs demonstrate that the new index generally parallels the BIS index. In particular, the ZDoA index is often faster than the BIS index to react to the transition period between consciousness and unconsciousness for this data set. A Bland-Altman plot indicates a 95.23% agreement between the ZDoA and BIS indices. The ZDoA trend is responsive, and its movement is consistent with the clinically observed and recorded changes of the patients.
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Brás S, Ferreira DA, Antunes L, Ribeiro L, Nunes CS, Gouveia S. EMG contributes to improve Cerebral State Index modeling in dogs anesthesia. Annu Int Conf IEEE Eng Med Biol Soc 2012; 2011:6593-6. [PMID: 22255850 DOI: 10.1109/iembs.2011.6091626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Cerebral State Index (CSI) is a measure of depth of anesthesia (DoA) developed for humans, which is traditionally modeled with the Hill equation and the propofol effect-site concentration (Ce). The CSI has been studied in dogs and showed several limitations related to the interpretation of EEG data. Nevertheless, the CSI has a lot of potential for DoA monitoring in dogs, it just needs to be adjusted for this species. In this work, an adapted CSI model is presented for dogs considering a) both Ce and EMG as inputs and b) a fuzzy logic structure with parameters optimized using the ANFIS method. The new model is compared with traditional Hill model using data from dogs in routine surgery. The results showed no significant impact in the model performance with the change of model structure (Fuzzy instead of Hill). The residuals of the Hill model were significantly correlated with the EMG, indicating that the latter should be considered in the model. In fact, the EMG introduction in CSI model significantly decreased the modeling error: 11.8 [8.6; 15.2] (fuzzy logic) versus 20.9 [16.4; 29.0] (Hill). This work shows that CSI modeling in dogs can be improved using the current human anesthesia set-up, once the EMG signal is acquired simultaneously with the CSI index. However, it does not invalidate the search of new DoA indices more adjusted to use in dog's anesthesia.
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Affiliation(s)
- Susana Brás
- Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto.
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Pilge S, Blum J, Kochs EF, Schöniger SA, Kreuzer M, Schneider G. Does the Cerebral State Index Separate Consciousness from Unconsciousness? Anesth Analg 2011; 113:1403-10. [DOI: 10.1213/ane.0b013e31823007cd] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Han DW, Linares-Perdomo OJ, Lee JS, Kim JH, Kern SE. Comparison between cerebral state index and bispectral index as measures of electroencephalographic effects of sevoflurane using combined sigmoidal E(max) model. Acta Pharmacol Sin 2011; 32:1208-14. [PMID: 21892201 DOI: 10.1038/aps.2011.99] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIM The cerebral state index (CSI) was recently introduced as an electroencephalographic monitor for measuring the depth of anesthesia. We compared the performance of CSI to the bispectral index (BIS) as electroencephalographic measures of sevoflurane effect using two combined sigmoidal E(max) models. METHODS Twenty adult patients scheduled for laparotomy were studied. After induction of general anesthesia, sevoflurane concentrations were progressively increased and then decreased over 70 min. An analysis of the BIS and CSI with the sevoflurane effect-site concentration was conducted using two combined sigmoidal E(max) models. RESULTS The BIS and CSI decreased over the initial concentration range of sevoflurane and then reached a plateau in most patients. A further increase in sevoflurane concentration produced a secondary plateau in the pharmacodynamic response. The CSI was more strongly correlated with effect-site sevoflurane concentration (R(2)=0.95±0.04) than the BIS was (R(2)=0.87±0.07) (P<0.05). The individual E(max) and C(eff50) (effect-site concentration associated with 50% decrease from baseline to plateau) values for the upper and lower plateaus were significantly greater for BIS (12.7±7.3, 1.6±0.4, and 4.2±0.5, respectively) than for CSI (3.4±2.2, 1.2±0.4, and 3.8±0.5, respectively) (P<0.05). The remaining pharmacodynamic parameters for the BIS and CSI were similar. CONCLUSION The overall performance of the BIS and CSI during sevoflurane anesthesia was similar despite major differences in their algorithms. However, the CSI was more consistent and more sensitive to changes in sevoflurane concentration, whereas the measured BIS seemed to respond faster. The newly developed combined E(max) model adequately described the clinical data, including the pharmacodynamic plateau.
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Silva A, Ribeiro LM, Bressan N, Oliveira P, Ferreira DA, Antunes LM. Dogs mean arterial pressure and heart rate responses during high propofol plasma concentrations estimated by a pharmacokinetic model. Res Vet Sci 2011; 91:278-80. [PMID: 21276995 DOI: 10.1016/j.rvsc.2011.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 11/26/2010] [Accepted: 01/02/2011] [Indexed: 11/28/2022]
Abstract
Propofol total intravenous anesthesia should provide stability of the cardiovascular system. In this study, mean arterial pressure and heart rate were evaluated in eight healthy dogs anesthetized with increasing rates of propofol. The cerebral state index (CSI) was studied as an additional parameter. Although the estimated propofol plasma concentration reached a maximal value of 15.3 μg ml(-1), no hypotension or bradycardia were observed. Exploration of each animal's data revealed high inter-individual variability regarding mean arterial pressure and heart rate. Considering the logarithmic of the concentration, a moderate depressant effect of propofol on mean arterial pressure was revealed in five dogs but the effect was not followed on heart rate.
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Affiliation(s)
- Aura Silva
- Departamento de Ciências Veterinárias, Universidade de Trás-os-Montes e Alto Douro, Vila Real, Portugal.
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Springman SR, Andrei AC, Willmann K, Rusy DA, Warren ME, Han S, Lee M. A comparison of SNAP II and bispectral index monitoring in patients undergoing sedation. Anaesthesia 2010; 65:815-9. [PMID: 20586747 DOI: 10.1111/j.1365-2044.2010.06408.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Clinical signs and patients' verbal responses have traditionally been used to assess patients' comfort and the depth of sedation. Recently, level-of-consciousness monitors have been used to guide sedation. The SNAP II(c) is a single-lead electroencephalogram device that displays a SNAP(c) Index - a derived value based on both high and low frequency electroencephalogram signals. Much of the current clinical research on monitoring during sedation involves the bispectral index monitor. We compared simultaneous readings recorded by the SNAP II and bispectral index during sedation in 51 consecutive patients undergoing surgery. The anaesthesia team was blinded to the SNAP II and bispectal index values. Concurrent SNAP II and bispectral index readings displayed similarly-shaped trajectories during sedation, but further studies are needed to establish the routine clinical utility of both these monitors.
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Affiliation(s)
- S R Springman
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Abstract
BACKGROUND The performance of propofol effect-site pharmacokinetic models during target-controlled infusion (TCI) might be affected by propofol administration rate. This study compares the predictive ability of three effect-site pharmacokinetic models during fast and slow infusion rates, utilizing the cerebral state index (CSI) as a monitor of consciousness. METHODS Sixteen healthy volunteers, 21-45 years of age, were randomly assigned to receive either a bolus dose of propofol 1.8 mg/kg at a rate of 1200 ml/h or an infusion of 12 mg/kg/h until 3-5 min after loss of consciousness (LOC). After spontaneous recovery of the CSI, the bolus was administered to patients who had first received the infusion and vice versa. The study was completed after spontaneous recovery of CSI following the second dose scheme. LOC was assessed and recorded when it occurred. Adequacies of model predictions during both administration schemes were assessed by comparing the effect-site concentrations estimated at the time of LOC during the bolus dose and during the infusion scheme. RESULTS LOC occurred 0.97 +/- 0.29 min after the bolus dose and 6.77 +/- 3.82 min after beginning the infusion scheme (P<0.05). The Ce estimated with Schnider (ke0=0.45/min), Marsh (ke0=1.21/min) and Marsh (ke0=0.26/min) at LOC were 4.40 +/- 1.45, 3.55 +/- 0.64 and 1.28 +/- 0.44 microg/ml during the bolus dose and 2.81 +/- 0.61, 2.50 +/- 0.39 and 1.72 +/- 0.41 microg/ml, during the infusion scheme (P<0.05). The CSI values observed at LOC were 70 +/- 4 during the bolus dose and 71 +/- 2 during the infusion scheme (NS). CONCLUSION Speed of infusion, within the ranges allowed by TCI pumps, significantly affects the accuracy of Ce predictions. The CSI monitor was shown to be a useful tool to predict LOC in both rapid and slow infusion schemes.
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Affiliation(s)
- P O Sepúlveda
- Departamento de Anestesiología, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
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Nishiyama T, Komatsu K. Cerebral state index versus bispectral index during propofol-fentanyl-nitrous oxide anesthesia. J Anesth 2010; 24:380-5. [PMID: 20339885 DOI: 10.1007/s00540-010-0906-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Accepted: 01/14/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to compare the cerebral state index (CSI) and bispectral index (BIS) during propofol-fentanyl-nitrous oxide anesthesia. METHODS Thirty patients scheduled for abdominal surgery, with a mean age of 30-70 years, were enrolled. Anesthesia was induced with propofol and fentanyl and was maintained with propofol, fentanyl, epidural mepivacaine, and nitrous oxide in oxygen. During surgery, the propofol infusion rate was adjusted to try to keep BIS at 40 + or - 3 for 10 min and then decreased to keep the BIS at 60 + or - 3 for 10 min. RESULTS The BIS had a larger value for the time between switching on the apparatus and starting to measure at a signal quality index >75%. The recovery time from disturbance by an electric cautery event was 41 + or - 14 s for the BIS and 3 + or - 1 s for the CSI (P < 0.05). The absolute values of the BIS and CSI were not significantly different and they showed a good correlation. The bias (mean of the differences, BIS - CSI) was negative at all measurement points, but the limits of agreement and percentage error were small. CONCLUSIONS The absolute values of the BIS and CSI were not significantly different during propofol-fentanyl-nitrous oxide anesthesia. The start of the measurement was faster with the CSI than with the BIS after switch-on, and measurement was less disturbed by electric cautery with the CSI.
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Ribeiro L, Ferreira D, Brás S, Castro A, Nunes C, Amorim P, Antunes L. Correlation between clinical signs of depth of anaesthesia and cerebral state index responses in dogs during induction of anaesthesia with propofol. Res Vet Sci 2009; 87:287-91. [DOI: 10.1016/j.rvsc.2009.02.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Revised: 01/06/2009] [Accepted: 02/10/2009] [Indexed: 11/19/2022]
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Wang Q, Xu M, Lei YN, Wang GN, Zhou JX. Use of cerebral state index monitoring to detect purposeful movement in unsedated brain-injured patients. J Int Med Res 2009; 37:689-96. [PMID: 19589252 DOI: 10.1177/147323000903700312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To test whether the cerebral state index (CSI) can be used as a measurement of the level of consciousness in unsedated brain-injured patients, 21 brain-injured adults were prospectively assessed in 77 separate sessions. After CSI monitoring was set up, the patient's motor responses to verbal and/or painful stimuli were assessed. CSI values were recorded before and after external stimulation. Purposeful movement in response to external stimuli was defined as command obeying and pain localization. Mean maximal CSI values increased significantly after external stimulation: from 71 to 89 and 49 to 62 in patients exhibiting purposeful and non-purposeful movements, respectively. The CSI value showed a high prediction probability (P(K) > 0.8) for detecting purposeful movement to external stimuli, especially after external stimulation (P(K) > 0.9). These results suggest that CSI monitoring might be a valid method for detecting purposeful movement in response to external stimuli in unsedated brain-injured patients.
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Affiliation(s)
- Q Wang
- Neurosurgical Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Delfino A, Cortinez L, Fierro C, Muñoz H. Propofol consumption and recovery times after bispectral index or cerebral state index guidance of anaesthesia. Br J Anaesth 2009; 103:255-9. [DOI: 10.1093/bja/aep138] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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BRÁS S, BRESSAN N, RIBEIRO L, FERREIRA DA, ANTUNES L, NUNES CS. A step towards effect-site target-controlled infusion with propofol in dogs: ake0for propofol. J Vet Pharmacol Ther 2009; 32:182-8. [DOI: 10.1111/j.1365-2885.2008.01019.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Keyl C, Trenk D, Laule S, Schuppe C, Staier K, Wiesenack C, Albiez G. Predicted and Measured Plasma Propofol Concentration and Bispectral Index During Deep Sedation in Patients With Impaired Left Ventricular Function. J Cardiothorac Vasc Anesth 2009; 23:182-7. [DOI: 10.1053/j.jvca.2008.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Indexed: 11/11/2022]
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Abstract
One of the most important mandates of the anaesthesiologist is to control the depth of anaesthesia. An unsolved problem is that a straight definition of the depth of anaesthesia does not exist. Concerning this it is rational to separate hypnosis from analgesia, from muscle relaxation and from block of cardiovascular reactions. Clinical surrogate parameters such as blood pressure and heart rate are not well-suited for a valid statement about the depth of hypnosis. To answer this question the brain has become the focus of interest as the target of anaesthesia. It is possible to visualize the brain's electrical activity from anelectroencephalogram (EEG). The validity of the spontaneous EEG as an anesthetic depth monitor is limited by the multiphasic activity, especially when anaesthesia is induced (excitation) and in deep anaesthesia (burst suppression). Recently, various commercial monitoring systems have been introduced to solve this problem. These monitoring systems use different interpretations of the EEG or auditory-evoked potentials (AEP). These derived and calculated variables have no pure physiological basis. For that reason a profound knowledge of the algorithms and a validation of the monitoring systems is an indispensable prerequisite prior to their routine clinical use. For the currently available monitoring systems various studies have been reported. At this time it is important to know that the actual available monitors can only value the sedation and not the other components of anaesthesia. For example, they cannot predict if a patient will react to a painful stimulus or not. In the future it would be desirable to develop parameters which allow an estimate of the other components of anaesthesia in addition to the presently available monitoring systems to estimate sedation and muscle relaxation. These could be sensoric-evoked potentials to estimate analgesia and AEPs for the detection of awareness.
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Fuentes R, Cortínez LI, Struys MMRF, Delfino A, Muñoz H. The Dynamic Relationship Between End-Tidal Sevoflurane Concentrations, Bispectral Index, and Cerebral State Index in Children. Anesth Analg 2008; 107:1573-8. [DOI: 10.1213/ane.0b013e318181ef88] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Şentürk M, Güçyetmez B, Özkan-Seyhan T, Karadeniz M, Dinçer S, Akpir D, Şengül T, Denkel T. Comparison of the effects of thoracic and lumbar epidural anaesthesia on induction and maintenance doses of propofol during total i.v. anaesthesia. Br J Anaesth 2008; 101:255-60. [DOI: 10.1093/bja/aen160] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ribeiro LM, Ferreira DA, Bressan NM, Nunes CS, Amorim P, Antunes LM. Brain monitoring in dogs using the cerebral state index during the induction of anaesthesia via target-controlled infusion of propofol. Res Vet Sci 2007; 85:227-32. [PMID: 18061223 DOI: 10.1016/j.rvsc.2007.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Revised: 10/15/2007] [Accepted: 10/19/2007] [Indexed: 11/16/2022]
Abstract
The aim of this study was to evaluate the correlation between the cerebral state index (CSI) and the estimated propofol plasma concentrations in dogs during induction of anaesthesia. Fifteen healthy dogs undergoing scheduled routine surgical procedures were enrolled in this study. Target controlled infusion (TCI) software, based on the pharmacokinetic model for propofol, was used to control the syringe pump and to estimate plasma propofol concentrations (PropCp) and the CSI values every five-seconds. Three electrodes placed in the centre of the forehead, on the left side of the forehead and on the left mastoid were used to collect the electroencephalographic (EEG) signal converted by the cerebral state monitor into the CSI. The cerebral electrical changes induced by increasing propofol concentrations appear to be detected by CSI monitoring in dogs. The negative correlation between CSI and PropCp demonstrates that the CSI could be used to assess electrical brain activity in dogs during the induction of anaesthesia with propofol.
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Abstract
Fast-track rehabilitation refers to an interdisciplinary multimodal procedure to improve and accelerate recovery and avoid perioperative complications. The concept aims at reducing morbidity and discharging patients faster. It includes preoperative patient information, atraumatic surgical technique, stress reduction, pain therapy mostly via regional anesthetic techniques (frequently, thoracic epidural anesthesia), optimized fluid and temperature management, early enteral feeding, prophylaxis of gastrointestinal atony and postoperative nausea and vomiting, fast postoperative patient mobilization, and earlier hospital discharge. Fast-track protocols exist for all kind of surgical procedures but are best established for colon surgery.
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Affiliation(s)
- T Möllhoff
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Marienhospital Aachen, Zeise 4, 52066 Aachen.
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Disma N, Lauretta D, Palermo F, Sapienza D, Ingelmo PM, Astuto M. Level of sedation evaluation with Cerebral State Index and A-Line Arx in children undergoing diagnostic procedures. Paediatr Anaesth 2007; 17:445-51. [PMID: 17474951 DOI: 10.1111/j.1460-9592.2006.02146.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Monitoring of anesthesia depth is difficult clinically, particularly in children. The aim of this study was to assess the correlation existing between CSI (Cerebral State Index), or AAI (A-line ARX) and a clinical sedation scale such as UMSS (University of Michigan Sedation Scale), during deep sedation with propofol in children undergoing diagnostic procedures. METHODS Twenty ASA I and II children, scheduled to undergo deep sedation for magnetic resonance imaging (MRI) or Esophagogastroduodenoscopy (EGDS), were enrolled. The patients were randomly assigned to receive depth of anesthesia monitoring with CSI or AAI. The anesthetist administered repeated doses of propofol every 10 s to a UMSS score of 3-4. An attending anesthetist, not involved in drug administration, recorded time and doses of sedation medications, vital signs, UMSS score and CSI or AAI score. All the evaluations were recorded at awake state (baseline), every 10 s until an UMSS score of 3-4 and every 3 min until the children were awake. RESULTS We enrolled 13 males and seven females ranging in age from 8 months to 7 years. After induction of anesthesia CSI and AAI scores decreased and from the end of the procedure to emergence the two scores increased. The CSI data showed a strong correlation with the UMSS scores (r = -0.861; P < 0.0001); we found a similar correlation between the AAI data and the UMSS scores (r = -0.823; P < 0.0001). CONCLUSIONS Our study suggests that CSI and AAI may be two, real-time and objective tools to assess induction and emergence during propofol sedation in children undergoing EGDS and MRI.
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Affiliation(s)
- Nicola Disma
- Department of Anesthesia and Intensive Care (Director Prof. A. Gullo), Policlinico University Hospital, Catania, Italy.
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Anderson RE, Sartipy U, Jakobsson JG. Use of conventional ECG electrodes for depth of anaesthesia monitoring using the cerebral state index: a clinical study in day surgery. Br J Anaesth 2007; 98:645-8. [PMID: 17371776 DOI: 10.1093/bja/aem061] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The cost-benefit relationship for depth of anaesthesia monitors is complicated by the high cost of specially designed EEG electrodes. The cerebral state index (CSI) monitor will accept regular ECG electrodes with snap connectors. The purpose of this study was to determine if generic ECG electrodes could replace the more expensive proprietary EEG electrodes for the CSI monitor. METHODS Two identical cerebral state monitors were used simultaneously during sevoflurane anaesthesia for knee arthroscopy in 14 ASA I-II patients. One monitor used proprietary (Danmeter) EEG electrodes and the other used ECG electrodes (3M Red Dot Diagnostic ECG Electrodes). Paired CSI values were recorded every other minute. Anaesthetic depth was titrated clinically. Sedation depth was scored according to the Observer's Assessment of Alertness/Sedation (OAAS) scale. RESULTS The agreement between the two measures was found to be high, mean difference--0.23, and the overall repeatability mean bias was 6.6 and 153/163 pairs (94%) were located within the 95% limits of agreement. No major difference was noted in impedance, noise, or artifacts. A large overlap in CSI was noted for each level of the OAAS scale; patients with CSI values as low as 40-50 responded whereas patients not responding to surgical stimulation had CSI values as high as 75. The direct cost of disposables decreased from 4euro to 0.50euro per patient by using ordinary ECG electrodes. CONCLUSIONS Switching from proprietary EEG electrodes to ordinary generic ECG electrodes maintains the same accuracy at about a 10th of the cost when measuring CSI during day surgery with sevoflurane anaesthesia.
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Affiliation(s)
- R E Anderson
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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Cortínez LI, Delfino AE, Fuentes R, Muñoz HR. Performance of the Cerebral State Index During Increasing Levels of Propofol Anesthesia: A Comparison with the Bispectral Index. Anesth Analg 2007; 104:605-10. [PMID: 17312217 DOI: 10.1213/01.ane.0000255152.96354.17] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The cerebral state monitor is a new device to measure depth of anesthesia. In this study we compared the cerebral state monitor with the bispectral index (BIS) monitor during propofol anesthesia. METHODS Fifteen healthy patients received a continuous infusion of propofol (300 mL/h). The cerebral state index (CSI) and the BIS values were recorded until burst suppression ratio > or =60%. Baseline variability, prediction probability, and agreement analysis between indices were evaluated. Clinical markers of loss of consciousness were also assessed. RESULTS Mean awake BIS and CSI values were 95.6 and 91.6, respectively (P = 0.01). BIS and CSI prediction probability values (mean +/- sd) were estimated to be 0.87 +/- 0.08 and 0.86 +/- 0.08, respectively (NS). The CSI tended to stabilize at values of 60-40 when estimated propofol concentrations at the effect site increased from 5 to 8 mug/mL. The BIS stabilized at values of 40-20 when the propofol concentrations at the effect site increased from 7 to 10 mug/mL. The mean BIS-CSI difference was -7.4 with 95% limits of agreement of 22.2 and -36.9. The BIS and CSI correlation with the burst suppression ratio was -0.60 and -0.97, respectively (P < 0.01). Predicted BIS and CSI values for loss of eyelash reflex in 50% and 95% of the patients were different (P < 0.05). CONCLUSION The overall performance of both monitors during propofol induction was similar. However, the different dynamic profiles of these monitors indicate that BIS may be a more useful index for evaluating intermediate anesthetic levels, whereas CSI may be better for evaluating deeper anesthetic levels.
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Affiliation(s)
- Luis I Cortínez
- Departamento de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Hoymork SC, Hval K, Jensen EW, Raeder J. Can the cerebral state monitor replace the bispectral index in monitoring hypnotic effect during propofol/remifentanil anaesthesia? Acta Anaesthesiol Scand 2007; 51:210-6. [PMID: 17330331 DOI: 10.1111/j.1399-6576.2006.01213.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In 2004, the cerebral state monitor, CSM, was launched as a low-cost alternative to the bispectral index, BIS, for monitoring depth of sleep during anaesthesia. We tested whether the two monitors would reflect hypnosis equally during propofol/remifentanil anaesthesia. METHODS During laparoscopy or breast/surface surgery, 55 non-paralyzed patients were monitored simultaneously with the BIS and the CSM. Trend curves for the indexes [BIS and cerebral state index (CSI)] were compared for congruence. The difference between the two indexes for the entire course was quantified, and the ability of the two monitors to separate awake from asleep during induction was described. RESULTS In the majority of the patients, 87%, there was a good fit between the indexes. There were major deviations in seven patients, in whom CSI indicated that the patients were awake during parts of the course despite clinical sleep, correctly identified with the BIS. Both indexes separated awake from asleep during induction in the individual patient, but the overlap in values between patients was more pronounced for CSI. CONCLUSION CSM and BIS show some important differences in measuring hypnotic state during clinical propofol/remifentanil anaesthesia.
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Affiliation(s)
- S C Hoymork
- Department of Anaesthesia, Ullevaal University Hospital and University of Oslo, Faculty Division of Ullevaal University Hospital, Oslo, Norway.
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Brás S, Bressan N, Ribeiro L, Ferreira DA, Antunes L, Nunes CS. Nonlinear modeling of cerebral state index in dogs. Annu Int Conf IEEE Eng Med Biol Soc 2007; 2007:537-540. [PMID: 18002012 DOI: 10.1109/iembs.2007.4352346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The Cerebral State Index (CSI) is an electroencephalogram derived signal representing the depression of central nervous activity produced by anesthetic drugs. In this study, a nonlinear model was developed to describe the CSI tendency during general anesthesia in dogs, by evaluating the effect of the anesthetic drug propofol. The model was based on a compartmental and Hill Equation structure with individually identified parameters. The clinical data of 14 dog surgeries were collected and used for modeling and testing. The model presented good results, following the CSI trend. A model for drug-effect for veterinarian anesthesia is an important step when developing advisory, educational and control systems. The overall aim is to improve animal safety and comfort.
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Affiliation(s)
- Susana Brás
- Faculdade de Ciências da Universidade do Porto, Departamento de Matemática Aplicada, Rua do Campo Alegre 687, Porto, Portugal.
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Anderson RE, Jakobsson JG. Cerebral state index: comparison between pairwise registrations from the left and the right sides of the brain. Br J Anaesth 2006; 97:347-50. [PMID: 16849383 DOI: 10.1093/bja/ael154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Lateralization of cerebral blood flow and EEG activity is known to vary during cognition, sleep and waking. In spite of this, electrode placement for the cerebral state index (CSI) monitor is not specified to a particular side of the brain. This study is designed to determine if pairwise registrations differ for CSI measured simultaneously from the left or right sides of the brain. METHODS In total, 25 ASA I-II patients undergoing elective day surgery under general anaesthesia were recruited. Pairwise recordings were made every minute from two CSI monitors (Cerebral State Monitor, Danmeter A/S; Odense, Denmark) connected to the left and the right side of the head. Sedation was graded according to the observer's assessment of alertness/sedation rating scale and correlated with CSI. RESULTS A large overlap of indices, of similar magnitude, for each side of the brain was seen between different levels of sedation. The agreement between pairwise registrations was high, correlation between the 584 CSI pairs of recordings left/right was r(2)=0.92. CONCLUSIONS Despite known lateralization of the EEC, this study found a very high correlation in CSI derived simultaneously from the left and right sides of the brain by two independent monitors.
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Affiliation(s)
- R E Anderson
- Department of Cardiothoracic Anaesthetics and Intensive Care, Karolinska Hospital Stockholm, Sweden
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