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Obert DP, Taetow R, Kratzer S, von Dincklage F, García PS, Schneider G, Kreuzer M. The Effect of Electroencephalographic Trajectory During Anesthesia Emergence on the Indices Monitoring the Hypnotic Component. Anesth Analg 2025:00000539-990000000-01265. [PMID: 40279280 DOI: 10.1213/ane.0000000000007499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2025]
Abstract
BACKGROUND Postoperative neurocognitive disorders (PNDs) are frequent and serious complications that cause an enormous social and economic burden. A previous study demonstrated that certain electroencephalographic (EEG) patterns during emergence from general anesthesia are associated with a higher risk for PND. Compared to patients demonstrating the most favorable trajectory (Traj Ref: delta-dominant slow-wave anesthesia (ddSWA)→spindle-dominant SWA (sdSWA)→non-SWA (nSWA)→wake), patients presenting Traj Abrupt (ddSWA→wake) had 4-fold increased odds to develop PND and patients with Traj High (nSWA→wake) had 8-fold increased odds of developing PND. We hypothesized that commonly used neuromonitoring devices (state entropy [SE], quantium consciousness index [qCON], bispectral index [BIS], and Patient State Index [PSI]) can differentiate between the various trajectories. METHODS From the original database of the study by Hesse et al, we analyzed 59 EEGs from patients emerging from general anesthesia. They were selected according to their trajectory. We included 19 patients who had shown the most favorable trajectory (Traj Ref), 20 who had demonstrated Traj Abrupt, and 20 who had followed Traj High. To evaluate the performance of the neuromonitoring devices, we replayed the patients' EEGs to the monitors using an EEG player. We compared the index values for the 3 different trajectories (Traj Ref, Traj Abrupt, and Traj High) generated by the different monitoring devices, respectively. Additionally, we evaluated the correlation between the monitoring devices. RESULTS SE and PSI were able to resolve significant differences between Traj Ref and Traj Abrupt during a major part of emergence. Traj Ref showed an almost linear increase of index values, whereas Traj Abrupt led to an episode of low index values followed by a sudden increase. However, when comparing Traj Ref vs Traj High, qCON, PSI, and BIS were the indices showing significant differences, especially at the beginning of emergence. Patients representing Traj Ref patterns had significantly lower index values than those depicting Traj High. Due to the Traj High cases starting in nSWA, their indices were already high at the start of emergence. CONCLUSIONS Our analysis revealed that the course of the different indices reflects spectral EEG patterns during the emergence from general anesthesia. Considering certain emergence trajectories associated with a higher risk of developing PND, our approach might enable the anesthetist to identify patients particularly susceptible to PND by observing the course of index values before admission to the postanesthesia care unit.
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Affiliation(s)
- David P Obert
- From the Department of Anesthesiology and Intensive Care, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts
| | - Robin Taetow
- From the Department of Anesthesiology and Intensive Care, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Stephan Kratzer
- Department of Anesthesia and Intensive Care Medicine, Hessing Foundation, Augsburg, Germany
| | - Falk von Dincklage
- Department of Anesthesia, Intensive Care, Emergency and Pain Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Paul S García
- Department of Anesthesiology, Columbia University, New York, New York
| | - Gerhard Schneider
- From the Department of Anesthesiology and Intensive Care, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Matthias Kreuzer
- From the Department of Anesthesiology and Intensive Care, School of Medicine and Health, Technical University of Munich, Munich, Germany
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Zhao BS, Deng B, Chen QB, Li X, Yang Y, Min S. Effect of quantitative consciousness index on seizure parameters during electroconvulsive therapy in patients with major depressive disorder. World J Psychiatry 2024; 14:1375-1385. [PMID: 39319236 PMCID: PMC11417648 DOI: 10.5498/wjp.v14.i9.1375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/18/2024] [Accepted: 08/28/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is both an effective treatment for patients with major depressive disorder (MDD) and a noxious stimulus. Although some studies have explored the effect of sedation depth on seizure parameters in ECT, there is little research on the noxious stimulation response to ECT. In this study, we used two electroencephalography (EEG)-derived indices, the quantitative consciousness (qCON) index and quantitative nociceptive (qNOX) index, to monitor sedation, hypnosis, and noxious stimulation response in patients with MDD undergoing acute ECT. AIM To evaluate the effect of anesthesia depth based on the qCON and qNOX indices on seizure parameters. METHODS Patients with MDD (n = 24) underwent acute bilateral temporal ECT under propofol anesthesia. Before ECT, the patients were randomly divided into three groups according to qCON scores (qCON60-70, qCON50-60, and qCON40-50). Continuous qCON monitoring was performed 3 minutes before and during ECT, and the qCON, qNOX, vital signs, EEG seizure parameters, and complications during the recovery period were recorded. The 24-item Hamilton Rating Scale for Depression, Zung's Self-rating Depression Scale, and Montreal Cognitive Assessment scores were evaluated before the first ECT session, after the fourth ECT session, and after the full course of ECT. RESULTS A total of 193 ECT sessions were performed on 24 participants. The qCON index significantly affected the EEG seizure duration, peak mid-ictal amplitude, and maximum heart rate during ECT (P < 0.05). The qNOX index significantly affected the post-ictal suppression index (P < 0.05). Age, number of ECT sessions, and anesthetic-ECT time intervals also had a significant effect on EEG seizure parameters (P < 0.05). However, there were no significant differences in complications, 24-item Hamilton Rating Scale for Depression scores, Zung's Self-rating Depression Scale scores, or Montreal Cognitive Assessment scores among the three groups (P > 0.05). CONCLUSION Electrical stimulation at a qCON index of 60-70 resulted in better EEG seizure parameters without increasing complications in patients with MDD undergoing bilateral temporal ECT under propofol anesthesia.
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Affiliation(s)
- Bang-Shu Zhao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Bi Deng
- Department of Anesthesiology, The First Clinical College of Chongqing Medical University, Chongqing 400016, China
| | - Qi-Bin Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xiao Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - You Yang
- Department of Anesthesiology, The First Clinical College of Chongqing Medical University, Chongqing 400016, China
| | - Su Min
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Lipp M, Schneider G, Kreuzer M, Pilge S. Substance-dependent EEG during recovery from anesthesia and optimization of monitoring. J Clin Monit Comput 2024; 38:603-612. [PMID: 38108943 PMCID: PMC11164797 DOI: 10.1007/s10877-023-01103-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/28/2023] [Indexed: 12/19/2023]
Abstract
The electroencephalographic (EEG) activity during anesthesia emergence contains information about the risk for a patient to experience postoperative delirium, but the EEG dynamics during emergence challenge monitoring approaches. Substance-specific emergence characteristics may additionally limit the reliability of commonly used processed EEG indices during emergence. This study aims to analyze the dynamics of different EEG indices during anesthesia emergence that was maintained with different anesthetic regimens. We used the EEG of 45 patients under general anesthesia from the emergence period. Fifteen patients per group received sevoflurane, isoflurane (+ sufentanil) or propofol (+ remifentanil) anesthesia. One channel EEG and the bispectral index (BIS A-1000) were recorded during the study. We replayed the EEG back to the Conox, Entropy Module, and the BIS Vista to evaluate and compare the index behavior. The volatile anesthetics induced significantly higher EEG frequencies, causing higher indices (AUC > 0.7) over most parts of emergence compared to propofol. The median duration of "awake" indices (i.e., > 80) before the return of responsiveness (RoR) was significantly longer for the volatile anesthetics (p < 0.001). The different indices correlated well under volatile anesthesia (rs > 0.6), with SE having the weakest correlation. For propofol, the correlation was lower (rs < 0.6). SE was significantly higher than BIS and, under propofol anesthesia, qCON. Systematic differences of EEG-based indices depend on the drugs and devices used. Thus, to avoid early awareness or anesthesia overdose using an EEG-based index during emergence, the anesthetic regimen, the monitor used, and the raw EEG trace should be considered for interpretation before making clinical decisions.
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Affiliation(s)
- Marlene Lipp
- Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, Ismaningerstr 22, 81675, Munich, Germany.
| | - Gerhard Schneider
- Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, Ismaningerstr 22, 81675, Munich, Germany
| | - Matthias Kreuzer
- Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, Ismaningerstr 22, 81675, Munich, Germany
| | - Stefanie Pilge
- Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, Ismaningerstr 22, 81675, Munich, Germany
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Wang H, Wang Q, He Q, Li S, Zhao Y, Zuo Y. Current perioperative nociception monitoring and potential directions. Asian J Surg 2024; 47:2558-2565. [PMID: 38548545 DOI: 10.1016/j.asjsur.2024.03.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 06/05/2024] Open
Abstract
Perioperative nociception-antinociception balance is essential for the prevention of adverse postoperative events. Estimating the nociception level helps optimize intraoperative management. In the past two decades, various nociception monitoring devices have been developed for the identification of intraoperative nociception. However, each type of nociception monitoring device has advantages and disadvantages, limiting their clinical application in particular patients and settings. Therefore, this review aimed to summarize the information on nociceptor monitoring in current clinical settings, explore each technique's particularities, and possible future directions to provide a reference for clinicians and researchers.
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Affiliation(s)
- Haiyan Wang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, China
| | - Qifeng Wang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, China
| | - Qinqin He
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, China
| | - Shikuo Li
- Department of Anesthesiology, Yan'an Hospital of Kunming City, Kunming Medical University, Kunming, Yunnan, China
| | - Yuyi Zhao
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yunxia Zuo
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, China.
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Praveen M, Kumar A, Parikh B, Sikdar I. Evaluation of qCON and qNOX indices in pediatric surgery under general anesthesia. J Anaesthesiol Clin Pharmacol 2024; 40:264-270. [PMID: 38919439 PMCID: PMC11196037 DOI: 10.4103/joacp.joacp_453_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 07/03/2023] [Accepted: 07/03/2023] [Indexed: 06/27/2024] Open
Abstract
Background and Aims The objective of the study was to evaluate the performances of qCON and qNOX indices in pediatric populations undergoing surgery under general anesthesia (GA), focusing on the induction and recovery periods. Both the indices are derived from electroencephalogram (EEG) and implemented in the CONOX monitor (Fresenius Kabi, Germany). Material and Methods After approval of the institutional ethics committee, this prospective observational study was conducted in pediatric patients of either sex in the age group of 1-12 years belonging to the American Society of Anesthesiology (ASA) grade I and II undergoing elective surgery under GA. Anesthetic technique was GA with or without regional analgesia (RA). All patients underwent inhalation induction and maintenance using sevoflurane. Patients were monitored with the use of a CONOX monitoring system (Fresenius Kabi, Germany), connected via a set of electrodes placed over the forehead. qCON and qNOX scores were recorded during awake (on operating table premedicated with oral midazolam 0.5 mg/kg), at induction, at loss of eyelash reflex, intubation/laryngeal mask airway (LMA) insertion, before and after regional anesthesia, surgical incision, at cessation of anesthesia, emergence, extubation, and eye-opening. Registered results were also analyzed compared with the minimum alveolar concentration of sevoflurane (MAC). Results A total of 46 pediatric patients were enrolled in the study with a mean age of 5.6 years. All the patients were either ASA I or II. There was a simultaneous fall and rise of qCON and qNOX upon induction and recovery, respectively. There was a rise in qNOX with surgical incision irrespective of RA. However, there was a greater rise in qNOX following surgical incision in those who did not receive RA (P = 0.33) Also both qCON (P = 0.06) and qNOX (P = 0.41) were poorly correlated with MAC values of sevoflurane during GA in the pediatric population. Conclusions Both qCON and qNOX values change predictably with changes in the conscious level and with different noxious stimuli. Further studies are required to confirm the findings taking into account the postoperative assessment of delirium and recall of intraoperative events.
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Affiliation(s)
- M Praveen
- Department of Anaesthesia and Critical Care, Army Hospital Research and Referral, New Delhi, India
| | - Alok Kumar
- Department of Anaesthesia and Critical Care, Army Hospital Research and Referral, New Delhi, India
| | - Badal Parikh
- Department of Anaesthesia and Critical Care, Army Hospital Research and Referral, New Delhi, India
| | - Indranill Sikdar
- Department of Anaesthesia and Critical Care, Army Hospital Research and Referral, New Delhi, India
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Rogozov V, Vanek T, Maly M, Rocek J, Kacer P. The nociceptive response during adult cardiac surgery measured by the qNOX index: A feasibility study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024; 168:62-67. [PMID: 36321735 DOI: 10.5507/bp.2022.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Monitoring nociception during general anaesthesia remains a substantial challenge. The Conox monitor uses two EEG indices, the qCon and the qNox. The qNox refers to the probability that a nociceptive stimulation triggers a movement of the patient and the response probability of reaction to nociceptive stimulation. We decided to test the feasibility of monitoring the qNOX index during adult cardiac surgery and to investigate whether this index correlates with hemodynamic and hormonal signs of nociceptive stimulation. METHOD We enrolled 19 patients undergoing elective cardiac surgery. These were randomised to 2 groups receiving different doses of sufentanil via target controlled infusion: group A (n=9) 0.25 ng/mL and group B (n=10) 0.75 ng/mL. All patients were maintained at the same depth of anaesthesia. We recorded the Conox monitor indices (qNOX, qCON, electromyographic), hemodynamic variables and plasmatic levels of cortisol and noradrenaline. RESULTS There was significantly higher blood pressure (P=0.013) and plasmatic cortisol (P=0.003) in group A and a significant increase in plasmatic noradrenaline with increasing intensity of surgical stimulation in both groups: A (P=0.001), B (P=0.008). We found no significant corresponding changes in the qNOX index. There was a positive correlation between qNOX and hemodynamic signs of stimulation (P=0.012) and between the qNOX and EMG indices (P=0.013) after endotracheal intubation, but not later after EMG index dropped. CONCLUSION Our results do not support the assumption that signs of nociceptive stimulation during adult cardiac surgery will be reflected by the qNOX index. This may be related to compounding of qNOX processing and use of muscle relaxants. Further investigation on this field is needed.
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Affiliation(s)
- Vladislav Rogozov
- Department of Cardiac Surgery, 3rd Faculty of Medicine, Charles University, Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
- Department of Anaesthesia, Leeds Teaching Hospitals, United Kingdom
| | - Tomas Vanek
- Department of Cardiac Surgery, 3rd Faculty of Medicine, Charles University, Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Marek Maly
- National Institute of Public Health, Prague, Czech Republic
| | - Jan Rocek
- Department of Cardiac Surgery, 3rd Faculty of Medicine, Charles University, Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Kacer
- Department of Cardiac Surgery, 3rd Faculty of Medicine, Charles University, Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
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Lersch F, Zingg TJG, Knapp J, Stüber F, Hight D, Kaiser HA. [Processed EEG for personalized dosing of anesthetics during general anesthesia]. DIE ANAESTHESIOLOGIE 2023; 72:662-676. [PMID: 37552241 PMCID: PMC10457248 DOI: 10.1007/s00101-023-01313-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 08/09/2023]
Abstract
Electroencephalogram (EEG)-guided anesthesia is indispensable in modern operating rooms and has become established as the standard form of monitoring. Many anesthesiologists rely on processed EEG indices in the hope of averting anesthesia-related complications, such as intraoperative awareness, postoperative delirium and other cognitive complications in their patients. This educational review aims to provide information on the five most prevalent monitors used to guide depth of sedation during general anesthesia. This article elucidates the principles underpinning the application of these monitors where known, which are generally based on power in various EEG frequency bands and on the burst suppression pattern. Convinced that EEG-guided anesthesia has the potential of benefitting many surgical patients, it is felt that many basic principles and shortcomings of processed EEG indices need to be better understood in the clinical practice. After discussing the different monitors and clinically relevant data from the literature, the article gives a short practical guidance on how to critically interpret processed EEG information and troubleshooting of confounded indices in the context of clinical situations.
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Affiliation(s)
- F Lersch
- Universitätsklinik für Anästhesiologie und Schmerzmedizin, Inselspital, Universitätsspital Bern, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz
| | - T J G Zingg
- Universitätsklinik für Anästhesiologie und Schmerzmedizin, Inselspital, Universitätsspital Bern, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz
| | - J Knapp
- Universitätsklinik für Anästhesiologie und Schmerzmedizin, Inselspital, Universitätsspital Bern, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz
| | - F Stüber
- Universitätsklinik für Anästhesiologie und Schmerzmedizin, Inselspital, Universitätsspital Bern, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz
| | - D Hight
- Universitätsklinik für Anästhesiologie und Schmerzmedizin, Inselspital, Universitätsspital Bern, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz
| | - H A Kaiser
- Universitätsklinik für Anästhesiologie und Schmerzmedizin, Inselspital, Universitätsspital Bern, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz.
- Zentrum für Anästhesiologie und Intensivmedizin, Hirslanden Klinik Aarau, Hirslanden AG, Schänisweg, 5001, Aarau, Schweiz.
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Boselli E, Fatah A, Ledochowski S, Allaouchiche B. Variations of qCON and qNOX during tracheal suction in ICU patients on sedation and curarization for SARS-CoV2 pneumonia: a retrospective study. J Clin Monit Comput 2023:10.1007/s10877-023-00998-3. [PMID: 37004662 PMCID: PMC10067008 DOI: 10.1007/s10877-023-00998-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 03/15/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Emmanuel Boselli
- Department of Anesthesiology, Centre Hospitalier Pierre Oudot, Bourgoin-Jallieu, France.
- University of Lyon, University Lyon I Claude Bernard, APCSe VetAgro Sup UP, 2021.A10, Marcy L'Étoile, France.
| | - Abdelhamid Fatah
- Department of Intensive Care, Centre Hospitalier Pierre Oudot, Bourgoin-Jallieu, France
| | - Stanislas Ledochowski
- Department of Intensive Care, Centre Hospitalier Pierre Oudot, Bourgoin-Jallieu, France
| | - Bernard Allaouchiche
- University of Lyon, University Lyon I Claude Bernard, APCSe VetAgro Sup UP, 2021.A10, Marcy L'Étoile, France
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Hight D, Kreuzer M, Ugen G, Schuller P, Stüber F, Sleigh J, Kaiser HA. Five commercial 'depth of anaesthesia' monitors provide discordant clinical recommendations in response to identical emergence-like EEG signals. Br J Anaesth 2023; 130:536-545. [PMID: 36894408 DOI: 10.1016/j.bja.2022.12.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND 'Depth of anaesthesia' monitors claim to measure hypnotic depth during general anaesthesia from the EEG, and clinicians could reasonably expect agreement between monitors if presented with the same EEG signal. We took 52 EEG signals showing intraoperative patterns of diminished anaesthesia, similar to those that occur during emergence (after surgery) and subjected them to analysis by five commercially available monitors. METHODS We compared five monitors (BIS, Entropy-SE, Narcotrend, qCON, and Sedline) to see if index values remained within, or moved out of, each monitors' recommended index range for general anaesthesia for at least 2 min during a period of supposed lighter anaesthesia, as observed by changes in the EEG spectrogram obtained in a previous study. RESULTS Of the 52 cases, 27 (52%) had at least one monitor warning of potentially inadequate hypnosis (index above range) and 16 of the 52 cases (31%) had at least one monitor signifying excessive hypnotic depth (index below clinical range). Of the 52 cases, only 16 (31%) showed concordance between all five monitors. Nineteen cases (36%) had one monitor discordant compared with the remaining four, and 17 cases (33%) had two monitors in disagreement with the remaining three. CONCLUSIONS Many clinical providers still rely on index values and manufacturer's recommended ranges for titration decision making. That two-thirds of cases showed discordant recommendations given identical EEG data, and that one-third signified excessive hypnotic depth where the EEG would suggest a lighter hypnotic state, emphasizes the importance of personalised EEG interpretation as an essential clinical skill.
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Affiliation(s)
- Darren Hight
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Matthias Kreuzer
- Department of Anesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine, Munich, Germany
| | - Gesar Ugen
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Schuller
- Department of Anaesthesia, Cairns Hospital, Cairns, QLD, Australia
| | - Frank Stüber
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jamie Sleigh
- Department of Anaesthesia, Waikato Clinical School, University of Auckland, Hamilton, New Zealand
| | - Heiko A Kaiser
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Centre for Anaesthesiology and Intensive Care Medicine, Hirslanden Klinik Aarau, Hirslanden Group, Aarau, Switzerland
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Real-time evaluation of the independent analgesic efficacy of dexmedetomidine. BMC Anesthesiol 2023; 23:68. [PMID: 36870944 PMCID: PMC9985296 DOI: 10.1186/s12871-023-02022-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/16/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Dexmedetomidine has analgesic properties, but the intraoperative analgesic effect of dexmedetomidine is often masked by the effects of other general anaesthetics. Therefore, the degree to which it reduces intraoperative pain intensity remains unclear. The objective of this double-blind, randomised controlled trial was to evaluate the independent intraoperative analgesic efficacy of dexmedetomidine in real-time. METHODS This single-centre study enrolled 181 patients who were hospitalised for below-knee orthopaedic surgeries between 19 January 2021 to 3 August 2021 were eligible for this is single-centre study. Peripheral neural block was performed on patients scheduled for below-knee orthopaedic surgeries. Patients were randomly assigned to the dexmedetomidine or midazolam group and were intravenously administered with 1.5 µg kg-1 h-1 dexmedetomidine or 50 µg kg-1 h-1 midazolam, respectively. The analgesic efficacy was evaluated using the real-time non-invasive nociception monitoring. The primary endpoint was the attainment rate of the nociception index target. The secondary endpoints included the occurrence of intraoperative hypoxemia, haemodynamic parameters, the consciousness index, electromyography and patient outcomes. RESULTS On Kaplan-Meier survival analysis, the defined nociception index target was attained in 95.45% and 40.91% of patients receiving dexmedetomidine and midazolam, respectively. Log-rank analysis revealed that the dexmedetomidine group attained the nociception index target significantly faster and the median attainment time of the nociception index target in the dexmedetomidine group was 15 min. Dexmedetomidine group was associated with a significantly lower incidence of hypoxemia. There was no significant difference in blood pressure between the dexmedetomidine and midazolam groups. Further, the dexmedetomidine group had a lower maximum visual analogue scale score and lower analgesic consumption postoperatively. CONCLUSIONS Dexmedetomidine has independent analgesia and systemically administered as an adjuvant agent has better analgesic efficacy than midazolam without severe side effects. TRIAL REGISTRATION clinicaltrial.gov Registry Identifier: NCT-04675372.Registered on 19/12 /2020.
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Relationship between ANI and qNOX and between MAC and qCON during outpatient laparoscopic cholecystectomy using remifentanil and desflurane without muscle relaxants: a prospective observational preliminary study. J Clin Monit Comput 2023; 37:83-91. [PMID: 35445895 DOI: 10.1007/s10877-022-00861-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 03/31/2022] [Indexed: 01/24/2023]
Abstract
This study was designed to investigate qCON and qNOX variations during outpatient laparoscopic cholecystectomy using remifentanil and desflurane without muscle relaxants and compare these indices with ANI and MAC. Adult patients undergoing outpatient laparoscopic cholecystectomy were included in this prospective observational study. Maintenance of anesthesia was performed using remifentanil targeted to ANI 50-80 and desflurane targeted to MAC 0.8-1.2 without muscle relaxants. The ANI, qCON and qNOX and desflurane MAC values were collected at different time-points and analyzed using repeated measures ANOVA. The relationship between ANI and qNOX and between qCON and MAC were analyzed by linear regression. The ANI was comprised between 50 and 80 during maintenance of anesthesia. Higher values of qNOX and qCON were observed at induction and extubation than during all other time-points where they were comprised between 40 and 60. A poor but significant negative linear relationship (r2 = 0.07, p < 0.001) was observed between ANI and qNOX. There also was a negative linear relationship between qCON and MAC (r2 = 0.48, p < 0.001) and between qNOX and remifentanil infusion rate (r2 = 0.13, p < 0.001). The linear mixed-effect regression correlation (r2) was 0.65 for ANI-qNOX and 0.96 for qCON-MAC. The qCON and qNOX monitoring seems informative during general anesthesia using desflurane and remifentanil without muscle relaxants in patients undergoing ambulatory laparoscopic cholecystectomy. While qCON correlated with MAC, the correlation of overall qCON and ANI was poor but significant. Additionally, the qNOX weakly correlated with the remifentanil infusion rate. This observational study suggests that the proposed ranges of 40-60 for both indexes may correspond to adequate levels of hypnosis and analgesia during general anesthesia, although this should be confirmed by further research.
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Horáček M. Monitoring of processed EEG under anesthesia II. ANESTEZIOLOGIE A INTENZIVNÍ MEDICÍNA 2022. [DOI: 10.36290/aim.2022.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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13
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Vazquez PM, Jensen EW. Different perspectives for monitoring nociception during general anesthesia. Korean J Anesthesiol 2022; 75:112-123. [PMID: 35172074 PMCID: PMC8980281 DOI: 10.4097/kja.22002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 02/15/2022] [Indexed: 11/30/2022] Open
Abstract
Safe anesthesia is achieved using objective methods that estimate the patient’s state during different phases of surgery. A patient’s state under anesthesia is characterized by three major aspects, which are linked to the main effects produced by each of the families of anesthetic agents administered: hypnosis, analgesia, and muscular relaxation. While quantification techniques designed to assess muscular relaxation under neuromuscular blocking agents have a relatively long history with a high degree of standardization and understanding (e.g., the train-of-four), the knowledge and techniques used to the depth of hypnosis assessment suffer from a lesser degree in both standardization and interpretation due to brain complexity. The problem of standardization and interpretation in the analgesia and nociception assessment increases since it involves more systems, the central nervous system, and the autonomic nervous system. This helps to explain why there are multiple a priori valid approaches to develop nociception monitoring from different interpretations and physiological bases of noxious stimuli processing. Thus, in this review, the current monitoring technologies clinically available for estimating a patient’s nociception under general anesthesia are described.
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Affiliation(s)
- Pablo Martinez Vazquez
- Deutsches Primaten Zentrum (DPZ), 37077 Goettingen, Germany.,R&D of Quantium Medical/Fresenius Kabi. Barcelona, Spain
| | - Erik Weber Jensen
- R&D of Quantium Medical/Fresenius Kabi. Barcelona, Spain.,Automatic Control and Information (ESAII) Department, CREB. UPC-Barcelonatech, Barcelona, Spain
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Harsha MS, Bhatia PK, Sharma A, Sethi P. Comparison of Quantium Consciousness Index and Richmond Agitation Sedation Scale in Mechanically Ventilated Critically Ill Patients: An Observational Study. Indian J Crit Care Med 2022; 26:491-495. [PMID: 35656063 PMCID: PMC9067479 DOI: 10.5005/jp-journals-10071-24183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The quantium consciousness index (qCON), an electroencephalography (EEG)-based modality, has no studies regarding intensive care unit (ICU) sedation, though very few studies describe its use for assessing depth of anesthesia in the operation theater. In this study, we evaluated qCON for assessing sedation compared with Richmond Agitation Sedation Scale (RASS) in patients on a mechanical ventilator in the ICU. MATERIALS AND METHODS Eighty-seven mechanically ventilated patients aged between 18 and 60 years were investigated over a 12-hour period. They were given a standardized dosage of sedation comprised of a bolus dose of propofol 0.5 mg/kg and fentanyl 1 µg/kg, and then infusions of propofol 2-5 mg/kg/hour and fentanyl 0.5-2 µg/kg/hour. These drug infusions were adjusted to achieve a RASS score between 0 and -3. Using the qCON monitor, the investigator recorded the qCON values and then assessed the RASS score. RESULTS A total of 1,218 readings were obtained. After contrasting each qCON value correspondingly with time to each RASS value, we found their correlation to be statistically significant (ρ = 0.288, p <0.0001). With the help of receiver operating characteristic (ROC) curves, we were able to differentiate appropriate from inappropriate levels of sedation. A qCON value of 80 had a sensitivity of 72.67% and a specificity of 67.42% (AUC 0.738 with SE 0.021). CONCLUSION qCON can be used for assessing sedation levels in mechanically ventilated critically ill patients. CLINICAL TRIAL REGISTRATION CTRI/2019/07/020064. HOW TO CITE THIS ARTICLE Harsha MS, Bhatia PK, Sharma A, Sethi P. Comparison of Quantium Consciousness Index and Richmond Agitation Sedation Scale in Mechanically Ventilated Critically Ill Patients: An Observational Study. Indian J Crit Care Med 2022;26(4):491-495.
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Affiliation(s)
- Makam S Harsha
- Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pradeep K Bhatia
- Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ankur Sharma
- Department of Trauma and Emergency (Anesthesia), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Priyanka Sethi
- Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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The Strength of Alpha Oscillations in the Electroencephalogram Differently Affects Algorithms Used for Anesthesia Monitoring. Anesth Analg 2021; 133:1577-1587. [PMID: 34543237 DOI: 10.1213/ane.0000000000005704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Intraoperative patient monitoring using the electroencephalogram (EEG) can help to adequately adjust the anesthetic level. Therefore, the processed EEG (pEEG) provides the anesthesiologist with the estimated anesthesia level. The commonly used approaches track the changes from a fast- and a low-amplitude EEG during wakefulness to a slow- and a high-amplitude EEG under general anesthesia. However, besides these changes, another EEG feature, a strong oscillatory activity in the alpha band (8-12 Hz), develops in the frontal EEG. Strong alpha-band activity during general anesthesia seems to reflect an appropriate anesthetic level for certain anesthetics, but the way the common pEEG approaches react to changes in the alpha-band activity is not well explained. Hence, we investigated the impact of an artificial alpha-band modulation on pEEG approaches used in anesthesia research. METHODS We performed our analyses based on 30 seconds of simulated sedation (n = 25) EEG, simulated anesthesia (n = 25) EEG, and EEG episodes from 20 patients extracted from a steady state that showed a clearly identifiable alpha peak in the density spectral array (DSA) and a state entropy (GE Healthcare) around 50, indicative of adequate anesthesia. From these traces, we isolated the alpha activity by band-pass filtering (8-12 Hz) and added this alpha activity to or subtracted it from the signals in a stepwise manner. For each of the original and modified signals, the following pEEG values were calculated: (1) spectral edge frequency (SEF95), (2) beta ratio, (3) spectral entropy (SpEntr), (4) approximate entropy (ApEn), and (5) permutation entropy (PeEn). RESULTS The pEEG approaches showed different reactions to the alpha-band modification that depended on the data set and the amplification step. The beta ratio and PeEn decreased with increasing alpha activity for all data sets, indicating a deepening of anesthesia. The other pEEG approaches behaved nonuniformly. SEF95, SpEntr, and ApEn decreased with increasing alpha for the simulated anesthesia data (arousal) but decreased for simulated sedation. For the patient EEG, ApEn indicated an arousal, and SEF95 and SpEntr showed a nonuniform change. CONCLUSIONS Changes in the alpha-band activity lead to different reactions for different pEEG approaches. Hence, the presence of strong oscillatory alpha activity that reflects an adequate level of anesthesia may be interpreted differently, by an either increasing (arousal) or decreasing (deepening) pEEG value. This could complicate anesthesia navigation and prevent the adjustment to an adequate, alpha-dominant anesthesia level, when titrating by the pEEG values.
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Christenson C, Martinez-Vazquez P, Breidenstein M, Farhang B, Mathews J, Melia U, Jensen EW, Mathews D. Comparison of the Conox (qCON) and Sedline (PSI) depth of anaesthesia indices to predict the hypnotic effect during desflurane general anaesthesia with ketamine. J Clin Monit Comput 2020; 35:1421-1428. [PMID: 33211251 DOI: 10.1007/s10877-020-00619-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
Abstract
Comparison of two depth of anesthesia indices, qCON (Conox) and PSI (Sedline), during desflurane sedation and their sensitivity to random ketamine boluses in patients undergoing routine surgery. The performance of desflurane and ketamine on both indices was analyzed for 11 patients, and the ketamine sensitivity was compared with another group of 11 patients under sevoflurane and propofol.The MOAA/S was used to determine sedation level and pain. Different boluses of ketamine ranging from 10 to 30 mg where randomly administered in both groups and the effect on the indexes were measured after 4 min.The indices were recorded during the whole surgery, and their correlations with the desflurane concentration and the discrimination between awake and anesthetized states were evaluated with the prediction probability statistic (Pk). The Pk values, mean (se), discriminating between awake and anesthetized states were 0.974(0.016) for the qCON and 0.962(0.0123) for the PSI, while the 1-Pk statistic for the qCON and the PSI with respect to the desflurane concentration were 0.927(0.016) and 0.918(0.018), respectively, with no statistically significant differences.The agreement between both depth of hypnosis parameters was assessed under the Bland-Altman plot and the Spearman correlation, rs = 0.57(p < 0.001).During the sevoflurane-propofol anesthesia, which served as a control group, both indices experienced a similar behavior with a no significant change of their median values after ketamine. However, during desflurane anesthesia the qCON index did not change significantly after ketamine administration, qCON (before = 33 (4), after = 30 (17); Wilcoxon, p = 0.89), while the PSI experienced a significant increase, PSI (before = 31(6), after = 39(16) Wilcoxon, p = 0.013).This study shows that qCON and PSI have similar performance under desflurane with good discrimination between the awake and anesthetized states. While both indices exhibited similar behavior under ketamine boluses under a sevoflurane-propofol anesthesia, the qCON index had a better performance under ketamine during desflurane anesthesia.
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Affiliation(s)
| | - Pablo Martinez-Vazquez
- Quantium Medical, Mataro, Barcelona, Spain. .,Deutsches Primaten Zentrum (DPZ)GmbH, Gottingen, Germany.
| | | | - Borzoo Farhang
- University of Vermont Medical Center, Burlington, VT, USA
| | | | | | - Erik Weber Jensen
- Quantium Medical, Mataro, Barcelona, Spain.,Fresenius Kabi GmbH, Bad Homburg, Germany
| | - Donald Mathews
- University of Vermont Medical Center, Burlington, VT, USA
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Time delay of the qCON monitor and its performance during state transitions. J Clin Monit Comput 2020; 35:379-386. [PMID: 32040794 PMCID: PMC7943427 DOI: 10.1007/s10877-020-00480-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 01/31/2020] [Indexed: 01/16/2023]
Abstract
We investigated the performance of the qCON index regarding its time delay for sudden changes in the anesthetic level as well as to separate responsiveness from unresponsiveness during loss and return of responsiveness (LOR and ROR). For evaluation of the time delay, we replayed relevant EEG episodes to the qCON to simulate sudden changes between the states (i) awake/sedation, (ii) adequate anesthesia, or (iii) suppression. We also replayed EEG from 40 patients during LOR and ROR to evaluate the qCON’s ability to separate responsiveness from unresponsiveness. The time delays depended on the type of transition. The delays for the important transition between awake/sedation and adequate anesthesia were 21(5) s from awake/sedation to adequate anesthesia and 26(5) s in the other direction. The performance of the qCON to separate responsiveness from unresponsiveness depended on signal quality, the investigation window, i.e. ± 30 s or ± 60 s around LOR/ROR, and the specific transition being tested. AUC was 0.63–0.90 for LOR and 0.61–0.79 for ROR. Time delay and performance during state transitions of the qCON were similar to other monitoring systems such as bispectral index. The better performance of qCON during LOR than ROR probably reflects the sudden change in EEG activity during LOR and the more heterogeneous EEG during ROR.
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Wang X, Zhang J, Feng K, Yang Y, Qi W, Martinez-Vazquez P, Zhao G, Wang T. The effect of hypothermia during cardiopulmonary bypass on three electro-encephalographic indices assessing analgesia and hypnosis during anesthesia: consciousness index, nociception index, and bispectral index. Perfusion 2019; 35:154-162. [PMID: 31387454 DOI: 10.1177/0267659119864821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The depth of anesthesia is commonly assessed in clinical practice by the patient's clinical signs. However, during cardiopulmonary bypass and hypothermia, common symptoms of nociception such as tachycardia, hypertension, sweating, or movement have low sensitivity and specificity in the description of the patient nociception and hypnosis, in particular, detecting nociceptive stimuli. Better monitoring of the depth of analgesia during hypothermia under cardiopulmonary bypass will avoid underdosage or overdosage of analgesia, especially opioids. Induced hypothermia has a multifactorial effect on the level of analgesia and hypnosis. Thermoregulatory processes appear essential for the activation of analgesic mechanisms, ranging from a physiological strong negative affiliation between nerve conduction velocity and temperature, until significant repercussions on the pharmacological dynamics of the analgesic drugs, the latter decreasing the clearance rate with a subsequent increase in the effect-site concentrations. Under the hypothesis that deep hypothermia induces massive effects on the analgesia and hypnosis levels of the patient, we studied whether hypothermia effects were mirrored by several neuromonitoring indices: two hypnosis indices, consciousness index and bispectral index, and a novel nociception index designed to evaluate the analgesic depth. In this clinical trial, 39 patients were monitored during general anesthesia with coronary atherosclerosis cardiopathy who were elective for on-pump coronary artery bypass graft surgery under hypothermia. The changes and correlation between the consciousness index, bispectral index, and nociception index with respect to the temperature were compared in different timepoints at basic state, during cardiopulmonary bypass and after cardiopulmonary bypass. While the three neuromonitoring indices showed significant correlations with respect to the temperature, the nociception index and consciousness index showed the strongest sensitivities, indicating that these two indices could be an important means of intraoperative neuromonitoring during induced hypothermia under cardiopulmonary bypass.
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Affiliation(s)
- Xiaohua Wang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jinfeng Zhang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kunpeng Feng
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yu Yang
- Department of Cardiac surgery, Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenwei Qi
- Department of Medical Informatics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Pablo Martinez-Vazquez
- Department of Medical Informatics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Guoguang Zhao
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tianlong Wang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
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Zhang H, Lu Y, Wang L, Lv J, Ma Y, Wang W, Li G, Li Y. Bispectral index monitoring of sedation depth during endoscopy: a meta-analysis with trial sequential analysis of randomized controlled trials. Minerva Anestesiol 2019; 85:412-432. [PMID: 30621373 DOI: 10.23736/s0375-9393.18.13227-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Abstract
INTRODUCTION The Bispectral Index (BIS) provides an objective measure of the level of sedation and general anesthesia. We performed this meta-analysis and trial sequential analysis (TSA) of randomized clinical trials to clarify whether BIS monitoring is helpful in enhancing intraprocedual safety, shortening procedure duration or promoting recovery during sedation for endoscopic procedures. EVIDENCE ACQUISITION PubMed, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials [CENTRAL]) databases, reference lists of articles as well as relevant articles from "Google Scholar" were searched until May 31st, 2018. Randomized controlled trials (RCTs) comparing BIS with clinical signs for titration of sedation depth during endoscopy were screened and identified if they reported one of the following outcome measures: intraprocedual safety (hemodynamic stability and cardiorespiratory complications such as hypoxia, hypertension/hypotension, and bradycardia/tachycardia), procedure duration, recovery time and patient/endoscopist's satisfaction. EVIDENCE SYNTHESIS Twelve studies with 13 RCTs recruiting 1372 patients were identified with great inter-trial heterogeneity. Meta-analysis found that BIS monitoring of sedation depth was associated with lower incidences of intraprocedural hypoxia (P=0.009) compared with clinical signs which was not confirmed by TSA. Meta-analysis and TSA found that the endoscopic procedure duration (P=0.143), recovery time (P=0.083), satisfaction scores from both the cases (P=0.085) and endoscopists (P=0.125) and the incidences of hypertension/ hypotension (P=0.639) or heart rates (P=0.201) were similar between BIS and control group. CONCLUSIONS More high-quality large-sampled RCTs are needed to confirm whether BIS monitoring for endoscopy sedation helps reduce intraprocedural hypoxia. BIS monitoring fails to shorten procedure duration, promote recovery or boost satisfaction among patients and endoscopists.
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Affiliation(s)
- Hao Zhang
- Department of Anesthesiology, General Hospital of PLA Rocket Force, Beijing, China
| | - Yan Lu
- Department of Neurology, General Hospital of PLA Rocket Force, Beijing, China
| | - Lei Wang
- Department of Neurology, General Hospital of PLA Rocket Force, Beijing, China
| | - Jin Lv
- Department of Nuclear and Radiation Injury, General Hospital of PLA Rocket Force, Beijing, China
| | - Yuheng Ma
- Department of Anesthesiology, General Hospital of PLA Rocket Force, Beijing, China
| | - Wei Wang
- Department of Anesthesiology, General Hospital of PLA Rocket Force, Beijing, China
| | - Guanhua Li
- Department of Anesthesiology, General Hospital of PLA Rocket Force, Beijing, China
| | - Yongwang Li
- Department of Anesthesiology, General Hospital of PLA Rocket Force, Beijing, China -
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Abstract
Drug-induced sleep endoscopy is a safe and practical technique to evaluate the dynamic upper airway collapse during sleep. We review drug-induced sleep endoscopy in adults, including its indications, technique, evaluation of upper airway collapse, and clinical application. Drug-induced sleep endoscopy is useful to improve treatment options selection for patients with obstructive sleep apnea, especially for those who are unable to accept or tolerate continuous positive airway pressure therapy. Owing to a lack of standardization for drug-induced sleep endoscopy, it is difficult to compare the published literature from different sleep centers across the world.
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Affiliation(s)
- Khai Beng Chong
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
| | - Andrea De Vito
- Head and Neck Department, ENT and Oral Surgery Unit, Morgagni-Pierantoni Hospital, AUSL of Romagna, Via Carlo Forlanini 34, Forlì 47121, Italy
| | - Claudio Vicini
- Head and Neck Department, ENT and Oral Surgery Unit, Morgagni-Pierantoni Hospital, AUSL of Romagna, Via Carlo Forlanini 34, Forlì 47121, Italy
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Eagleman SL, Drover DR. Calculations of consciousness: electroencephalography analyses to determine anesthetic depth. Curr Opin Anaesthesiol 2018; 31:431-438. [PMID: 29847364 DOI: 10.1097/aco.0000000000000618] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW Electroencephalography (EEG) was introduced into anesthesia practice in the 1990s as a tool to titrate anesthetic depth. However, limitations in current analysis techniques have called into question whether these techniques improve standard of care, or instead call for improved, more ubiquitously applicable measures to assess anesthetic transitions and depth. This review highlights emerging analytical approaches and techniques from neuroscience research that have the potential to better capture anesthetic transitions to provide better measurements of anesthetic depth. RECENT FINDINGS Since the introduction of electroencephalography, neuroscientists, engineers, mathematicians, and clinicians have all been developing new ways of analyzing continuous electrical signals. Collaborations between these fields have proliferated several analytical techniques that demonstrate how anesthetics affect brain dynamics and conscious transitions. Here, we review techniques in the following categories: network science, integration and information, nonlinear dynamics, and artificial intelligence. SUMMARY Up-and-coming techniques have the potential to better clinically define and characterize altered consciousness time points. Such new techniques used alongside traditional measures have the potential to improve depth of anesthesia measurements and enhance an understanding of how the brain is affected by anesthetic agents. However, new measures will be needed to be tested for robustness in real-world environments and on diverse experimental protocols.
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Affiliation(s)
- Sarah L Eagleman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, California, USA
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Franzen DP, Walder B, Caduff C, Hetzel J. Conscious Sedation During Bronchoscopy: How Far We’ve Come. CURRENT PULMONOLOGY REPORTS 2017. [DOI: 10.1007/s13665-017-0193-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bispectral Index monitoring in cancer patients undergoing palliative sedation: a preliminary report. Support Care Cancer 2017; 25:3143-3149. [DOI: 10.1007/s00520-017-3722-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
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