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Changes in the bispectral index in Response to Loss of Consciousness and No Somatic Movement to Nociceptive Stimuli in Elderly Patients

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Chinese Medical Journal 2016年第4期129卷 410-416页

作者： Ning Yang Yun Yue Jonalhan Z Pan Ming-Zhang Zuo Yu Shi Shu-Zhen Zhou Wen-Ping Peng Jian-Dong Gao Department of Anesthesiology Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China Department of Anesthesiology Beijing Hospital Beijing 100730 China Department of Anesthesiology and Perioperative Care Brain and Spinal Injury Center University of California San Francisco CA 94110 USA

Background： bispectral index （BIS） is considered very useful to guide anesthesia care in elderly patients, but its use is controversial for the evaluation of the adequacy of analgesia.This study compared the BIS changes in response to loss of consciousness （LOC） and loss of somatic response （LOS） to nociceptive stimuli between elderly and young patients receiving intravenous target-controlled infusion （TCI） of propofol and remifentanil.Methods： This study was performed on 52 elderly patients （aged 65-78 years） and 52 young patients （aged 25-58 years）, American Society of Anesthesiologists physical status Ⅰ or Ⅱ.Anesthesia was induced with propofol administered by TCI.A standardized noxious electrical stimulus （transcutaneous electrical nerve stimulation, [TENS]） was applied （50 Hz, 80 mA, 0.25 ms pulses for 4 s） to the ulnar nerve at increasing remifentanil predicted effective-site concentration （Ce） until patients lost somatic response to TENS.Changes in awake, prestimulus, poststimulus BIS, heart rate, mean arterial pressure, pulse oxygen saturation, predicted plasma concentration, Ce of propofol, and remifentanil at both LOC and LOS clinical points were investigated.Results： BISLOC in elderly group was higher than that in young patient group （65.4 ＆#177; 9.7 vs.57.6 ＆#177; 12.3）（t =21.58, P 〈 0.0001） after TCI propofol, and the propofol Ce at LOC was 1.6 ＆#177; 0.3 μg/ml in elderly patients, which was significantly lower than that in young patients （2.3 ＆#177; 0.5 μg/ml）（t =7.474, P 〈 0.0001）.As nociceptive stimulation induced BIS to increase, the mean of BIS maximum values after TENS was significantly higher than that before TENS in both age groups （t =8.902 and t =8.019, P 〈 0.0001）.With increasing Ce of remifentanil until patients lost somatic response to TENS, BISLOS was the same as the BISLOC in elderly patients （65.6 ＆#177; 10.7 vs.65.4 ＆#177; 9.7）, and there were no marked differences between elderly and young patient groups in BISawake, BISLOS, and Ce of remifentanil required for LOS.Conclusion： In e

关键词： bispectral index Elderly Nociceptive Stimuli Propofol Remifentanil

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Neuroprotective effect of bispectral index-guided fast-track anesthesia using sevoflurane combined with dexmedetomidine for intracranial aneurysm embolization

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Neural Regeneration Research 2018年第2期13卷 280-288页

作者： Chao-liang Tang Juan Li Zhe-tao Zhang Bo Zhao Shu-dong Wang Hua-ming Zhang Si Shi Yang Zhang Zhong-yuan Xia Department of Anesthesiology Renmin Hospital of Wuhan University Department of Anesthesiology Anhui Provincial Hospital of Anhui Medical University Department of Pharmacy Anhui Provincial Hospital of Anhui Medical University Department of Neurosurgery Anhui Provincial Hospital of Anhui Medical University

Dexmedetomidine has sedative, anxiolytic, analgesic, anti-sympathetic, and anti-shivering effects. Dexmedetomidine might be effective in combination with sevoflurane for anesthesia, but prospective randomized controlled clinical trials with which to verify this hypothesis are lacking. In total, 120 patients who underwent embolization of an intracranial aneurysm were recruited from Anhui Provincial Hospital and Renmin Hospital of Wuhan University of China and randomly allocated to two groups. After intraoperative administration of 2% to 3% sevoflurane inhalation, one group of patients received pump-controlled intravenous injection of 1.0 ~tg/kg dexmedetomidine for 15 minutes followed by maintenance with 0.3 ~tg/kg/h until the end of surgery; the other group of patients only underwent pump-controlled infusion of saline. bispectral index monitoring revealed that dexmedetomidine-assisted anesthesia can shorten the recovery time of spon- taneous breathing, time to eye opening, and time to laryngeal mask removal. Before anesthetic induction and immediately after laryngeal mask airway removal, the glucose and lactate levels were low, the S100~ and neuron-specific enolase levels were low, the perioperative blood pressure and heart rate were stable, and postoperative delirium was minimal. These findings indicate that dexmedetomidine can effectively assist sevoflurane for anesthesia during surgical embolization of intracranial aneurysms, shorten the time to consciousness and extubation, reduce the stress response and energy metabolism, stabilize hemodynamic parameters, and reduce adverse reactions, thereby reducing the damage to the central nervous system. This trial was registered at the Chinese Clinical Trial Registry （http：//***. cn/）（registration number： ChiCTR-IPR- 16008113）.

关键词： nerve regeneration dexmedetomidine sevoflurane bispectral index fast-track anesthesia embolization of intracranial aneurysm stress response neuroprotection neural regeneration

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Comparison of the ability of wavelet index and bispectral index for reflecting regain of consciousness in patients undergone surgery

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Chinese Medical Journal 2010年第12期123卷 1520-1523页

作者： ZHANG Xiao-tong CHENG Hao XIONG Wei WANG Bao-guo Department of Anesthesiology Beijing Tiantan Hospital CapitalMedical University Beijing 100050 China

Background Wavelet index （WLI） is a new parameter for monitoring depth of anesthesia based on Wavelet analysis. We observed the change of WLI and bispectral index （BIS） in patients regain of consciousness （ROC） in the absence of frontalis electromyographic （EMG） interference. The aim of this study was to compare the ability of WLI and BIS for reflecting ROC in patients undergone surgery. Methods Twelve patients who were scheduled for maxillofacial surgeries were enrolled in the study. BIS and WLI values were monitored continually. After being given midazolam and remifentanil, patients were asked to squeeze the investigator＇s hand ever 30 seconds. Patients were continuously given propofol until loss of consciousness （LOC1）. Tunstalrs isolated forearm technique was used to test the surgical consciousness in patients. After total muscle relaxation endotracheal intubations were performed, and the patients were connected to a ventilator. Then, propofol was withdrawn until the patients showed regain of consciousness （ROC1） and an awareness reaction. After the command test, patients were readministered with propofol until loss of consciousness （LOC2）. After surgery, all of the sedatives were withdrawn, and the patients were let to regain consciousness （ROC2）, Results The BIS values of twelve patients at ROC1 after using muscle relaxant were much lower than those at LOC1 and ROC2 without using muscle relaxant, showing statistical significance （P 〈0.05）. Meanwhile, the WLI values of twelve patients at ROC1 after using muscle relaxant were much higher than those at LOC1 and equal to ROC2 without using muscle relaxant, showing statistical significances （P 〈0.05） between ROC1 and LOCI. Conclusions This study showed that under muscle relaxation or facial paralysis, when there is no EMG signal, BIS can not accurately reflect regain of consciousness in surgical patients, but WLI can reflect it accurately. So WLI may have advantages for reflecting state of consciousness in surgical patients.

关键词： frontalis electromyographic activity wavelet index bispectral index tunstall＇s isolated forearmexperiments regain of consciousness

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Comparison of C50 for Propofol-remifentanil Target-controlled Infusion and bispectral index at Loss of Consciousness and Response to Painful Stimulus in Elderly and Young Patients

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Chinese Medical Journal 2015年第15期128卷 1994-1999页

作者： Ning Yang Ming-Zhang Zuo Yun Yue Yun Wang Yu Shi Xue-Na Zhang Department of Anaesthesiology Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China Department of Anaesthesiology Beijing Hospital Beijing 100730 China

Background：In this prospective randomized study,we compared the predicted blood and effect-site C50 for propofol and remifentanil target-controlled infusion （TCI） and the bispectral index （BIS） values at loss of consciousness （LOC） and response to a standard noxious painful stimulus （LOS） in elderly and young patients,respectively.We hypothesized that the elderly patients will require lower target concentration of both propofol and remifentanil at above two clinical end-points.Methods：There were 80 American Society of Anesthesiologists （ASA） physical status Ⅰ Ⅱ unpremedicated patients enrolled in this study,they were divided into elderly group （age ≥65 years,n =40） and young group （aged 18-54 years,n =40）.Propofol was initially given to a predicted blood concentration of 1.2 μg/ml and thereafter increased by 0.3 μg/ml every 30 s until Observer＇s Assessment of Alertness and Sedation score was 1.The propofol level was kept constant,and remifentanil was given to provide a predict blood concentration of 2.0 ng/ml,and then increased by 0.3 ng/ml every 30 s until loss of response to a tetanic stimulus.BIS （version 3.22,BIS Quattro sensor） was also recorded.Results：In elderly group,the propofol effect-site C50 at LOC of was 1.5 （1.4-1.6） μg/ml,was significantly lower than that of young group,which was 2.2 （2.1-2.3） μg/ml,the remifentanil effect-site C50 at LOS was 3.5 （3.3-3.7） ng/ml in elderly patients,was similar with 3.7 （3.6-3.8） ng/ml in young patients.Fifty percent of patients lost consciousness at a BIS value of 57.3 （56.4-58.1）,was similar with that of young group,which was 55.2 （54.0-56.3）.Conclusion：In elderly patients,the predicted blood and effect-site concentrations of propofol at LOC were lower than that of young patients.At same sedation status,predicted blood and effect-site concentrations of remifentanil required at LOS were similar in elderly and young patients.BIS were not affected by age.Low-propofol/high-opioid may be optional TCI strategy for elderly patients.

关键词： bispectral index Painful Stimulus Propofol-remifentanil Target-controlled Infusion

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Comparison of Entropy vs. bispectral index Anesthetic Depth Monitoring during Isoflurane Anesthesia in Living Donor Liver Transplantation: Observational Study

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Open Journal of Anesthesiology 2021年第5期11卷 137-148页

作者： Sang Hyun Lee Janie Jang Kyunga Kim Heejin Yoo Yu Jeong Bang Ji-Won Choi Gaab Soo Kim Department of Anesthesiology and Pain Medicine Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea Statistics and Data Center Research Institute for Future Medicine Samsung Medical Center Seoul Korea

Liver transplantation (LT) recipients are known to require less anesthetic agents. Providing minimally required anesthetics while avoiding awareness is especially important in LT recipients because it would help manage perioperative hemodynamic instability with less vasopressor and fast track recovery. This study aims to compare state entropy (SE) against bispectral index (BIS) during isoflurane anesthesia in LT. We adjusted anesthesia to BIS values 40 - 60, and compared it with concomitant SE values. BIS, SE values, and anesthetic requirements according to liver failure severity, etiology and LT stages were analyzed. For BIS-SE differences, SE value that is different from the concomitant BIS by more than 15 was defined as a significant disagreement. Mann Whitney, Kruskal Wallis test and a Poisson exact test were used for analysis. The BIS-SE pair sets of 2895 from 38 patients were analyzed. BIS, SE values and anesthetic requirements were significantly lower in MELD ≥ 20 (p < 0.001 in all) and in alcoholic etiology (p < 0.001 in all). For BIS-SE differences, 320 disagreement data pairs were seen at a rate of 1.33 times/hr (95% CI = [1.19, 1.48], p < 0.001). A significant disagreement was delineated in MELD score ≥ 20 (3.04 times/hr, CI = [2.64, 3.49], p < 0.001), alcoholic etiology (3.19 times/hr, [2.67, 3.78], p < 0.001) and postreperfusion stage (1.63 times/hr, [1.43, 1.85], p < 0.001). In these significant BIS-SE differences, 95.9% (307/320 disagreement data pairs) showed higher BIS than SE. In conclusion, in high MELD and alcoholic etiology, anesthetic requirements were significantly less, and BIS and SE showed great discrepancy with lower SE values. Therefore, when SE monitoring is used during LT, anesthesiologists may need to consider that in high MELD and alcoholic etiology, SE tends to show lower values than the concomitant BIS values that are within optimal anesthetic depth ranges.

关键词： Anesthetic Depth bispectral index Entropy Liver Transplantation Isoflurane

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The bispectral index Interest during General Anesthesia at the University Hospital of Parakou (Republic of Benin) in 2019

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Open Journal of Anesthesiology 2021年第3期11卷 59-71页

作者： Tchaou Blaise Adelin Tchégnonsi N'vènonfon Charles Frédéric Ezadjomo Evouna Ndoh Agnès Nina Zoumenou Eugene Brouh Yapo Chobli Martin Department of Anesthesia-Resuscitation and Emergency Borgou-Alibori University Hospital Center Parakou Benin Anesthesia-Resuscitation and Pediatric Emergencies Hospital of Mother and Child of Bingerville Bingerville Rep. Cote d’Ivoire

Background: The bispectral index (BIS) derived from the electroencephalogram is an additional means of monitoring the depth of narcosis. Objective: To compare the monitoring of the depth of narcosis by the BIS associated with clinical data versus standard monitoring at the University Hospital of Parakou in Benin in 2019. Methods: This was an observational study for descriptive and analytical purposes with prospective data collection, carried out in general surgery and intensive care unit for 4 months. The inclusion criteria were: an age ≥ 18 years, an ASA score ≤ 3, surgery under general anesthesia and informed consent of the patient. Two groups were formed: non-BIS group monitored by clinical parameters (PA, FC, FR, EtCO2, and SpO2) only and BIS group monitored by bispectral index in addition to clinical parameters. Patients were seen 48 hours after the procedure. Results: 36 patients were collected. The mean age was 40.63 ± 16.77 years with a sex ratio of 3. ASA 1 patients represented 86.11% of the sample and ASA2 patients 13.89%. The average doses of Propofol were not significantly reduced in the BIS group (p = 0.555). On the other hand, the period of intraoperative recovery (p-value = 0.007) and the NVPO (p = 0.043;OR = 0.10;95% CI [0.01 - 0.97]) were significantl

关键词： General Anesthesia Narcosis bispectral index Monitoring

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bispectral index in predicting the prognosis of patients with coma in intensive care unit

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World Journal of Emergency Medicine 2014年第1期5卷 53-56页

作者： Lin Dou Hong-mei Gao Ling Lu Wen-xiu Chang Intensive Care Unit Tianjin First Central Hospital

BACKGROUND: The bispectral(BIS) index is a processed electroencephalogram(EEG) parameter with extensive validation and demonstrated clinical utility. The study aimed to investigate the correlation between the BIS index and the prognosis of patients with coma in the ICU.METHODS: A total of 208 patients with coma in the ICU were enrolled in this study. According to the BIS value, the patients were divided into four groups: group I, BIS value 0 to 20; group II, BIS value 21 to 40; group III, BIS value 41 to 60; and group IV, BIS value greater than 60. The difference in BIS values with the differences in prognosis of patients with coma was compared between the four groups, and the prognosis of patients with coma was stratified into consciousness, coma, vegetative state, and brain death. Subsequently, the best cut-off score of BIS values calculated for determining the correlation between BIS value and mental state was proposed.RESULTS: There are no significant differences in the age and APACHE II scores between the four groups(P>0.05). An inverse correlation was observed between BIS value and mental state(r= –0.749, P=0.00). According to the ROC curve, as BIS value was greater than 42.5, there were higher sensitivity and specificity in conscious-coma patients.CONCLUSION: BIS value is correlated with the prognosis of patients with coma in ICU, and BIS value can be a useful marker for estimating the prognosis of comatose patients.

关键词： bispectral index Coma Prognosis

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Comparison between the performance of bispectral index and Skin conductance monitoring during propofol sedation with target-controlled infusion

Comparison between the performance of bispectral index and S...

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中国中西医结合麻醉学会[CSIA]年会暨第二届全国中西...

作者： XU Zhi-xin WANG Tian-hai WANG tao YIN Ji-feng Department of Anesthesiology First Affiliated Hospital of Xin Jiang Medical University

Objective The purpose of this study was to compare the performance of bispectral index(BIS) and skin conductance(SC) to predict the level of consciousness during sedation produced by propofol with target-controlled infusion(TCI).Methods Epidural anesthesia for orthopaedics surgery were enrolled into this study.After the onset of epidural anesthesia,TCI of propofol was initiated at target plasma concentration of 0.8 μg/ml,increased by 0.8 μg/ml until 0AA/S≤2 stop the target controlled infusion,the patient gradually regained consciousness,until the OAA/S score returned to 5,every 3 minutes evaluation OAA/S score,SC and BIS values were recorded.Results The BIS and SC through this test that could better reflect the general patient’s state of consciousness during sedation,ROC curves specific to the OAA/S score of each level was found,SC in the clear sedation grade(5 4) has fared much better than BIS,the ROC curves were(0.919,0.949;0.761,0.493) and the reaction time is more sensitive;but in the OAA/S <2 and awareness of the recovery process,BIS’s performance is better than the SC,the ROC curves were(0.919,0,949;0.761,0.493);In the process of loss of consciousness the OAA/S correlated fairly well with BIS,SC and target-controlled concentration and r were 0.950,-0.859,-0.710.Logistic regression(logistic regression) correctly predict loss of consciousness 5%50%95%change in skin conductance values were 4.47 uS,3.34 uS and 2.22 uS.Conclusion:SC and BIS can correctly reflect the TCI the depth of sedation during propofol sedation,SC conscious patients for the difference of sedation level than when the BIS more have an advantage.

关键词： bispectral index Skin conductance Conscious sedation Propofol Target-controlled infusion

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Response surface analysis of sevoflurane-remifentanil interactions on consciousness during anesthesia

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Chinese Medical Journal 2012年第15期125卷 2682-2687页

作者： WANG Hui-ling YANG Lu GUO Xiang-yang ZHANG Li-ping BI Shan-shan LU Wei Department of Anesthesiology Peking University Third HospitalBeijing 100191 China Peking University School of Pharmaceutical Science Beijing100191 China

Background Recently, the combination of sevoflurane and remifentanil has been widely used in general anesthesia. In this study, we investigated the sevoflurane-remifentanil pharmacodynamic interactions at clinical concentrations using the observer＇s assessment of alertness/sedation （OAA/S） and the bispectral index （BIS） by response surface analysis. Methods Totally 65 American Society of Anesthesiologists （ASA） I patients age 20 to 50 years old were included in this study. Patients were randomly assigned to be anesthetized with different target end-tidal sevoflurane concentrations that ranged from 0.2% to 3.4% in increments of 0.2%. The end-tidal sevoflurane concentration was maintained constant throughout the study. Remifentanil was infused with a target controlled infusion （TCI） system at increasing step-wise concentrations from 1 ng/ml to 10 ng/ml. The values of OAA/S and BIS at different sevoflurane-remifentanil concentration combinations were measured. The pharmacodynamic interactions between sevoflurane and remifentanil were analyzed by a response surface method. The three-dimensional response surfaces were constructed with Minitab Software. Model parameters were estimated with NONMEM program. Results Sevoflurane and remifentanil acted synergistically on OANS. Sevoflurane alone could produce OANS 〈1 at a minimal alveolar concentration （MAC） of 0.93%. When used in combination with remifentanil at 1, 3, 6, and 10 ng/ml, the corresponding sevoflurane MACs were reduced to 0.79%, 0.58%, 0.48%, and 0.38%, with reductions of 17.2%, 37.6%, 48.4%, and 62.0% from baseline, respectively. In patients administered remifentanil alone, the OANS score was 〉3 even when the remifentanil concentration reached 10 ng/ml. BIS was closely associated with the sevoflurane concentration and the remifentanil concentration did not noticeably influence the relationship between the sevoflurane concentration and BIS. A sevoflurane concentration of （1.04＋0.19）% to （1.81＋0.21）% could maintain a BIS between 60 and 40. Conclusions The respon

关键词： sevoflurane remifentanil response surface, the observer＇s assessment of alertness/sedation bispectral index

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BIS Monitoring on Intraoperative Awareness： A Meta-analysis

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Current Medical Science 2018年第2期38卷 349-353页

作者： Wen-wei GAO Yu-hong HE Lian LIU Quan YUAN Ya-feng WANG Bo ZHAO Department of Critical Care Medicine Renmin Hospital of Wuhan University Wuhan 430060 China Office of Infection Control Renmin Hospital of Wuhan University Wuhan 430060 China Department of Anesthesiology Renmin Hospital of Wuhan University Wuhan 430060 China

Intraoperative awareness is a very serious complication of general anesthesia. Several studies have evaluated the potential association between bispectral index （BIS） and intraoperative awareness, however, the results obtained were controversial. Therefore, we performed a metaanalysis to further assess the association between the BIS monitoring and the incidence of intraoperative awareness. A comprehensive search was conducted to identify all eligible studies from the online literature databases published prior to Feb. 2017. A total of five studies with 17 432 cases and 16 749 controls were included. An odds ratio （OR） and a 95% confidence interval （CI） were calculated to examine the strength of the association. The results showed that in the overall analysis, the association between the BIS monitoring and the incidence of intraoperative awareness was not significant （OR=0.58, 95% CI= 0.22-1.58, P=0.29）. A stratified analysis by comparing different anesthesia methods revealed that BIS monitoring group showed a lower incidence of intraoperative awareness in patients with intravenous anesthesia when compared with non-BIS monitoring group （OR=0.20, 95% CI=0.08-0.49, P=-0.0004）, whereas there was no statistically significant difference in the incidence of intraoperative awareness between BIS and non-BIS monitoring groups in patients with inhalation anesthesia （OR=1. 13, 95% CI=0.56- 2.26, P=-0.73）. In conclusion, our meta-analysis showed that BIS monitoring had no appreciable advantage in the reduction of the intraoperative awareness incidence in inhalation anesthesia, while showed a remarkable superiority in intravenous anesthesia.

关键词： bispectral index intraoperative awareness general anesthesia meta-analysis

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