Dataset Information

The Effects of Glasgow Coma Scales and Bispectral Index on General Anaesthesia in Neurosurgery Patients.

ABSTRACT:

Objective

Monitorisation under anaesthesia is important for objective evaluation in intracranial surgery. We investigated general anaesthesia management performed by bispectral index (BIS) monitoring in patients who underwent surgery due to intracranial pathology with different Glasgow Coma Scales (GCS).

Methods

Forty-five patients who had been planned to undergo intracranial surgery under general anaesthesia were included in the study. Patients were divided into three groups according to GCS: Group I (n ¼ 15) ¼ 13-15 mildly injured; Group II (n ¼ 15) ¼ 9-12 moderately damaged; Group III (n ¼ 15) ¼ 3-8 severely damaged. Heart rate (HR), mean blood pressure, and use of anaesthetic agent were recorded.

Results

It was found that the consumption of the inhalation agent in Group III was lower than Groups I and II at all time intervals measured, and it was lower in Group II than Group I during the intervals at intraoperative 15th minute and up to 150th minute thereafter. The inhalation agent consumption rates according to the duration of anaesthesia were different between groups. The HR was significantly higher in Group III compared with Group II during the post-operative period. The mean arterial pressure was significantly lower in Group I than Group II preoperatively and at 5th, 10th, 15th, 20th, and 40th minute intra-operatively, whilst it was significantly lower in Group I than Group III preoperatively and 10th minute and 15th minute, intraoperatively.

Conclusion

We found that in patients whose GCS was severely damaged and underwent intracranial surgery under general anaesthesia with BIS monitoring, the consumption of inhalation anaesthetic agent decreased, but opioid consumption did not change.

SUBMITTER: Coker T

PROVIDER: S-EPMC10335724 | biostudies-literature | 2021 Jun

REPOSITORIES: biostudies-literature

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Publications

The Effects of Glasgow Coma Scales and Bispectral Index on General Anaesthesia in Neurosurgery Patients.

Çoker Taygun T Hekimoğlu Şahin Sevtap S Süt Necdet N

Turkish journal of anaesthesiology and reanimation 20210601 3

<h4>Objective</h4>Monitorisation under anaesthesia is important for objective evaluation in intracranial surgery. We investigated general anaesthesia management performed by bispectral index (BIS) monitoring in patients who underwent surgery due to intracranial pathology with different Glasgow Coma Scales (GCS).<h4>Methods</h4>Forty-five patients who had been planned to undergo intracranial surgery under general anaesthesia were included in the study. Patients were divided into three groups acco ...[more]

PMID: 35110143

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Project description:IntroductionThe use of Bispectral Index (BIS) monitors for assessing depth of sedation has led to a reduction in both the incidence of awareness and anaesthetic consumption in total intravenous anaesthesia. However, these monitors are vulnerable to artefacts. In addition to the processed number, the raw frontal electroencephalogram (EEG) can be displayed as a curve on the same monitor. Anaesthesia practitioners can learn to interpret the EEG in a short tutorial and may be quicker and more accurate thanBIS in assessing anaesthesia depth by recognising EEG patterns. We hypothesise that quality of recovery (QoR) in patients undergoing laparoscopic surgery is better, if propofol is titrated by anaesthesia practitioners able to interpret the EEG.Methods and analysisThis is a multicentre, double-blind (patients and outcome assessors) randomised controlled trial taking place in four Swiss hospitals. Patients aged 18 years or older undergoing laparoscopic procedures with general anaesthesia using propofol and anaesthesia practitioners with more than 2 years experience will be eligible. The primary study outcome is the difference in QoR 24 hours after surgery. Secondary outcomes are propofol consumption, incidence of postoperative nausea and vomiting (PONV) and postoperative delirium.QoR and propofol consumption are compared between both groups using a two-sample t-test. Fisher's exact test is used to compare the incidences of PONV and delirium. A total of 200 anaesthesia practitioners (and 200 patients) are required to have an 80% chance of detecting the minimum relevant difference for the QoR-15 as significant at the 5% level assuming a SD of 20.Ethics and disseminationEthical approval has been obtained from all responsible ethics committees (lead committee: Ethikkommission Nordwest- und Zentralschweiz, 16 January 2021). The findings of the trial will be published in a peer-reviewed journal, presented at international conferences, and may lead to a change in titrating propofol in clinical practice.Trial registration numberwww.Clinicaltrialsgov:NCT04105660.

Project description:BackgroundReducing depth of anesthesia and anesthetic exposure may help prevent delirium, but trials have been conflicting. Most studies were conducted under general anesthesia or in cognitively impaired patients. It is unclear whether reducing depth of anesthesia beyond levels consistent with general anesthesia reduces delirium in cognitively intact patients. The authors' objective was to determine whether a bundled approach to reduce anesthetic agent exposure as determined by Bispectral Index (BIS) values (spinal anesthesia with targeted sedation based on BIS values) compared with general anesthesia (masked BIS) reduces delirium.MethodsImportant eligibility criteria for this parallel-arm randomized trial were patients 65 yr or greater undergoing lumbar spine fusion. The intervention group received spinal anesthesia with targeted sedation to BIS greater than 60 to 70. The control group received general anesthesia (masked BIS). The primary outcome was delirium using the Confusion Assessment Method daily through postoperative day 3, with blinded assessment.ResultsThe median age of 217 patients in the analysis was 72 (interquartile range, 69 to 77). The median BIS value in the spinal anesthesia with targeted sedation based on BIS values group was 62 (interquartile range, 53 to 70) and in the general anesthesia with masked BIS values group was 45 (interquartile range, 41 to 50; P < 0.001). Incident delirium was not different in the spinal anesthesia with targeted sedation based on BIS values group (25.2% [28 of 111] vs. the general anesthesia with masked BIS values group (18.9% [20 of 106]; P = 0.259; relative risk, 1.22 [95% CI, 0.85 to 1.76]). In prespecified subgroup analyses, the effect of anesthetic strategy differed according to the Mini-Mental State Examination, but not the Charlson Comorbidity Index or age. Two strokes occurred among patients receiving spinal anesthesia and one death among patients receiving general anesthesia.ConclusionsSpinal anesthesia with targeted sedation based on BIS values compared with general anesthesia with masked BIS values did not reduce delirium after lumbar fusion.Editor’s perspective

Dataset Information

The Effects of Glasgow Coma Scales and Bispectral Index on General Anaesthesia in Neurosurgery Patients.

Objective

Methods

Results

Conclusion

Publications

The Effects of Glasgow Coma Scales and Bispectral Index on General Anaesthesia in Neurosurgery Patients.

Similar Datasets

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