Intrapatient Reproducibility of the BISxp® Monitor

2006 ◽  
Vol 104 (2) ◽  
pp. 242-248 ◽  
Author(s):  
Dagmar J. Niedhart ◽  
Heiko A. Kaiser ◽  
Eric Jacobsohn ◽  
Charles B. Hantler ◽  
Alex S. Evers ◽  
...  
Keyword(s):  
Regression Coefficient ◽  
Anesthetic Management ◽  
Depth Of Anesthesia ◽  
Medical Systems ◽  
Limits Of Agreement ◽  
Zero Bias ◽  
Anesthetic Depth ◽  
Anesthetic Agents ◽  
Anesthesia Providers ◽  
Single Number

Background The Bispectral Index (BIS) reportedly reflects anesthetic depth. It is recommended that anesthetic agents should be titrated to maintain the BIS between 40 and 60 arbitrary BIS units during anesthesia. For anesthesia providers to follow this recommendation, the monitor should be predictably affected by different anesthetic agents and have good interpatient and intrapatient reproducibility. The authors hypothesized that when two BISxp devices (Aspect Medical Systems, Newton, MA) are placed concurrently on the same patient, their readings are concordant throughout the anesthetic period. Methods Simultaneous BIS recordings from two BISxp monitors were obtained during anesthesia at 5-s intervals from 12 participants. Results In total 22,860 concurrent paired BIS readings were obtained. For 10.7% of the time, there were sustained periods of 30 s or greater where the readings suggested a different depth of anesthesia. For 6% of the time, there were sustained periods of 30 s or greater where the readings differed by 10 or more arbitrary BIS units. The regression coefficient (R) for the two devices was 0.65 (range, 0.35-0.92). There was zero bias between the devices, and the 95% limits of agreement ranged between -18 and +17. Conclusion A conflicting anesthetic management was suggested by the simultaneous BIS readings 10.7% of the time. These results suggest that BISxp does not always provide a reproducible single number. Anesthesia providers should not rely exclusively on the BIS reading when assessing depth of anesthesia.

Intraoperative Monitoring of Central Neurophysiology

2017 ◽  
Author(s):  
Alan D. Legatt ◽  
Marc R. Nuwer ◽  
Ronald G. Emerson
Keyword(s):  
Intraoperative Monitoring ◽  
Corticospinal Tract ◽  
Motor Evoked Potentials ◽  
Anesthetic Management ◽  
Depth Of Anesthesia ◽  
Central Nervous System Function ◽  
Anatomy And Physiology ◽  
Anesthetic Agents ◽  
Nervous System Function ◽  
Signal Changes

This chapter covers neurophysiological intraoperative monitoring (NIOM). It describes the relevant neurophysiological signals, their anatomical sources, the techniques used to record them, the manner in which they are assessed, and possible causes of intraoperative signal changes. Techniques used include electroencephalography (EEG), electromyography, and auditory, somatosensory, and motor evoked potentials. Some of these techniques can be used to localize and identify areas of cerebral cortex or the corticospinal tract. Recording of the electromyogram generated by reflex activity can be used to evaluate central nervous system function in some circumstances. EEG can be used to assess depth of anesthesia. Signals can be affected by anesthesia, and the chapter discusses various anesthetic agents, their effects on signals, and considerations for anesthetic management during NIOM. Personnel performing NIOM must be knowledgeable about the anatomy and physiology underlying the signals, the technology used to record them, and the factors (including anesthesia) that can affect them.

scholarly journals BIS-Vista™ Occipital Montage in Patients Undergoing Neurosurgical Procedures during Propofol–Remifentanil Anesthesia

2010 ◽  
Vol 112 (3) ◽  
pp. 645-651 ◽  
Author(s):  
Ashraf A. Dahaba ◽  
Ji Xiu Xue ◽  
Guo Guang Zhao ◽  
Qing Hai Liu ◽  
Guo Xun Xu ◽  
...  
Keyword(s):  
Sensor Placement ◽  
Anesthesia Induction ◽  
Neurosurgical Procedures ◽  
Negative Bias ◽  
Altman Analysis ◽  
Medical Systems ◽  
Limits Of Agreement ◽  
Anesthetic Depth ◽  
Off Label ◽  
Level Of Agreement

Background Neurosurgical procedures that require a frontal approach could be an impediment for a successful Bispectral Index (BIS) frontal sensor placement. The aim of this study was to explore the utility of using the new BIS-Vista monitor (Aspect Medical Systems, Newton, MA) for occipital sensor placement in the patients undergoing brain neurosurgical procedures during propofol-remifentanil anesthesia. Methods Two BIS Quatro sensors (Aspect Medical Systems, Newton, MA) mounted on the occipital and frontal regions were connected to two BIS-Vista monitors at three anesthesia states: before induction, during anesthesia maintenance, and recovery. Results There were significant differences before induction (P = 0.0002) and at anesthesia maintenance (P = 0.0014) between mean +/- SD occipital (83.4 +/- 4.8, 66.7 +/- 7.2) and frontal (93.1 +/- 3.4, 56.9 +/- 9.1) BIS-Vista values. During anesthesia recovery, there was no difference (P = 0.7421) between occipital (54.6 +/- 9.3) and frontal (53.1 +/- 7.3) BIS-Vista values. Bland and Altman analysis revealed a BIS-Vista negative-bias (limits of agreement) of -9.7 (+1.1, -20.5) before anesthesia induction, +9.8 positive-bias (+22.8, -1.7) during anesthesia maintenance, and -0.9 bias (+10.9, -12.8) during anesthesia recovery. Conclusion We demonstrated that not only the regional limits of agreement are too wide to allow data of the two montages to be used interchangeably but also the variation is a function of anesthetic depth. However, keeping in mind a relatively consistent BIS-Vista -10 bias before induction and +10 bias during anesthesia maintenance with limits of agreement of approximately +/-11 BIS units, approximately double the clinically acceptable less than 10 BIS units level of agreement, BIS-Vista off-label occipital montage might be helpful in following a trend of propofol-remifentanil anesthesia in individual cases where frontal access is particularly difficult.

Anesthesia for rabbits submitted to experimental surgeries: Report of a series of eight anesthesias

2020 ◽  
pp. 151-158
Author(s):  
Rafael Antonio Caldart Bedin ◽  
Maisa Schultz ◽  
Antonio Bedin
Keyword(s):  
Muscle Relaxation ◽  
Anesthetic Management ◽  
Laboratory Animals ◽  
Average Weight ◽  
Anesthetic Induction ◽  
Anesthetic Agents ◽  
Reasonable Degree ◽  
Bioethical Debate ◽  
Precordial Stethoscope

Anesthesia for laboratory animals is a matter of biomedical concern and one of the most present dilemmas in the current bioethical debate. The use of anesthetic agents in experimental surgery aims at analgesia and restraining the animal, in order to achieve a reasonable degree of muscle relaxation and to produce sufficient analgesia. This practice requires the use of protocols for the administration of safe and efficient doses. Eight New Zealand rabbits were submitted to laparotomies demonstrating the surgical technique discipline of the local medical course. For pre-anesthetic medication, acepromazine 1 mg.kg-1 associated with ketamine 15 mg.kg-1 was used subcutaneously. Anesthesia was maintained with isoflurane and oxygen under a laryngeal mask in a Mapleson D anesthesia system and under spontaneous breathing. Hydration was performed with 10 ml.kg-1 saline every hour. A thermal mattress was used. Precordial stethoscope, pulse oximetry and clinical parameters were used for monitoring. For euthanasia, ketamine 10 mg.kg-1 associated with potassium chloride 19.1% 1 ml.kg-1 was used intravenously. The average weight of the rabbits was 2721.25 ± 275.01 grams and the duration of the anesthetic procedure was 120 ± 87 minutes. Discussion. In long-term anesthesia, such as laparotomies, the use of pre-anesthetic medication and then anesthetic induction by the combination of agents is recommended. However, anesthetic management requires monitoring to prevent insufficient or excessive doses from occurring.

scholarly journals General anesthesia with remimazolam in a patient with mitochondrial encephalomyopathy: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuji Suzuki ◽  
Matsuyuki Doi ◽  
Yoshiki Nakajima
Keyword(s):  
Lactic Acidosis ◽  
General Anesthesia ◽  
Mitochondrial Disease ◽  
Muscle Relaxation ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Mitochondrial Encephalomyopathy ◽  
Anesthesia Induction ◽  
General Anesthetic ◽  
Anesthetic Agents

Abstract Background Systemic anesthetic management of patients with mitochondrial disease requires careful preoperative preparation to administer adequate anesthesia and address potential disease-related complications. The appropriate general anesthetic agents to use in these patients remain controversial. Case presentation A 54-year-old woman (height, 145 cm; weight, 43 kg) diagnosed with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes underwent elective cochlear implantation. Infusions of intravenous remimazolam and remifentanil guided by patient state index monitoring were used for anesthesia induction and maintenance. Neither lactic acidosis nor prolonged muscle relaxation occurred in the perioperative period. At the end of surgery, flumazenil was administered to antagonize sedation, which rapidly resulted in consciousness. Conclusions Remimazolam administration and reversal with flumazenil were successfully used for general anesthesia in a patient with mitochondrial disease.

Studies to Evaluate the Safety of Constant Rate Infusions of Dexmedetomidine, Ketamine and Lidocaine Alone or in Combination during Isoflurane Anesthesia in Horses

2021 ◽  
Author(s):  
Aswathy Gopinathan ◽  
Kiranjeet Singh ◽  
Sherin B. Sarangom ◽  
V. Ramya ◽  
P. Sangeetha ◽  
...  
Keyword(s):  
Significant Decline ◽  
Constant Rate Infusion ◽  
Anesthetic Depth ◽  
Isoflurane Anesthesia ◽  
Anesthetic Agents ◽  
Constant Rate ◽  
Sparing Effect ◽  
Rate Infusion ◽  
Operative Quality

Background: Horses mount a huge stress response to anesthesia when compared to other animals, hence are risky candidates for anesthesia. Inhalant anesthetic agents offer more control to anesthetic depth and facilitate rapid recovery, hence are considered to be safer than intravenous agents for surgical procedures requiring more than an hour, however, newer drug combinations are being explored to minimize the undesired consequences and dose rate of inhalant agents. The present study explored the safety of dexmedetomidine, ketamine and lidocaine constant rate infusion alone or as a combination along with Isoflurane for safer anesthesia in horses.Methods: The study was conducted on 28 horses divided into S, D, DK and DKL groups having 7 animals in each. Xylazine (1 mg/kg) and butorphanol (0.05mg/kg) were given intravenously for premedication. Ketamine (2 mg/kg) and midazolam (0.2 mg/kg) were used for induction and anesthesia was maintained with isoflurane. Normal saline (1000ml/hour), Dexmedetomidine (2µg/kg/hr), Dexmedetomidine and ketamine (2 µg/kg/hr and 2 mg/kg/hr) and Dexmedetomidine, ketamine and lidocaine (2 µg/kg/hr, 2 mg/kg/hr and 2 mg/kg/h) were given as CRI in groups S, D, DK and DKL, respectively. Thiopentone sodium (250mg bolus, 5%) was given as a fast intravenous bolus whenever required. Anesthetic efficacy was evaluated based on clinical, haemato-biochemical, hemodynamic, and endocrine variables.Result: A significant decline in mean arterial pressure was noticed in group DKL but changes in CVP and SpO2 in different groups were non-significant. Higher Blood glucose and low Insulin levels were seen in group DK during 45-60 min. Constant rate infusions of Dexmedetomidine, Ketamine and Lidocaine alone or in combination produced a significant sparing effect on Isoflurane and thiopentone while they improved peri-operative quality of anesthesia in horses.

scholarly journals Anesthetic Management of the Hypertensive Patient: Part II

2018 ◽  
Vol 65 (3) ◽  
pp. 206-213 ◽  
Author(s):  
Russell Yancey
Keyword(s):  
Blood Pressure ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Anesthetic Management ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Antihypertensive Medications ◽  
Converting Enzyme Inhibitors ◽  
Anesthesia Providers ◽  
Treatment Of Hypertension ◽  
Important Health

Hypertension is an important health challenge that affects millions of people across the world today and is a major risk factor for cardiovascular disease. It is critical that anesthesia providers have a working knowledge of the systemic implications of hypertension. This review article will discuss the medical definitions of hypertension, the physiology of maintaining blood pressure, outpatient treatment of hypertension, anesthetic implications, and the common medications used by anesthesia providers in the treatment of hypertension. Part I provided an overview of hypertension and blood pressure regulation. In addition, drugs predominantly affecting control of hypertension via renal mechanisms such as diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and renin-inhibiting agents were discussed. In part II, the remaining major antihypertensive medications will be reviewed as well as anesthetic implications of managing patients with hypertension.

Transsphenoidal/Pituitary Surgery

2018 ◽  
Author(s):  
Vaia T. Abatzis ◽  
Edward C. Nemergut
Keyword(s):  
Pituitary Gland ◽  
Anesthetic Management ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
Pituitary Surgery ◽  
Anesthetic Care ◽  
Anesthetic Agents ◽  
Intraoperative Management ◽  
Transsphenoidal Pituitary Surgery ◽  
Early Diagnosis Of Diabetes

Patients with tumors of the pituitary gland represent a heterogeneous yet commonly encountered neurosurgical population. Optimal anesthetic care requires an understanding of the complex pathophysiology secondary to each patient’s endocrine disease. Although patients presenting with Cushing’s disease and acromegaly have unique manifestations of endocrine dysfunction, all patients with tumors of the pituitary gland require meticulous preoperative evaluation and screening. There are many acceptable strategies for optimal intraoperative anesthetic management; however, the selection of anesthetic agents should be tailored to facilitate surgical exposure, preserve cerebral perfusion and oxygenation, and provide for rapid emergence and neurological assessment. Postoperatively, careful monitoring of fluid balance and serum sodium is essential to the early diagnosis of diabetes insipidus (DI). DI is most often transient but can require medical therapy. A thorough understanding of the preoperative assessment, intraoperative management, and potential complications are fundamental to successful perioperative patient care and avoidance of morbidity and mortality.

scholarly journals Anesthetic Management of a Child with Mitochondrial Neurogastrointestinal Encephalopathy

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Vianey Q. Casarez ◽  
Acsa M. Zavala ◽  
Pascal Owusu-Agyemang ◽  
Katherine Hagan
Keyword(s):  
Case Report ◽  
Anesthetic Management ◽  
Volatile Anesthetic ◽  
Autosomal Recessive Disorder ◽  
Hearing Impairments ◽  
Hematopoietic Stem ◽  
Gastrointestinal Dysmotility ◽  
Anesthetic Agents ◽  
Medication Selection ◽  
Repeated Use

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an autosomal recessive disorder associated with deficiency of thymidine phosphorylase (TP). Associated manifestations include visual and hearing impairments, peripheral neuropathies, leukoencephalopathy, and malnutrition from concomitant gastrointestinal dysmotility and pseudoobstruction. Given the altered metabolic state in these patients, specific consideration of medication selection is advised. This case report will describe the anesthetic management used in a 10-year-old girl with MNGIE. She had multiple anesthetics while undergoing allogeneic hematopoietic stem cell transplantation. This case report will discuss the successful repeated use of the same anesthetic in this pediatric patient, with the avoidance of volatile anesthetic agents, propofol, and muscle relaxant.

scholarly journals BIS-Guided Total Intravenous Anesthesia for Orchiopexy and Circumcision in a Child with Severe Autism: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Selçuk Okur ◽  
Müge Arıkan ◽  
Gülşen Temel ◽  
Volkan Temel
Keyword(s):  
Bispectral Index ◽  
Index System ◽  
Anesthetic Management ◽  
Hospital Setting ◽  
Total Intravenous Anesthesia ◽  
Intravenous Anesthesia ◽  
Anesthetic Agents ◽  
Postanesthetic Care Unit ◽  
Severe Autism

Autistic children are very difficult to manage in the hospital setting because they react badly to any change in routine. We describe a case of 10-year-old male patient with severe autism undergoing orchidopexy and circumcision. Following premedication, anesthesia was induced with remifentanil, propofol, atracurium, and maintained with total intravenous anesthesia (propofol and remifentanil). The Bispectral Index System was monitored for determination of the depth of anesthesia. After surgery, all infusions were discontinued. The patient was then transferred to the postanesthetic care unit. There were no adverse events observed during the anesthetic management. The patient was discharged from the hospital on the second postoperative day. Bispectral Index System-guided Total Intravenous Anesthesia can provide some advantages for patient with autism, such as hemodynamic stability, early and easy recovery, to facilitate faster discharge, to optimize the delivery of anesthetic agents, to minimize its adverse effects, and to maximize its safety.

scholarly journals Anesthetic Management of a Patient With Systemic Sclerosis and Microstomia

2020 ◽  
Vol 67 (1) ◽  
pp. 28-34
Author(s):  
Yoshiki Shionoya ◽  
Hatsuko Kamiga ◽  
Gentarou Tsujimoto ◽  
Eishi Nakamura ◽  
Kiminari Nakamura ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Respiratory Depression ◽  
Dental Treatment ◽  
Anesthetic Management ◽  
Moderate Sedation ◽  
Emergency Airway ◽  
Analgesic Effects ◽  
Anesthetic Agents ◽  
History Of ◽  
Skin Blood Vessels

Systemic sclerosis (SSc) is an autoimmune disease that can cause fibrosis in vital organs, often resulting in damage to the skin, blood vessels, gastrointestinal system, lungs, heart, and/or kidneys. Patients with SSc are also likely to develop microstomia, which can render dental treatment difficult and painful, thereby necessitating advanced anesthetic management. This is a case report of a 61-year-old woman with a history of SSc with microstomia, interstitial pneumonia, and gastroesophageal reflux disease in whom intravenous moderate sedation was performed using a combination of dexmedetomidine and ketamine for dental extractions. Both anesthetic agents are known to have analgesic effects while minimizing respiratory depression. Consequently, the increased discomfort caused by opening the patient's mouth and stretching the buccal mucosa was sufficiently managed, permitting an increase in maximum interincisal opening and completion of treatment without complications. Patients with SSc present with serious comorbidities that can negatively impact anesthetic management, so the implementation of an anesthetic plan that takes such risks into account is required. Furthermore, emergency airway management is likely to be difficult in patients with microstomia. For intravenous moderate sedation, combined use of dexmedetomidine and ketamine, which have analgesic effects while minimizing respiratory depression, may be particularly effective in patients with SSc and microstomia.

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