The cumulative duration of bispectral index less than 40 concurrent with hypotension is associated with 90-day postoperative mortality: a retrospective study

Abstract Background The relationship between intraoperative low bispectral index (BIS) values and poor clinical outcomes has been controversial. Intraoperative hypotension is associated with postoperative complication. The purpose of this study was to investigate the influence of intraoperative low BIS values and hypotension on postoperative mortality in patients undergoing major abdominal surgery. Methods This retrospective study analyzed 1,862 cases of general anesthesia. We collected the cumulative time of BIS values below 20 and 40 as well as electroencephalographic suppression and documented the incidences in which these states were maintained for at least 5 minutes. Durations of intraoperative mean arterial pressures (MAP) less than 50 mmHg were also recorded. Multivariable logistic regression was used to evaluate the association between suspected risk factors and postoperative mortality. Results Ninety-day mortality and 180-day mortality were 1.5% and 3.2% respectively. The cumulative time in minutes for BIS values falling below 40 coupled with MAP falling below 50 mmHg was associated with 90-day mortality (odds ratio, 1.26; 95% confidence interval, 1.04-1.53; P = .019). We found no association between BIS related values and 180-day mortality. Conclusions Delicate adjustment of anesthetic depth is important to avoid excessive brain suppression and hypotension, which could be associated with postoperative mortality.

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The cumulative duration of bispectral index less than 40 concurrent with hypotension is associated with 90-day postoperative mortality: a retrospective study

10.21203/rs.3.rs-16106/v2 ◽

2020 ◽

Author(s):

Soohyuk Yoon ◽

Seokha Yoo ◽

Min Hur ◽

Sun-Kyung Park ◽

Hyung-Chul Lee ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Retrospective Study ◽

Abdominal Surgery ◽

Bispectral Index ◽

Odds Ratio ◽

Postoperative Mortality ◽

Anesthetic Depth ◽

Cumulative Duration ◽

Cumulative Time

Abstract Background The influence of intraoperative low bispectral index (BIS) values and hypotension on poor clinical outcomes has been controversial. The purpose of this study was to investigate the influence of intraoperative low BIS values and hypotension on postoperative mortality in patients undergoing major abdominal surgery. Methods This retrospective study analyzed 1,862 cases of general anesthesia. We collected the cumulative time of BIS values below 20 and 40 as well as electroencephalographic suppression and documented the incidences in which these states were maintained for at least 5 minutes. Durations of intraoperative mean arterial pressures (MAP) less than 50 mmHg were also recorded. Multivariable logistic regression was used to evaluate the association between suspected risk factors and postoperative mortality. Results Ninety-day mortality and 180-day mortality were 1.5% and 3.2% respectively. The cumulative time in minutes for BIS values falling below 40 coupled with MAP falling below 50 mmHg was associated with 90-day mortality (odds ratio, 1.26; 95% confidence interval, 1.04-1.53; P = .019). We found no association between BIS related values and 180-day mortality. Conclusions Delicate adjustment of anesthetic depth is important to avoid excessive brain suppression and hypotension, which could be associated with postoperative mortality.

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Bispectral Index Monitoring, Duration of Bispectral Index Below 45, Patient Risk Factors, and Intermediate-term Mortality after Noncardiac Surgery in the B-Unaware Trial

Anesthesiology ◽

10.1097/aln.0b013e31820c2b57 ◽

2011 ◽

Vol 114 (3) ◽

pp. 545-556 ◽

Cited By ~ 85

Author(s):

Miklos D. Kertai ◽

Ben J. A. Palanca ◽

Nirvik Pal ◽

Beth A. Burnside ◽

Lini Zhang ◽

...

Keyword(s):

Risk Factors ◽

Bispectral Index ◽

Cox Regression ◽

Postoperative Mortality ◽

Noncardiac Surgery ◽

Volatile Agent ◽

Discriminative Ability ◽

Cox Regression Analysis ◽

Cumulative Duration ◽

End Tidal

Background Postoperative mortality has been associated with cumulative anesthetic duration below an arbitrary processed electroencephalographic threshold (bispectral index [BIS] <45). This substudy of the B-Unaware Trial tested whether cumulative duration of BIS values lower than 45, cumulative anesthetic dose, comorbidities, or intraoperative events were independently associated with postoperative mortality. Methods The authors studied 1,473 patients (mean ± SD age, 57.9 ± 14.4 yr; 749 men) who underwent noncardiac surgery at Barnes-Jewish Hospital in St. Louis, Missouri. Multivariable Cox regression analysis was used to determine whether perioperative factors were independently associated with all-cause mortality. Results A total of 358 patients (24.3%) died during a follow-up of 3.2 ± 1.1 yr. There were statistically significant associations among various perioperative risk factors, including malignancy and intermediate-term mortality. BIS-monitored patients did not have lower mortality than unmonitored patients (24.9 vs. 23.7%; difference = 1.2%, 95% CI, -3.3 to 5.6%). Cumulative duration of BIS values less than 45 was not associated with mortality (multivariable hazard ratio, 1.03; 95% CI, 0.93-1.14). Increasing mean and cumulative end-tidal anesthetic concentrations were not associated with mortality. The multivariable Cox regression model showed a good discriminative ability (c-index = 0.795). Conclusions This study found no evidence that either cumulative BIS values below a threshold of 40 or 45 or cumulative inhalational anesthetic dose is injurious to patients. These results do not support the hypothesis that limiting depth of anesthesia either by titration to a specific BIS threshold or by limiting end-tidal volatile agent concentrations will decrease postoperative mortality.

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Pleural Solitary Fibrous Tumors—A Retrospective Study on 45 Patients

Medicina ◽

10.3390/medicina56040185 ◽

2020 ◽

Vol 56 (4) ◽

pp. 185 ◽

Cited By ~ 1

Author(s):

Cornel Savu ◽

Alexandru Melinte ◽

Radu Posea ◽

Niculae Galie ◽

Irina Balescu ◽

...

Keyword(s):

Retrospective Study ◽

Ct Scan ◽

Single Case ◽

Postoperative Mortality ◽

Diagnostic Methods ◽

Chest Wall Resection ◽

En Bloc ◽

Curative Intent ◽

Solitary Fibrous Tumors ◽

Thoracic Ct

Introduction: The purpose of this paper is to study the type, the clinical presentation, and the best diagnostic methods for pleural solitary fibrous tumors (PSFTs), as well as to evaluate which is the most appropriate treatment, especially as PSFTs represent a rare occurrence in the thoracic pathology. Material and Method: A retrospective study was conducted on a group of 45 patients submitted to surgery between January 2015 and December 2019. In most cases, the diagnosis was established through imaging studies—thoracic computed tomography (CT) scan with or without contrast—but also using magnetic resonance imaging (MRI) or positron emission tomography (PET) scans when data from CT scans were scarce. All patients were submitted to surgery with curative intent. Results: Most patients included in this study were asymptomatic, with this pathology being more common in patients over 60 years of age, and more common in women. The occurrence of malignant PSFT in our study was 17.77% (8 cases). All cases were submitted to surgery with curative intent, with a single case developing further recurrence. In order to achieve complete resection en bloc resection of the tumor with the chest wall, resection was performed in two cases, while lower lobectomy, pneumectomy, and hemidiaphragm resection, respectively, were needed in each case. Postoperative mortality was null. Conclusion: Thoracic CT scan remains the most important imagistic investigation in diagnosing. MRI is superior to thoracic CT, especially in cases that involved the larger blood vessels within the thorax, spinal column, or diaphragm. Complete surgical resection is the gold standard in treatment of PSFT, and the prognosis in benign cases is very good.

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Depth of anesthesia measured by bispectral index and postoperative mortality: A meta-analysis of observational studies

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2019.01.046 ◽

2019 ◽

Vol 56 ◽

pp. 119-125 ◽

Cited By ~ 5

Author(s):

Yu-Hua Liu ◽

Dong-Jie Qiu ◽

Li Jia ◽

Jun-Tao Tan ◽

Jin-Meng Kang ◽

...

Keyword(s):

Bispectral Index ◽

Observational Studies ◽

Meta Analysis ◽

Postoperative Mortality ◽

Depth Of Anesthesia

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Retrospective Study of Postoperative Mortality at a Tertiary Children's Hospital in Iran: A Cross Sectional Study

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2021.10.051 ◽

2021 ◽

Author(s):

Mohammad Gharavifard ◽

Majid Sharifian ◽

Amir R. Reihani

Keyword(s):

Retrospective Study ◽

Postoperative Mortality ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Children's Hospital ◽

Children’S Hospital

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Association of Perioperative Risk Factors and Cumulative Duration of Low Bispectral Index with Intermediate-term Mortality after Cardiac Surgery in the B-Unaware Trial

Anesthesiology ◽

10.1097/aln.0b013e3181d5e0a3 ◽

2010 ◽

Vol 112 (5) ◽

pp. 1116-1127 ◽

Cited By ~ 117

Author(s):

Miklos D. Kertai ◽

Nirvik Pal ◽

Ben J. A. Palanca ◽

Nan Lin ◽

Sylvia A. Searleman ◽

...

Keyword(s):

Cardiac Surgery ◽

Bispectral Index ◽

Cox Regression ◽

Medical Center ◽

Discriminative Ability ◽

Cox Regression Analysis ◽

Risk Of Death ◽

Increased Risk ◽

Significant Difference ◽

Cumulative Duration

Background Current data suggest that mortality after noncardiac surgery may be associated with persistent hypotension and the cumulative duration of low processed electroencephalogram-based bispectral index (BIS). This study assessed the relationships among cumulative duration of low BIS (BIS < 45), intermediate-term mortality, and anesthetic dose after cardiac surgery. Methods The authors studied 460 patients (mean age, 63.0 +/- 13.1 yr; 287 men) who underwent cardiac surgery between September 2005 and October 2006 at Washington University Medical Center, St Louis, Missouri. By using multivariable Cox regression analysis, perioperative factors were evaluated for their potential association with intermediate-term all-cause mortality. Results A total of 82 patients (17.8%) died during a median follow-up of 3 yr (interquartile range, 2.7-3.3 yr). Comparing patients who died with those who survived, there was no statistically significant difference in the relationship between end-tidal anesthetic gas concentrations during the anesthetic maintenance phase and the BIS. Cumulative duration of low BIS was independently associated with intermediate-term mortality. The 1.29 adjusted hazard ratio (95% CI, 1.12-1.49) for intermediate-term mortality with cumulative duration of low BIS translated into a 29% increased risk of death for every cumulative hour spent with a BIS less than 45. The final multivariable Cox regression model showed a good discriminative ability (c-index of 0.78). Conclusions This study found an association between cumulative duration of low BIS and mortality in the setting of cardiac surgery. Notably, this association was independent of both volatile anesthetic concentration and duration of anesthesia, suggesting that intermediate-term mortality after cardiac surgery was not causally related to excessive anesthetic dose.

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