Contact dermatitis associated with the Bispectral index™ sensor: a case report

Background Contact dermatitis caused by electroencephalography electrodes is rare and insufficiently studied. We described a case of contact dermatitis caused by Bispectral Index (BIS) monitor electrodes. Case presentation A 38-year-old woman underwent tooth extraction under general anesthesia with BIS monitoring. She noticed erythema on her forehead 3 days after surgery, which peaked on the fifth postoperative day. Slight pigmentation was observed at 42 days after surgery. We performed patch testing and confirmed positive reactions to the sensor and some allergens. Conclusions Many reports have attributed contact dermatitis to an allergen present in electrocardiogram electrodes. It is important to recognize that complications similar to those caused by electrocardiogram electrodes can occur with this sensor.

Anaesthetic equipment

This chapter presents anaesthetic equipment used in paediatric anaesthesia. Airway equipment is described in detail with specific examples. This includes a description of the variety of supraglottic airway devices, endotracheal tubes, laryngoscopes for direct and indirect visualization of the larynx, breathing systems, ventilators, and modes of ventilation. Equipment for perioperative monitoring of the paediatric patient is reviewed. Practical advice regarding monitoring neonates and small babies is given particular attention. The use of the bispectral index (BIS) monitor and near-infrared spectroscopy (NIRS) are discussed. New advances in pulse oximetry that enable better monitoring with low perfusion states and motion are included.

Early Diagnosis of Nonconvulsive Status Epilepticus Recurrence with Raw EEG of a Bispectral Index Monitor

Background. Seizures are frequent in ICU and their diagnosis is challenging, often delayed or missed. Their diagnosis requires a conventional EEG recording. When cEEG is not available, there is no consensus on how patients should be monitored when there is high risk of seizure. This case illustrates how a bispectral index monitor allowed an early diagnosis of an NCSE recurrence. Case Presentation. A NCSE was diagnosed at the admission. cEEG was not available and then a bispectral index (BIS) monitor was placed and processed parameters were monitored as usual. During the first and second day, both conventional and BIS’s EEG showed patterns of burst suppression and the BIS value varied between 25 and 35 while the suppression ratio (SR) varied between 20 and 35. On the third day, while hypnotic drugs were withdrawn progressively, raw EEG of the BIS monitor showed spikes, spikes waves, and polyspikes without significant variation of BIS and SR values. Even if processed parameters stayed between their usual ranges, the typical aspect of the real time EEG raised concern for NCSE recurrence. An unplanned conventional EEG recording was urgently requested, and the diagnosis was confirmed and treated. Conclusion. Primitive and secondary brain injuries can lead to seizures which are often purely electrical. Even though BIS monitors cannot substitute the conventional EEG, processed parameters and raw EEG should be always analysed jointly. In the present case, seizure was suspected only on the aspect of real time EEG which showed spikes, spikes waves, and polyspikes.

Monitoring the Depth of General Anaesthesia with Bis Monitor in the Course of Surgical Procedure in Children Shortens the Period of Recovery from General Anaesthesia

Monitoring the depth of general anaesthesia (GA) enables the anaesthetist to reach the optimal depth of GA, and thus prevent the occurrence of too deep or too shallow anaesthesia, together with all associated consequences. Anaesthesia, which is too shallow, increases the risk of perioperative awareness. In adult patients, the incidence of perioperative awareness is 0.1-0.2 % for the total number of GA procedures, in paediatric population, the clinical studies present the incidence of up to 5 % (1973), 0.8 % (2005) for the total number of GA procedures. Perioperative awareness is a serious complication, with possible psychological consequences for the patients, including post-traumatic stress disorder. BIS monitoring is one of the possibilities how to assess the depth of GA. This technique is based on the assessment of EEG curve, when individual parameters of the EEG signal are, using mathematical methods, transformed into a dimensionless number, so-called bispectral index (BIS), the value of which is expressed on the scale from 0 to 100, and which reflects the depth of general anaesthesia. This prospective randomized clinical trial has proven, on a group of 101 children that the use of BIS monitor in the course of GA shortens the period of recovery from general anaesthesia, however, it does not decrease the consumption of inhalation anaesthetics when compared to GA performed without BIS monitoring. The results of the study confirmed the importance of monitoring the depth of GA in patients with intravenous administration of Propofol. The authors have observed an inverse linear relation between the values of BIS and MAC (minimum alveolar concentration).

Optimization of Deep Sedation with Spontaneous Respiration for Therapeutic Endoscopy Combining Propofol and Bispectral Index Monitoring

Background/Aims.This study aimed to establish optimal propofol anesthesia for therapeutic endoscopy, which has not been established.Methodology.We retrospectively investigated data on 89 patients who underwent upper-GI endoscopic submucosal dissection or endoscopic mucosal resection under anesthesia with propofol. Examined doses of propofol were changed according to efficacy and/or adverse events and classified into 5 periods. A bispectral index (BIS) monitor was used at Period 5 to decrease the incidence of adverse events caused by oversedation. The initial dose of propofol was administered after bolus injection of pethidine hydrochloride (0.5 mg/kg), and 1.0 mL of propofol was added every minute until the patients fell asleep. Continuous and bolus infusion were performed to maintain sedation. When the patient moved or an adverse event occurred, the maintenance dose examined was increased or decreased by 5 mL/h regardless of body weight.Results.Dose combinations (introduction : maintenance) and patient numbers for each period were as follows: Period 1 (n=27), 0.5 mg/kg : 5 mg/kg/h; Period 2 (n=11), 0.33 mg/kg : 3.3 mg/kg/h; Period 3 (n=7), 0.5 mg/kg : 3.3 mg/kg/h; Period 4 (n=14), 0.5 mg/kg : 2.5 mg/kg/h; Period 5 (n=30), 0.5 mg/kg : 2.5 mg/kg/h, using BIS monitor. During Period 5, an adverse event occurred in 10.0% of patients, which was lower than that for Periods 1–4.Conclusions.Period 5 propofol anesthesia with BIS protocol could be safe and useful for therapeutic endoscopy under deep sedation with spontaneous respiration.

Abstract 202: The Use of Bispectral Index EEG Monitoring as a Screening Tool for the Reliable Detection of Epileptic Activity in Post--Cardiac Arrest Patients

Background: Assessment of prognosis in post[[Unable to Display Character: –]]cardiac arrest (CA) patients became very challenging since the introduction of therapeutic hypothermia (TH). Continuous EEG monitoring has been proposed to improve prognostication; however, its use is limited due to difficulties in readily interpretation. This emerges the need for a simple EEG montage. The bispectral index (BIS) monitor is a simplified EEG system, mainly calculating an index ranging from 0 (isoelectric EEG) to 100 (full consciousness) to provide information on hypnotic depth of anesthesia. The aim of the study was to validate the accuracy of simplified EEG monitoring in a CA - setting. Methods: BIS monitoring (BIS VISTA TM ) was applied to collect frontotemporal data in TH-treated CA patients. A standard 19 [[Unable to Display Character: –]] channel EEG was performed after return to normothermia. Afterwards, small EEG frames coincident with the time of full EEG registration were extracted from the BIS monitor. We asked 2 neurologists to indicate the presence of status epilepticus (SE), cerebral inactivity (CI), burst suppression (BS) or a diffuse slowing pattern (DS). In addition, these samples were analyzed by 2 inexperienced physicians, who were asked to indicate the presence of SE. Results: Thirty simplified EEG samples were analyzed. According to standard EEG, 11 patients showed a DS pattern, 3 had CI, 6 showed BS and 10 had an SE. Neurologists interpreted all samples with a high accuracy (sensitivity: 82% and specificity: 92%). Only 1 SE was missed by one neurologist. Interobserver reliability was high (kappa=0.843). High correlations were found for the comparison of full and simplified EEG for both neurologists (r=0.809). Further, the 2 inexperienced physicians identified SE with a sensitivity of 85% and specificity of 98%. Conclusion: Simplified EEG monitoring, using BIS, resulted in high accuracy of a simple classification system in post [[Unable to Display Character: –]] CA patients. Not only neurologists, but also treating physicians were capable to identify SE, which may play an important role in the early detection of SE. We suggest using BIS as a screening tool in post [[Unable to Display Character: –]] CA patients to save valuable time in the detection of SE, without replacing the need of full EEG monitoring for confirmation.