Clinical assessment of homeostasis parameters in evaluation of operation stress

Background. The expansion of the range of clinical and physiological methods, also the development of ideas related with operational stress caused the increase in the number of indicators used to judge the adequacy level of anaesthetic protection. Objective. The research aim was clinical evaluation of the informational content of homeostasis parameters in determining the adequacy of anaesthesia. Materials and methods. The research was conducted on 92 patients, aged 21-79, who underwent large-scale surgical operations in abdominal cavity. Continuous monitoring was conducted to identify hemodynamic indicators: systolic, diastolic, medium and pulse arterial pressure, central venous pressure and heart rate. In the course of the anaesthesia the level of anaesthesia and consciousness of the patient were defined with the aid of BIS (Bispectral Index) monitor and the state of myorelaxation was evaluated according to the indicators of frontal muscle electromyography. Cortisol, adrenocorticotropic hormone (ACTH) and prolactin levels were defined in three stages: I – preoperative, II – at the peak of surgical aggression, III – 30 min after the end of the surgery. In addition to continuous monitoring of other indicators of anesthesia adequacy, comparisons were also made with the data obtained during these stages. Results. At the peak of surgical aggression, which means during the II stage, the level of stress hormones (ACTH, cortisol) were considerably above their upper norm limit despite the fact that the hemodynamics, BIS monitor and electromyography indicators corresponded with the adequate anaesthesia state. At this stage of the operation the attempts to normalize stress hormones values require high doses of analgesics and anaesthetics which can contribute to an increase in anaesthetic risk. Conclusions. Of all the criteria for assessing the adequacy of the anesthesia, the indicators of hemodynamics and gas exchange together with BIS monitoring data are sufficiently informative and easy to provide in the operating period, which is also very important. These indicators respond fairly quickly to the body stress impact.

Dysmenorrhea is associated with a higher incidence of pain after diagnostic hysteroscopy or treatment

Purpose: The purpose of this study was to evaluate whether dysmenorrhea could predict the occurrence of pain perceived after diagnostic hysteroscopy or treatment. Methods: 58 women undergoing diagnostic hysteroscopy or treatment were divided into two groups: patients with dysmenorrhea (Group A) and patients without dysmenorrhea (Group B). Patients underwent routine monitoring after the administration of 7.5 µg of sufentanil by intravenous injection. Propofol infusion was initiated by using a target-controlled infusion pump with concentration initially set at 2 µg/mL in order to maintain a bispectral index monitor (BIS) of 60 to 80. Remifentanil was administered as continuous infusion at 0.05 µg/kg per minute. The total dose of propofol and remifentanil utilized during the procedure was calculated. Results: There were no differences in the characteristics of patients in either group. Multivariate analysis revealed that the presence of dysmenorrhea was significantly correlated with pain (P < 0.05) following the procedure. Conclusion: Dysmenorrhea is associated with a higher incidence of pain after diagnostic hysteroscopy.

Neurophysiologic Monitoring

Neurophysiologic monitoring is a diverse group of instruments that are used to monitor the central and peripheral nervous system during surgical procedures. Some are used to monitor anesthetic depth, whereas others are used by neurologists to monitor the integrity of the nervous system during surgical procedure. The goal of neurophysiologic monitoring is to have reliable, reproducible, and predictive monitors that can identify impending compromise to the neurologic system (or anesthetic) with minimal false predictive value and high positive predictive value. This allows for the identification of neurologic tissues by location and type that are at risk of compromise by vascular and/or mechanical injury. This review contains 3 figures, 8 tables, and 34 references. Key Words: auditory evoked potentials, bispectral index monitor, electrocorticography, electroencephalography, electromyographic monitoring, M-ENTROPY, motor evoked potentials, narcotrend index, sensory evoked potentials, spectral analysis

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.