the bispectral index a sensitive monitor for survival after living donor liver transplantation?

Bispectral index [BIS] monitoring has been established as a standard monitoring method for the assessment of the depth of anesthesia during living donor liver transplantation [LDLT]. We tested the sensitivity and specificity of BIS readings during LDLT in predicting the postoperative 3-month survival. After receiving ethical approval, 42 patients who had undergone LDLT under sevoflurane-fentanyl-rocuronium anesthesia were studied. Correlations between BIS readings and extubation time, postoperative liver function tests, intensive care unit stay, and 3-month mortality were tested. Receiver operating characteristic curves were generated to determine the sensitivity and specificity of the BIS readings during different phases of surgery in predicting the survival outcome. The extubation time, liver function tests, coagulation factors V and VII, and intensive care unit stay were not statistically correlated with the BIS values. Receiver operating characteristic curve analyses showed reasonable sensitivity and specificity of mean BIS values during hepatic resection and neohepatic periods for predicting the 3-month mortality, with an unweighted accuracy of 76 and 73%, respectively. The nonsurvivors had significantly higher mean BIS values during the neohepatic phase [P<0.05]. The researchers concluded that the BIS monitoring during hepatic resection and neohepatic phases seems to be a suitable noninvasive monitoring tool with reasonable sensitivity and specificity for predicting the 3-month mortality after LDLT under sevoflurane-fentanyl anesthesia

Haemodynamic profile of isoflurane versus total intravenous anaesthsia in patients submitted for closed mitral commissurotomy

This study was conducted on 16 patients submitted to closed mitral commissurotomy surgery. They were randomly classified into two groups eight patients each. The first group recieved thiopentone-for induction and isoflourane-vecronium for maintenance The second group received kjtamine-midazolam for induction and then followed by continuous infusion according to a pharmacokinetics based multistepped decreasing regimen. Arterial cannulation and pulmonary artrey catheter were fixed to measure the haemodynamic variables at 5 time points before and during surgery. Data are collected and analysed statistically to compare both groups and record changes during the course of surgery inside each group. The results showed non significant changes between the two groups regarding the haemodynamic parameters recorded, but the systemic vascular resistance [SVR] was significantly increased in the isoflourane group at post-commissurotomy time point. In conclusion, TIVA with ketamine-midazolam can provide a pattern of haemodynamic stability during mitral valve stenosis surgery comparable to that of isoflurane. Concomitant ad-minsteration of midazolam to ketamine according to the regemin used in this study almost neutralized the cardiovascular effects of ketamine