Clinical significance of bispectral index monitoring in patients with acute severe carbon monoxide poisoning / 中华劳动卫生职业病杂志

Objective: To analyze the correlation of bispectral index (BIS) with the prognosis of patients with acute severe carbon monoxide poisoning (ASCMP) and its predictive value of adverse outcomes. Methods: In March 2021, 106 ASCMP patients who were treated in Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2019 to December 2020 were taken as research objects. All patients underwent 24-hour BIS monitoring after admission, and were divided into good prognosis group (n=75) and poor prognosis group (n=31) according to the prognosis of the patients' cranial nerve function after 60 d. The general conditions, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, Glasgow Coma Scale (GCS) score at admission and 24-hour BIS mean were compared between the two groups. Pearson correlation analysis was used to analyze the correlations between the 24-hour BIS mean and GCS score at admission, APACHEⅡ score and coma time. The receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of 24-hour BIS mean, GCS score at admission, APACHEⅡ score and coma time on adverse outcome of ASCMP patients. Results: The coma time and APACHEⅡ score of the patients in the poor prognosis group were significantly higher than those in the good prognosis group, the GCS score at admission and 24-hour BIS mean were significantly lower than those in the good prognosis group (P<0.05) . Pearson correlation analysis showed that the 24-hour BIS mean was positively correlated with the GCS score at admission, and negatively correlated with the APACHEⅡ score, coma time (r=0.675, -0.700, -0.565, P<0.001) . The 24-hour BIS mean had the highest predictive value for adverse outcome of ASCMP patients, with a cut-off value of 74, the area under the curve was 0.883 (95%CI: 0.814-0.951, P<0.001) , and the sensitivity and specificity were 73.3% and 87.1%, respectively. Conclusion: The 24-hour BIS mean has a good correlation with the acute brain nerve injury, the severity of the disease and coma time of patients with ASCMP. And it has a high predictive value for the adverse outcome in patients with ASCMP.

Application of depth of anesthesia monitoring in predicting postoperative cognitive impairment in elderly cancer patients / 肿瘤研究与临床

Objective:To investigate the role of depth of anesthesia monitoring in predicting postoperative cognitive impairment in elderly cancer patients.Methods:The clinical data of 70 elderly cancer patients in Shanxi Province Cancer Hospital from February 2020 to February 2021 were retrospectively analyzed. According to the postoperative cognitive function, they were divided into the postoperative cognitive impairment group (20 cases) and the normal postoperative cognitive function group (50 cases). Statistical analyses of the mini mental state examination (MMSE) score of cognitive function, mean arterial pressure (MAP) and bispectral index score (BIS) before anesthesia (T 0), before skin incision (T 1), 1 h after skin incision (T 2), 2 h after skin incision (T 3), at the completion of surgery (T 4), and at the time point of extubation (T 5), as well as the levels of interleukin-6 (IL-6) and central nervous specific protein (S100-β) at 1 d before operation, immediately after surgery and 1 d after surgery between the two groups were performed. Results:The MMSE score of patients in the postoperative cognitive impairment group was lower than that in the normal postoperative cognitive function group [(21±3) points compared with (25±5) points], and the difference between the two groups was statistically significant ( t = 2.98, P < 0.05). The MAP of the two groups at T 1, T 2, T 3, T 4, and T 5 gradually increased (both P < 0.05), the MAP at T 1, T 2, T 3, T 4 was lower than that at T 0 (all P < 0.05), and the MAP at T 5 was higher than that at T 0 (both P < 0.05). There were no statistical differences in MAP between the two groups at T 0, T 1, T 2, T 3, T 4, and T 5 (all P > 0.05). BIS values of the two groups at T 0, T 1, T 2, and T 3 gradually decreased (both P < 0.05), BIS values at T 4 and T 5 gradually increased (both P < 0.05). At T 2 and T 3, BIS value of the postoperative cognitive impairment group was lower than that of the normal postoperative cognitive function group (both P < 0.05). The duration of BIS < 45 in the postoperative cognitive impairment group was longer than that in the normal postoperative cognitive function group [(44.1±7.7) min than (12.6±2.2) min], and the difference between the two groups was statistically significant ( t = 26.68, P < 0.001). The levels of IL-6 and S100-β in the two groups were gradually increased 1 d before surgery, immediately after surgery and 1 d after surgery (both P < 0.05). On the 1st day after surgery, the S100-β level in the postoperative cognitive impairment group was higher than that in the normal postoperative cognitive function group ( P < 0.05). Conclusions:The application of depth of anesthesia monitoring is of high value in predicting postoperative cognitive impairment in elderly cancer patients.

Application value of BIS and S100β combined with Copeptin in patients with acute severe carbon monoxide poisoning / 中华劳动卫生职业病杂志

Objective: To explore the application value of bispectral index(BIS) , specific protein 100β(S100β) combined with Copeptinin patients with acute severe carbon monoxide poisoning (ASCMP). Methods: A total of 256 patients with acute carbon monoxide poisoning admitted to Hengshui People's Hospital from June 2018 to June 2020 were collected, and they were divided into 30 mild cases, 40 moderate cases and 186 severe cases according to the degree of poisoning. Among them, patients with severe carbon monoxide poisoning were divided into a poor prognosis group (20 cases) and a good prognosis group (166 cases) according to whether adverse events occurred. The changes of creatine kinase isoenzyme (CK-MB) , N-terminal precursor B-type brain natriuretic peptide (NT-proBNP) , BIS, S100β, and Copeptin in poisoned patients were measured. Logistic regression analysis and receiver operating characteristic (ROC) curve were used to evaluate the significance of relevant indicators for ASCMP patients. Results: Compared with the mild-to-moderate group, CK-MB, NT-proBNP, S100β, Copeptin increased, and BIS value decreased in the severe group (P< 0.05). 24 hours after admission, compared with the good prognosis group, CK-MB, NT-proBNP, S100β, Copeptin in the poor prognosis group increased, and the BIS value decreased (P<0.05). In the poor prognosis group, CK-MB, NT-proBNP, S100β, and Copeptin at 72 hours after admission were all lower than those at 24 hours after admission, and the BIS value was higher than that at 24 hours after admission (P<0.05). Logistic regression analysis showed that ASCMP patients with increased S100β, Copeptin, and decreased BIS values had an increased risk of adverse events (P<0.05). The ROC curve showed that the area under the curve of the combined detection of BIS, S100β and Copeptin was 0.859, which had a great predictive value for the prognosis of ASCMP patients. Conclusion: BIS, S100β combined with Copeptin detection is of great value for early assessment of ASCMP disease and prognosis prediction.

Correlation between 95% spectral edge frequency and depth of anesthesia in patients with schizophrenia / 中国基层医药

Objective:To investigate the value of 95% spectral edge frequency (SEF) in identifying the depth of anesthesia in patients with schizophrenia subjected to modified electroconvulsive therapy center.Methods:A total of 195 patients with schizophrenia who received treatment in The Affiliated Kangning Hospital of Wenzhou Medical University in April to December 2020 were included in this study. They were randomly divided into three groups with 65 patients each. Three groups of patients received different doses of anesthesia before undergoing MECT as follows: group A: propofol 1.5 mg/kg, atropine 0.5 mg/kg, succinylcholine chloride 1.0 mg/kg; group B: propofol 2.0 mg/kg, atropine 0.5 mg/kg, succinylcholine chloride 1.0 mg/kg; group C: propofol 2.5 mg/kg, atropine 0.5 mg/kg, succinylcholine chloride 1.0 mg/kg. 95% SEF and bispectral index (BIS) were measured when patients were awake before treatment (T 1), when eyelash reflex disappeared (T 2), at the beginning of electrical stimulation (T 3), at 3 minutes after electrical stimulation (T 4), and when patients were completely awake (T 5) and compared between groups. The incidence of adverse reaction was recorded at 1 day after treatment. Results:At T 1-T 5, 95% SEF in the group A was (28.50 ± 0.87) Hz, (21.49 ± 0.91) Hz, (21.99 ± 0.92) Hz, (28.42 ± 1.29) Hz, (28.40 ± 1.15) Hz respectively, and it was (28.34 ± 0.91) Hz, (18.93 ± 0.86) Hz, (19.05 ± 0.83) Hz, (27.54 ± 0.73) Hz, (28.42 ± 1.21) Hz respectively in group B and (28.26 ± 0.90) Hz, (16.41 ± 0.75) Hz, (16.36 ± 0.75) Hz, (26.58 ± 0.64) Hz, (28.48 ± 1.19) Hz respectively in group C. 95% SEF measured at T 2 ( t = 24.49, 48.60, both P < 0.05), T 3 ( t = 28.47, 54.51, both P < 0.05), and T 4 ( t = 7.61, 15.91, both P < 0.05) in groups B and C were significantly lower than those in group A. 95% SEF measured at T 2 ( t = 24.11, P < 0.05), T 3 ( t = 26.04, P < 0.05) and T 4 ( t = 8.30, P < 0.05) in group C were significantly lower than those in group B. At T 1-T 5, BIS in group A was (94.16 ± 2.07), (55.34 ± 1.93), (56.61 ± 1.84), (76.29 ± 1.94) and (93.84 ± 2.39) respectively, and it was (94.51 ± 2.25), (52.39 ± 1.58), (52.45 ± 1.94), (73.58 ± 2.19), (93.28 ± 2.52) respectively in group B and (93.97 ± 2.16), (50.57 ± 1.96), (51.60 ± 2.03), (69.51 ± 2.12), (93.57 ± 2.66) respectively in group C. BIS values measured at T 2 ( t = 24.49, 48.60, both P < 0.05), T 3 ( t = 28.34, 54.28, both P < 0.05), and T 4 ( t = 7.61, 15.91, both P < 0.05) in groups B and C were significantly lower than those in group A. BIS measured at T 2 ( t = 24.11, P < 0.05), T 3 ( t = 25.93, P < 0.05), and T 4 ( t = 8.30, P < 0.05) in group C were significantly lower than those in group B. Correlation analysis showed that 95% SEF measured at T 2 ( r = 0.65, P < 0.05), T 3 ( r = 0.68, P < 0.05) and T 4 ( r = 0.49, P < 0.05) were positively correlated with BIS measured at corresponding time points. There were no significant differences in duration of electrical stimulation [(61.25 ± 4.32) seconds, (45.19 ± 3.68) seconds, and (27.54 ± 2.54) seconds, F = 1 434.14, P < 0.05], post-onset inhibition index [(87.68 ± 5.82)%, (81.59 ± 5.35)%, (75.27 ± 4.87)%, F = 87.09, P < 0.05], and average seizure energy index [(5 668.38 ± 1 264.01) μV2, (4 555.61 ± 1 058.96) μV2, (3 642.25 ± 792.68) μV2, F = 59.97, P < 0.05] among the three groups. Duration of electrical stimulation ( t = 36.07, 75.71, both P < 0.05), post-onset inhibition index ( t = 9.15, 18.66, both P < 0.05), and average seizure energy index ( t = 8.49, 15.46, both P < 0.05) in groups B and C were significantly lower than those in group A. Duration of electrical stimulation, post-onset inhibition index and average seizure energy index in group C were significantly lower than those in group B ( t = 39.64, 9.50, 6.97, all P < 0.05). BIS was positively correlated with duration of electrical stimulation ( r = 0.68, P < 0.05), post-onset inhibition index ( r = 0.55, P < 0.05) and average seizure energy index ( r = 0.42, P < 0.05). There were no significant differences in the incidences of headache, myalgia, nausea and vomiting among the three groups ( P > 0.05). Conclusion:95% SEF was positively correlated with BIS in patients with schizophrenia. BIS measured at T 2 was positively correlated with effect of modified electroconvulsive therapy center.

Different Anesthesia and Sedation Depths of BIS-guided Closed-loop Target-controlled Infusion on Perioperative Th1/Th2 Balance in Elderly Patients Undergoing Laparoscopic Radical Gastrectomy / 肿瘤防治研究

Objective To investigate the effect of BIS-guided closed-loop target-controlled infusion on perioperative Th1/Th2 balance in elderly patients undergoing laparoscopic radical gastrectomy under different anesthesia and sedation depths. Methods We applied random number table method to divide 73 elderly patients undergoing elective laparoscopic radical gastrectomy into BIS closed-loop target-controlled infusion group with BIS value of 55(group H, n=36) and BIS value of 45(group L, n=37).Intravenous blood samples were collected immediately before surgery (T1), 2h after surgery (T2), 24h after surgery (T3) and 72h after surgery (T4).IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ were determined by flow cytometry microsphere array.We compared operation duration, postoperative PACU stay time and postoperative hospitalization time between two groups. Results Compared with T1, IL-6 and IL-10 concentration in group H at T2, T3 and T4 significantly increased (P < 0.05), IL-4 and TNF-α in group H at T4 were significantly increased (P < 0.05), IL-2 and IFN-γ in group H at T2 and T4 were significantly increased (P < 0.05), the concentration of IL-6 and IL-10 in group L at T2, T3 and T4 were increased (P < 0.05), IL-2 in group L at T4 was decreased (P < 0.05), and IFN-γ/IL-6 in two groups were decreased at T2, T3 and T4(P < 0.05).Compared with group L, IL-6 and IL-10 in group H were significantly increased at T2(P < 0.05), IFN-γ/IL-6 in group H was significantly decreased (P < 0.05), IL-2 and IL-10 in group H were significantly increased at T4(P < 0.05).Operation duration, postoperative PACU stay time and postoperative hospitalization time had no statistical significance between two groups (P > 0.05). Conclusion The anesthesia and sedation depth of BIS-guided closed-loop target-controlled infusion set at 45 is better than 55 in maintaining Th1/Th2 balance in elderly patients undergoing laparoscopic radical gastrectomy, but it has no obvious effect on long-term prognosis.

Early temperature control can improve the prognosis for brain injury after carbon monoxide poisoning / 中华物理医学与康复杂志

Objective:To observe the effect of early temperature control on the prognosis of brain injury patients after severe carbon monoxide poisoning (COP).Methods:A total of 277 patients hospitalized with severe COP were randomly divided into a fever group ( n=78), a normal temperature group ( n=113) and a mild hypothermia group ( n=86). All were given hyperbaric oxygen therapy and any necessary supportive treatment. The mild hypothermia group were kept in a room at 34 to 35℃. Evaluation was with the Glasgow Coma Scale (GCS), version II of the Acute Physiology and Chronic Health Evaluation (APACHE), the Hasegawa dementia scale (HDS) and the mini mental state examination (MMSE). The incidence of delayed encephalopathy (DEACMP) and mortality were compared among the three groups. The bispectral index (BIS) and neuron-specific enolase (NSE) levels were correlated with DEACMP. Results:After the treatments, improvement was observed in multiple indexes of all three groups compared with before the treatment. Compared with the fever group, the average GCS of the mild hypothermia group was significantly higher on the 2nd, 4th, 8th and 31st day after the intervention. It was significantly higher than the normal temperature group′s averages on the 4th, 8th and 31st day. The average APACHE scores of the normal temperature and the mild hypothermia groups were significantly lower than the fever group′s average, with that of the mild hypothermia group significantly lower than that of the normal group. The average HDS scores of the normal temperature and mild hypothermia groups were significantly higher than the fever group′s average, with that of the mild hypothermia group significantly higher than that of the normal group. The average MMSE score of the mild hypothermia group was significantly improved after 7 days, one month and three months of treatment. That of the normal group showed significant improvement after one and three months, but the mild hypothermia group′s averages were superior. Compared with the fever group, the average BIS score of the mild hypothermia group was significantly better after one, three and seven days, and one month. This was true for the normal group beyond three days after the intervention. The average NSE concentration of the normal group after 7 days and one month was significantly lower than that of the fever group. For the mild hypothermia group this was true after only 3 days. Compared with the other two groups, the average coma time, incidence of DEACMP and nervous system injury were significantly lower in the hypothermia group. The average GCS, BIS and NSE values were closely related to the occurrence of DEACMP.Conclusions:Early temperature control can significantly reduce the severity of brain injury after COP and reduce the incidence of neurological sequelae. Early dynamic detection of GCS, NSE concentration and BIS is of great significance for predicting the incidence of DEACMP.

Predictive value of early cerebral oxygen utilization combined with the bispectral index for delayed encephalopathy after acute carbon monoxide poisoning in elderly patients / 中华老年医学杂志

Objective:To investigate clinical value of early cerebral oxygen utilization(O 2UCc)combined with the bispectral index(BIS)for monitoring delayed encephalopathy after acute carbon monoxide poisoning(DEACMP)in elderly patients. Methods:This was a retrospective analysis.A total of 90 elderly patients with acute severe carbon monoxide poisoning(ASCMP)treated in Harrison International Peace Hospital from Nov.2018 to Jan.2020 were considered as research objects.Patients were divided into the DEACMP group(n=25)and the good prognosis group(n=65)according to their prognosis.Oxygen quantity absorbed into UCC(O 2UCc)and Bispectral index(BIS)at different times in the early stages were compared between the two groups.Correlations of O 2UCc and BIS with the occurrence of DEACMP were analyzed.Clinical significance of O 2UCc or BIS alone and of the two parameters in combination for the prediction of DEACMP was investigated. Results:O 2UCc was higher and BIS was lower in the DEACMP group than in the good prognosis group at 0 h, 6 h, 12 h, and 24 h after admission(all P<0.01). Pearson correlation analysis showed that O 2UCc was negatively correlated with DEACMP( r0 h=-0.482, r6 h=-0.534, r12 h=-0.587, r24 h=-0.514, all P<0.01), BIS was positively correlated with DEACMP( r0 h=0.348, r6 h=0.583, r12 h=0.679, r24 h=0.489, all P<0.01), and the correlation was the strongest at 12h after admission.ROC curve analysis was performed with O2UCc, BIS and the combined predictors at 12 h, and the results showed that the areas under the ROC curve of O 2UCc, BIS and the two in combination for DEACMP prediction were 0.845, 0.850 and 0.909, respectively, the sensitivities were 78.5%, 90.8% and 96.9% and the specificities were 80.0%, 76.0% and 84.0%, respectively. Conclusions:Early detection of O 2UCc or BIS has a good clinical value for predicting the development of ASCMP to DEACMP, and their combined value is even better.

Value of regional cerebral oxygen saturation and anesthesia depth in predicting postoperative cognitive dysfunction in patients with non-macrovascular surgery / 中国医师杂志

Objective:To explore the value of regional cerebral oxygen saturation (rScO 2) and anesthesia depth monitoring in predicting postoperative cognitive dysfunction (POCD) in patients with non-macrovascular surgery. Methods:A retrospective analysis of 147 patients with non-macrovascular surgery under general anesthesia admitted to the First Affiliated Hospital of Xi'an Jiaotong University from August 2017 to June 2019 was performed and divided into the POCD group ( n=37) and the non-POCD group ( n=110) according to the presence/absence of postoperative POCD. The changes of bispectral index (BIS) and rScO 2 in patients before anesthesia induction (T 0), endotracheal intubation (T 1), 2 hours after operation (T 2), after operation (T 3), and at extubation (T 4) were recorded, and the predictive value for the occurrence of POCD was analyzed by receiver operating characteristic (ROC) curve. Results:There was no statistically significant difference in anesthesia time, operation time and operation type between the two groups ( P>0.05). There was no significant difference in BIS and rScO 2 levels between the two groups at T 0, T 1 and T 4 ( P>0.05). BIS and rScO 2 levels in the POCD group at T 2 and T 3 were lower than those in the non-POCD ( P<0.05). Both BIS and rScO 2 of the two groups reached the lowest value at T 2, and the reduction rate of rScO 2 in the POCD group was higher than that in the non-POCD group [(31.84±3.27)% vs (14.81±2.52)%, P<0.05]. The ROC curve of BIS-T 2, rScO 2-T 2, BIS-T 3, rScO 2-T 3, rScO 2 reduction from the baseline value to predict POCD in patients with non-macrovascular surgery was plotted, and the AUCs were 0.514, 0.617, 0.505, 0.633, 0.724, respectively. The highest AUC value of 0.808 was found for combined detection at T 2 (rScO 2 and BIS). Conclusions:The combined detection of intraoperative regional cerebral oxygen saturation and anesthesia depth monitoring is of good clinical application value in predicting postoperative cognitive dysfunction in patients with non-macrovascular surgery.

The sedative effect after congenital heart disease surgery in children under the bi-spectral index monitoring / 中国小儿急救医学

Objective:To investigate the sedative effect after congenital heart disease surgery in children under the bi-spectral index monitoring(BIS).Methods:A prospective cohort study was performed, we selected 264 children with congenital heart disease who were admitted to the cardiac intensive care unit at Shanghai Children′s Medical Center from September 2018 to August 2019, 126 cases in the intervention group, and 138 cases in the control group.The control group used Ramsay sedation score to evaluate the sedative effect, meanwhile the intervention group was evaluated by Ramsay sedation score and BIS.The incidence of adverse events related to extubation performed within 8 hours after congenital heart disease surgery, and the length of stay in ICU between two groups were compared.The average mechanical ventilation time of the patients whose mechanical ventilation time was more than 8 hours in two groups was compared.The use of sedative drugs midazolam and morphine in children with mechanical ventilation time for more than 24 hours and liver damage, and the incidence of respiratory depression during ventilator withdrawal were analyzed.Results:In children with early extubation, there were 62 cases in the intervention group and 70 cases in the control group.Compared with the control group, the intervention group had a low incidence of extubation-related adverse events (including unplanned extubation, dysphoria after sputum aspiration, and inhalation inhibition after extubation). The average mechanical ventilation time in the intervention group[(8.18±1.95)h] was less than that in the control group[(9.53±1.37)h, P<0.05] of the patients whose mechanical ventilation time was more than 8 hours but less than 24 hours.In children with mechanical ventilation time more than 24 hours, 28 cases were in the intervention group and 35 cases in the control group.The average doses of midazolam and morphine in the intervention group[(1.82±0.40)μg/(kg·min), (8.64±3.03)μg/(kg·h)] were less than those in the control group[(2.73±0.79) μg/(kg·min), (14.32±5.01)μg/(kg·h), all P<0.05]. Among the 28 children in the intervention group with mechanical ventilation time more than 24 hours, 13 cases had liver damage, and 15 cases of the 35 children in the control group had liver damage.The average doses of midazolam and morphine in the intervention group[(1.42±0.51)μg/(kg·min), (6.88±2.17)μg/(kg·h)] were lower than those in the control group[(2.25±0.62)μg/(kg·min), (11.88±3.56)μg/(kg·h), all P<0.05]. The incidence of inhalation inhibition in the intervention group was lower than that in the control group ( χ2=48.303, P<0.05). Conclusion:The sedation after congenital heart disease surgery in children under the BIS is effective.

An anesthesia depth computing method study based on wavelet transform and artificial neural network / 生物医学工程学杂志

General anesthesia is an essential part of surgery to ensure the safety of patients. Electroencephalogram (EEG) has been widely used in anesthesia depth monitoring for abundant information and the ability of reflecting the brain activity. The paper proposes a method which combines wavelet transform and artificial neural network (ANN) to assess the depth of anesthesia. Discrete wavelet transform was used to decompose the EEG signal, and the approximation coefficients and detail coefficients were used to calculate the 9 characteristic parameters. Kruskal-Wallis statistical test was made to these characteristic parameters, and the test showed that the parameters were statistically significant for the differences of the four levels of anesthesia: awake, light anesthesia, moderate anesthesia and deep anesthesia (

The value of early NSE combined with BIS monitoring in predicting the neurological prognosis in patients with severe intracerebral hemorrhage / 中华急诊医学杂志

Objective:To investigate the clinical value of neuron specific enolase (NSE) and bispectral index (BIS ) in predicting the neurological prognosis in patients with severe intracerebral hemorrhage.Methods:Patients with severe intracerebral hemorrhage admitted to the ICU of Xiaolan Hospital of Southern Medical University from January 2019 to December 2020 were selected, and serum NSE detection and BIS monitoring were performed at an early stage. According to the Glasgow outcome scale (GOS) at 90 days after intracerebral hemorrhage, the patients were divided into the good neurologic prognosis group (GOS 4-5) and poor neurologic prognosis group (GOS 1-3). The levels of NSE and BIS between the two groups were compared. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the predictive value of NSE, BIS and their combination in predicting neurological prognosis.Results:A total of 126 patients with severe intracerebral hemorrhage were enrolled in this study, and 32 patients (25.4%) had poor neurological prognosis. The level of NSC in the poor neurological prognosis group was significantly higher than that in the good neurologic prognosis group [28 (13.7, 50.4) ng/mL vs. 13.5 (9.6, 18.5) ng/mL, P < 0.05], while the BIS level was significantly lower than that in the good neurologic prognosis group [32 (25.2, 45) vs. 55 (48, 62.2), P <0.05]. For detection of poor neurologic outcome in patients with severe intracerebral hemorrhage, NSE and BIS yielded the AUC values of 0.768 (0.685, 0.839) and 0.866 (0.793, 0.920), respectively, with cut-off values of 21.7 ng/mL and 47, respectively. The combination of NSE and BIS yielded a remarkably higher AUC value of 0.927 (0.867, 0.966) for predicting poor neurologic outcome than each index alone ( P<0.05). Conclusions:Early monitoring of NSE and BIS can effectively predict the neurological prognosis of patients with severe intracerebral hemorrhage, and the combination of NSE and BIS can further improve the prediction efficiency.

Comparison of anesthesia effects between closed / 中南大学学报(医学版)

OBJECTIVES@#Bispectral index (BIS) can reflect the depth of propofol sedation. This study aims to compare the anesthetic satisfaction, anesthetic dose, and hemodynamic changes between closed-loop target controlled infusion (CLTCI) and open-loop target controlled infusion (OLTCI) during abdominal surgery.@*METHODS@#From December 2016 to December 2018, 70 patients undergoing abdominal surgery under general anesthesia were selected in Beijing Hospital, including 51 males and 19 females, at the age from 49 to 65 years old. They were classified as grade I-II by the American Society of anesthesiologists (ASA) and were randomly divided into the CLTCI group and the OLTCI group (@*RESULTS@#In the induction stage, the percentage of adequate anesthesia time in the CLTCI group was higher than that in the OLTCI group, and the percentage of deep anesthesia time in the CLTCI group was significantly lower than that in the OLTCI group (both @*CONCLUSIONS@#Compared with propofol OLTCI, anesthesia with propofol CLTCI under BIS guidance can maintain a more appropriate depth of anesthesia sedation and more stable hemodynamics.

Effect of anesthesia depth on stress response during single-lung ventilation in thoracic surgery / 肿瘤研究与临床

Objective@#To study the effects of different anesthesia depths on stress response during single-lung ventilation in patients with thoracoscopic lobectomy.@*Methods@#Sixty patients selected for elective thoracoscopic lobectomy in the Second Hospital of Shanxi Medical University from September 2018 to May 2019 were randomly divided into three groups according to the digital random table method, with 20 patients in each group. Group A maintained deep anesthesia with the bispectral index (BIS) 36-45, group B maintained moderate anesthesia with BIS 46-55, and group C did not undergo BIS monitoring. The changes of heart rate, mean arterial pressure (MAP), stress indexes cortisol and blood glucose before anesthesia induction (T0), immediately after one-lung ventilation (T1), 60 min after one-lung ventilation (T2) and immediately after skin suture (T3) in the three groups were compared.@*Results@#The concentration of blood glucose in group A at T1, T2 and T3 was (5.28±0.49) mmol/L, (5.34±0.49) mmol/L and (5.40±0.47) mmol/L, and the cortisol was (142.75±31.45) ng/ml, (181.36±19.62) ng/ml and (153.81±33.92) ng/ml; the blood glucose in group B was (5.63±0.35) mmol/L, (6.06±0.19) mmol/L and (5.79±0.44) mmol/L, and the cortisol was (168.45±31.16) ng/ml, (171.09±25.28) ng/ml and (159.39±18.77) ng/ml; the blood glucose in group C was (6.35±0.56) mmol/L, (7.04±0.26) mmol/L and (6.17±0.54) mmol/L, and the cortisol was (191.13±46.00) ng/ml, (283.25±30.07) ng/ml and (183.01±19.71) ng/ml, respectively. The blood glucose and cortisol levels in group C at T1, T2 and T3 were higher than those in group A and group B (all P < 0.05). The MAP in group A at T1, T2 and T3 were (69±5) mmHg (1 mmHg= 0.133 kPa), (67±6) mmHg and (75±7) mmHg, respectively, and group B was (80±8) mmHg, (79±4) mmHg and (84±9) mmHg, the differences between the two groups were statistically significant (all P < 0.05). There was significant difference in cortisol between group A and group B at T1 (P < 0.05). The heart rate and MAP at T1, T2 and T3 in group A and group C were significantly different from those at T0 (all P < 0.05). The heart rate and MAP at T1 and T2 in groups B were significantly different from those at T0 (all P < 0.05).@*Conclusion@#BIS anesthesia depth monitoring should be performed during single-lung ventilation in thoracic surgery, and BIS should be maintained at 46-55, which can not only inhibit the stress response but also have a slight effect on hemodynamics.

Does Perioperative Lidocaine Infusion Decrease the Mininmum Alveolar Concentration of Isoflurane viz-a-viz Depth of Anaesthesia using Processed Electroencephalogram (Bispectral Index)

Introduction: Minimal alveolar concentration (MAC) ofvolatile anaesthetics is that which prevent movement in50% of subjects in response to a noxious stimulus. MACis influenced by several drugs like fentanyl, midazolam,propofol, clonidine. Various successful studies have been doneto demonstrate the effect of IV anaesthetics and opioids onMAC of various inhaled anaesthetics in balanced anaesthesiasettings. To assess the effect of a perioperative lidocaineinfusion on the MAC of isoflurane in a balanced anaesthesiatechnique by correlating it with the depth of anaesthesia asassessed by the Bispectral Index (BIS).Material and methods: It is a prospective randomized studyconsisting of 100 patients. The patients were categorized intogroup L and group S, Group L received a bolus of 1.5mg/kg of lidocaine five minutes before the induction of generalanaesthesia followed by 1.5mg/kg/hr of lidocaine infusiontill the end of the surgical procedure or upto a maximum ofthree hours (whichever was earlier). Group S received salinesimilarly. BIS was maintained between 40 to 60 and MAC ofisoflurane was measured in both group.Result: Significant difference with regard to MAC ofisoflurane used to maintain anaesthesia was noted betweenthe two groups. It was found overall average MAC ofisoflurane in Group L was (0.761±0.011) and control groupwas (0.885±0.020).Conclusion: Our study found that lidocaine loading dosefollowed by infusion significantly reduces volatile anaestheticrequirement as measured by MAC of isoflurane.

Evaluation of Bispectral Index time delay in response to anesthesia induction: an observational study / Avaliação do tempo de atraso do índice bispectral na resposta à indução da anestesia: estudo observacional

Abstract Background and objectives According to the manufacturer, the Bispectral Index (BIS) has a processing time delay of 5-10 s. Studies addressing this have suggested longer delays. We evaluated the time delay in the Bispectral Index response. Methods Based on clinical data from 45 patients, using the difference between the predicted and the real BIS, calculated during a fixed 3 minutes period after the moment the Bispectral Index dropped below 80 during the induction of general anesthesia with propofol and remifentanil. Results The difference between the predicted and the real BIS was in average 30.09 ± 18.73 s. Conclusion Our results may be another indication that the delay in BIS processing may be much longer than stated by the manufacture, a fact with clinical implications.

Resumo Justificativa e objetivos De acordo com o fabricante, o índice bispectral (BIS) tem um tempo de processamento de cinco a dez segundos. Estudos que avaliaram esse tempo de processamento sugeriram atrasos mais longos. Nós avaliamos o tempo de atraso na resposta do BIS. Métodos Com base em dados clínicos de 45 pacientes, calculamos a diferença entre o tempo de atraso previsto e real do índice bispectral durante um período fixo de três minutos após o momento em que o BIS caiu abaixo de 80 durante a indução da anestesia geral com propofol e remifentanil. Resultados A diferença entre o BIS previsto e real foi em média 30,09 ± 18,73 segundos. Conclusão Nossos resultados sugerem que o atraso no processamento do índice bispectral pode ser muito maior do que o declarado pelo fabricante, um fato com implicações clínicas.

Application of EEG BIS monitor in precision anesthesia / 中国医学装备

Objective:To study the application value of electroencephalograph bispectral index (EEG-BIS) monitor in precision anesthesia and its effect on postoperative awakening time.Methods:A total of 100 patients who prepared to undergo thyroid surgery were randomly divided into observation group (n=50) and control group (n=50) .Under the same anesthesia way of the two groups, observation group adopted the results from EEG-BIS monitor to adjust the depth of anesthesia for patients, and control group adopted routine monitoring included weight, blood pressure and heart rate to adjust the depth of anesthesia.The amount of anesthetic and the awakening time of the patients in the two groups were observed and recorded, and the incidence of postoperative adverse events between the two groups were further compared.Results:The amount of propofol of observation group was significantly larger than that of control group (t=2.72, P<0.05) .And the awakening time, extubation time and the time of leaving PACU of observation group were significantly less than those of control group (t=4.45, t=4.83, t=5.92, P<0.05) .The differences of blood pressure at 20 min, 30 min and 60 min after patients underwent thyroid surgery between the two groups were significant (t=2.87, t=3.90, t=2.76, P<0.05) .Conclusion:BIS monitor can guide the adjustment for the depth of anesthesia during operation, and reduce the amount of general anesthetics of patients and shorten the awakening time in PACU, which is worthy in clinical application.

The study on the feasibility of using bispectral index value to assess the degree of acute brain injury / 中国神经精神疾病杂志

Objective To explore the feasibility of using bispectral index (BIS)value to assess the degree of acute brain injury (ABI) and study the correlation between Glasgow Coma Scale (GCS)scores and BIS values in ABI patients. Method A prospective and double-blinded study was conducted to assess GCS scores and BIS values in 330 patients with ABI from January 2013 till July 2017. Mean BIS values (BISMEAN) in mild, moderate and severe group of ABI were calculated. Linear regression between BIS values and GCS scores was constructed. Receiver operating characteristic(ROC) curves to predict non-mild ABI (GCS score less than 13) and severe ABI (GCS score less than 9) were plotted respectively. Results BISMEAN were significantly different among mild, moderate and severe ABI group (75.46±12.94、64.30±12.56、50.37±16.90 respectively, P＜0.01). There were a significant positive correlations between GCS scores and BIS values (R2=0.446, F=264.374, P＜0.01). Regression equation was BIS=2.96 GCS+33.77. ROC curve to predict non-mild ABI demonstrated that area under the curve (AUC)was equal to 0.835 and the optimal cut-off point (BIS value) corresponding with the maximum of sensitivity+specificity was 72.7(sensitivity=0.689, specificity=0.840); ROC curve to predict severe ABI demonstrated that AUC was equal to 0.846 and the optimal cut-off point (BIS value) corresponding with the maximum of sensitivity + specificity was 65.8 (sensitivity=0.721, specificity=0.861). Conclusion BIS values significantly correlate with GCS scores in ABI patients, indicating the feasiblity of using BIS value to assess the degree of ABI. Furthermore, continuous and real-time BIS monitoring can assess degree of ABI better than BIS value.

Comparison of the effects of bispectral index monitoring with three different depths of sedation in lucid fiberoptic bronchoscopy / 中国医师进修杂志

Objective To compare the effects of bispectral index (BIS) monitoring with three different depths of sedation in lucid fiberoptic bronchoscopy. Methods Ninety patients underwent lucid fiberoptic bronchoscopy from July 2017 to January 2018 in Wenzhou Integrated Traditional Chinese and Western Medicine Hospital in Zhejiang Province were selected. The patients were divided into group A, group B and group C according to the random digits table method with 30 cases each. The depth of sedation in group A was set BIS at 65 to 69, in group B BIS at 70 to 74, and in group C BIS at 75 to 79. At the beginning of sedation, propofol and remifentanil were administered continuously intravenously at a target concentration of 1 μg/ml and 3 ng/ml, then 0.25 μg/ml of propofol was adjusted according to the change of BIS. Fiberoptic bronchoscopy was performed after the patient′s BIS reached the pre-set target value. The BIS, heart rate, mean arterial pressure (MAP) and pulse oxygen saturation (SpO2) at admission to the examination room (T0), sedation (T1), fiberoptic bronchoscopy through glottis (T2), fiberoptic bronchoscopy into trachea (T3), 15 min after the examination (T4) were recorded. During fiberoptic bronchoscopy, the numbers of cough accompanied by body movement, additional injection of lidocaine, hypoxemia, assisted ventilation, detection time and degree of patients or doctors satisfaction were recorded. Results The heart rate and MAP at T1 in 3 groups were significantly lower than those at T0, and there were statistical differences (P＜0.05); the heart rate and MAP at T2 and T3 in group C were significantly higher than those at T1 and the same time points in group A and group B, and there were statistical differences (P＜0.05); the SpO2 at T3 in group A was significantly lower than that in group B and group C, and there was statistical difference (P＜0.05). The incidences of cough accompanied by body movement and additional injection of lidocaine in group C were significantly higher than those in group A and group B: 63.3% (19/30) vs. 10.0% (3/30) and 13.3% (4/30), 50.0% (15/30) vs. 6.7% (2/30) and 10.0% (3/30), and there were statistical differences (P＜0.05); the incidence of hypoxemia in group A was significantly higher than that in group B and group C: 63.3% (19/30) vs. 23.3% (7/30) and 6.7% (2/30), group B was significantly higher than group C, and there were statistical differences (P＜0.05); the incidence of assisted ventilation in group A was significantly higher than that in group B and group C:36.7% (11/30) vs. 3.3% (1/30) and 0, there was statistical difference (P＜0.05). The detection time in group B was significantly shorter than that in group A and group C: (17.6 ± 2.8) min vs. (22.6 ± 3.3) and (21.0 ± 2.6) min, the degree of patients satisfaction in group A and group B was significantly higher than that in group C: (95.5 ± 2.6) and (95.2 ± 3.3) scores vs. (79.3 ± 2.9) scores, the degree of doctors satisfaction in group B was significantly higher than that in group A and group C: (95.8 ± 3.3) scores vs. (83.9 ± 4.2) and (81.0 ± 2.6) scores, there were statistical differences (P＜0.05). Conclusions The BIS setting of sedation depth between 70 and 74 during lucid fiberoptic bronchoscopy has more advantages, less adverse reactions, stable hemodynamics, and higher degree of patients and doctors satisfaction.

Effects site concentrations of propofol using target-controlled infusion in dental treatment under deep sedation among different intellectual disability types

BACKGROUND: We aimed to assess the dose needed to achieve the propofol effect-site concentration using target-controlled infusion in intellectually disabled patients and to detail the most effective method for achieving a safe level of consciousness without hemodynamic changes as well as detail any resulting adverse effects. METHODS: We performed a retrospective review of sedation service records of 138 intellectually disabled patients (51, mental retardation; 36, autism; 30, brain lesion, 12 genetic diseases, 9 dementia) aged over 15 years and weighing over 30 kg. These patients had received propofol via target-controlled infusion in the special care dental clinic of Seoul National University Dental Hospital from May 2008 to September 2018 for restorative treatment (112), minor surgery (13), prosthodontics (7), periodontics treatment (5), and implant (1). RESULTS: For all groups, the duration of dental treatments was 43 ± 18 minutes, total sedation time was 73 ± 23 minutes, and total BIS values was 57 ± 12. The propofol maintenance dosage values for each group were: mental retardation, 3 ± 0.5 (2–4) µg/ml; autism, 3.1 ± 0.7 (2–5) µg/ml; brain lesion, 2.8 ± 0.7 (1.5–5) µg/ml; genetic disease, 2.9 ± 0.9 (1–4) µg/ml; and dementia 2.3 ± 0.7 (1–3.4) µg/ml. CONCLUSIONS: The dementia group needed a lower dosage to reach a safe, effective propofol effect-site concentration than the other groups. Since there were no complications, deep sedation is a great alternative to general anesthesia for dental treatment of intellectually disabled patients.

Clinical observation on perfusion index for detection of noxious stimuli in pediatric patients under general anesthesia / 上海交通大学学报（医学版）

Objective·To observe the changes of perfusion index (PI),bispectral index (BIS),heart rate (HR),systolic blood pressure (SBP) and respiratory rate (RR) under pulling stimuli in children undergoing open inguinal hernia repairs with spontaneous ventilation,so as to evaluate the clinical value of PI in monitoring the stress response.Methods·Thirty children undergoing selective open inguinal hernia repairs with American Society of Anesthesiologists (ASA) physical status Ⅰ or Ⅱ were recruited.Anesthesia was induced with fentanyl and propofol,and was maintained with sevoflurane after the insertion of laryngeal mask.The PI,BIS,HR,SBP and RR were observed at the following time points:before induction of anesthesia (T0),before pulling hernia sac (T1),at the time point of pulling hernia sac (T2),1 min after pulling hernia sac (T3) and 5 min after pulling hernia sac (T4).Results·Compared with the baseline level at T0,the PI value at T1,T3 and T4 increased significantly (P=0.000,P=0.033 and P=0.000,respectively).The BIS,HR and SBP values at T1-T4 were significantly lower than baseline levels at T0(all P=0.000).The PI values at T2 and T3 reduced significantly compared with T1.The HR value at T2 was significantly higher than that ofT1 (P=0.033).Compared with the SBP values at T1,the SBP values at T3 and T4 were significantly higher (P=0.000 and P=0.011,respectively).And the RR values at T2 and T3 were higher than that at T1 (both P=0.000).The proportion of children with positive stress response based on PI was significantly higher than that based on other variables (all P=0.000).Conclusion·Perfusion index can reflect the noxious stimuli of the pulling hernia sac effectively and immediately.