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BACKGROUND: Cerebral state index (CSI) is an anesthesia depth monitor alternative to bispectral index (BIS). Published comparative studies have used propofol or sevoflurane. However, studies using desflurane have not been reported yet. Different volatile anesthetics have different electroencephalography signatures. The performance of CSI may be different in desflurane anesthesia. Therefore, the objective of this study was to compare CSI and BIS during desflurane anesthesia. METHODS: Thirty-three patients were recruited. Desflurane and remifentanil were used to maintain general anesthesia. BIS and CSI were recorded simultaneously every minute. End-tidal concentration of desflurane was maintained at 4% from the beginning of surgery for 5 minutes. Pairwise data of CSI and BIS were obtained five times at one-minute intervals. This process was repeated in the order of 6%, 8%, and 10%. RESULTS: BIS and CSI were negatively correlated with the end-tidal concentration of desflurane with a similar degree of correlation (correlation coefficient BIS: –0.847, CSI: –0.844). The relationship between CSI and BIS had a good linearity with a slope close to 1 (R2 = 0.905, slope = 1.01). For the relationship between CSI and BIS at each end-tidal concentration of desflurane, CSI and BIS showed good linearity in 4% and 10% (R2 = 0.559, 0.540). However, the linearity and slope were decreased in 6% and 8% (R2 = 0.163, 0.014). CONCLUSIONS: CSI showed an equivalent degree of overall performance compared to BIS in desflurane anesthesia. Accounting for previous literature, CSI can be used as a good substitute for BIS regardless of the kind of anesthetics used.
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Humans , Anesthesia , Anesthesia, General , Anesthetics , Electroencephalography , PropofolABSTRACT
Objective To compare the efficacy and safety of nicardipine versus urapidil in blood pressure (BP) management during the acute phase of intracerebral hemorrhage (ICH).Methods ICH patients admitted in Emergency Intensive Care Unit of Shenzhen People's Hospital from March,2013 through March,2016 were retrospectively studied.Patients were enrolled as nicardipine group or urapidil group depending on the initial antihypertensive drug given at admission.The differences in rate of patients reached the goal BP within the first 24 h,time required for getting goal BP,blood pressure variability (BPV),rebleeding or hematoma expansion during the first 24 h,cerebral state index (CSI) within 7 days and 28-day mortality were compared between the two groups.The differences in adverse events including bradycardia,tachycardia and hypotension were also compared between two groups.An independent t test and x2 test were performed to compare different variables.An analysis of variance of repeated measurement was performed to compare CSI within 7 days between two groups.Results Seventy-seven patients were included with 42 in nicardipine group and 55 in urapidil group.Rate of patients getting goal BP in nicardipine group was (94±5)％ and (86±11)％ in urapidil group (P＜0.01).Time required to get goal BP was (35 ± 28) min in nicardipine group and (52 ± 37) min in urapidil group (P =0.02).BPV was (11.23 ± 2.38) in nicardipine group and (13.16 ± 3.15) in urapidil group (P =0.003).Rebleeding or hematoma expansion rate during the first 24 h and 28-day mortality rate were comparable between the two groups (P ＞ 0.05).Through analysis of variance of repeated measurement,CSI in nicardipine group improves more rapidly than that in urapidil group (F =1 581.115,P =0.000).Hypotension,bradycardia and tachycardia were also comparable between groups (P ＞ 0.05).Conclusion Compared with urapidil,nicardipine produces effect more rapidly with more stable BP and higher rate of patients with ICH getting goal BP.Moreover,the application of nicardipine may be better to improve the CSI of ICH patients.
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Objective To study the effect of target controlled infusion of etomidate and propofol during general anesthesia induction period on haemodynamics and stress by cerebral state index (CSI) in elderly hypertensive patients. Methods Forty ASAⅠor Ⅱelderly hypertensive patients undergoing selective laparoscopic cholecystectomy were randomly divided into two groups by random digits table method with 20 cases each: propofol group and etomidate group. CSI, mean arterial pressure (MAP), heart rate, blood glucose, concentration of plasma cortisol in the two groups were observed before induction of anesthesia, at 1 min before intubation, and at 1 min, 3 min and 5 min after intubation. Results The level of CSI, MAP, heart rate, blood glucose, cortisol between two groups at before induction of anesthesia had no significant difference (P>0.05).The levels of CSI in two groups at 1 min before intubation, and at 1 min, 3min after intubation were significantly lower than that at before induction of anesthesia, but compared with that at 1 min before tracheal intubation, CSI was significantly higher in two group at 1 min, and 3 min after intubation, and there was significant difference (P0.05). Compared with before induction of anesthesia, the concentrations of blood glucose and cortisol at 1min before intubation in patients of the two groups decreased significantly, while glucose and cortisol concentrations at 1 min, 3 min and 5 min after intubation in two group significantly increased , and there was significant difference (P<0.05);cortisol concentration in etomidate group at 1 min before intubation and 1 min, 3 min, 5 min after intubation was significantly lower than that at the same period in propofol group:(260.6 ± 39.6) nmol/L vs. (290.2 ± 35.6) nmol/L, (380.3 ± 37.6) nmol/L vs.(410.8 ± 46.6) nmol/L, (361.2 ± 25.2) nmol/L vs. (392.6 ± 31.6) nmol/L, (352.3 ± 25.6) nmol/L vs. (370.3 ± 28.8) nmol/L, and there were significant differences (P < 0.05). Conclusions During induction of general anesthesia with the guidance of cerebral state index, target controlled infusion of etomidate has more stable hemodynamics, and also attenuates the stress response to tracheal intubation in elderly hypertensive patients.
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Objective To explore the similarities and differences between finger photoplethysmogram (PPG) and CSI in monitoring the depth of anaesthesia in Chinese adults under general anaesthesia. Methods Ninety-three patients, ASA ⅠorⅡ, aged 20-67, under general anaesthesia were enrolled. Anaesthesia was induced with target-controlled infusion (TCI) of propofol. The initial TCI concentration of propofol was set at 0.5 mg·L-1 followed by increments of 0.5 mg·L-1 at 3-min interval until the score of Modified Observer's Assessment of Alertness/Sedation Scale (MOAAS)reached 0. PPG and CSI were continuously monitored and their values were recorded every 2-4 seconds. MOAAS was recorded every 30 seconds to evaluate the sedation level in the study period. ResultsFor the periodfrom pre-induction to pre-intubation, the difference of photoplethysmogram amplitudevalues had statistical significance between level 4 and level 3, level 3 and level 2 of MOAAS (P<0.05). CSIvalues declined along with the decrease of MOAAS levels and were statistically different between every two neighboring levels of MOAAS (P < 0.05). Photoplethysmogram amplitude (PPGA) and pulse beat interval (PBI) values showed significant differences before and after intubation, pre- and post-incision (P < 0.05). Conclusions PPGA and PBI appear to be suitable to monitor the nociceptive component of balanced general anesthesia , while the CSI exhibits a good performance in monitoring the sedation or hypnotic component of balanced general anesthesia , thusthe combination of PPGA and CSI would benefit the monitoring of the adequacy of depth of anaesthesia.
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Objective: To examine the feasibility of using cerebral state index (CSI) for monitoring the sedation depth during target-controlled infusion (TCI) with propofol and remifentanil. Methods: Forty-four consenting ASA I or II patients (aged 18-60 years) undergoing elective surgery under general anesthesia were randomly divided into 4 groups (n=11 each) according to the target effect-site concentrations of remifentanil administered by TCI during induction of anesthesia. The target effect-site concentrations of remifentanil of R0, R2, R4, and R6 groups were 0,2 ng · ml-1, 4 ng · ml-1, and 6 ng · ml-1, respectively. Anesthesia was induced by TCI with remifentanil and propofol. CSI and bispectral index (BIS) were used to measure the sedation depth. The initial effect-site propofol concentration(PCe) was 1.5 μg · ml-1, which was increased by 0.5 μg · ml-1 every 4 min. The modified OAA/S score (5=alert, 1=does not respond to prodding),loss of eyelash reflex (LOR eyelash) and loss of response to electric tetanic stimulation (LOR tetanic) were compared against CSI, BIS and PCe(calculated effect-site propofol concentration). Correlation coefficients were calculated between CSI and other parameters. Results: The 4 groups were comparable with respect to the ages and bodyweights. CSI and BIS values were higher but PCe value were lower at LOR eyelash and LOR tetanic in R2, R4, and R6 than those in the R0 group (P<0.05 or 0.01). CSI was positively correlated with modified OAA/S score and BIS, but negatively with PCe (All P<0.01). Conclusion: CSI can be used for monitoring the depth of sedation produced by TCI with propopol and remifentanil.
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Objective To study the feasibility of cerebral state index(CSI)modulating the depth of general anesthesia in the elderly with laryngeal mask anesthesia.Methods Tmenty-four ASA physical status of Ⅱ-Ⅲ patients undergoing selective lower abdominal surgery were divided two groups with 12 cases.The anesthesia was induced by sufentanil、 propofuland maintained with TCI propofol.The depth of anesthesia was modulated by CSI index in group I or by hemodynamics in group Ⅱ.HR、SBP、DBP、MAP and CSI were recorded.The time of awakening form anesthesia(the time when OAA/S reached 4 score after the drawal of propofol)and the dosage of propofol and fentanyl were recored.Results The time of awakening from anesthesia was 16?5min in group Ⅱ,which was significantly longer than that in group I(P
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Objective:To study the clinical benefit of propofol anesthesia with target-controlled influsion technic modulated by cerebral state index in the elderly patients with tumor. Methods:A total of 126 ASA Ⅰ or Ⅱ aged65 yrs or older patients underwent gastrectomy and rectal surgery were randomly divided into tow groups(n=63 each):group by target-controlled influsion technic modulated(groupⅠ)and group by target-controlled influsion(groupⅡ). CSI of groupⅠwas 50. Propofol of two groups was administered by TCI at a target blood concertration of 2?g/ml during induction of anesthesia and maintenance of anesthesia,sufentanil of two groups was administered by TCI at a target blood concertration of 1.5?g/ml during induction of anesthesia and of 0.3ng/ml during maintenance of anesthesia. MAP,HR,HRV and CSI of the foundation(T1),intubation(T2),five minutes after intubation(T3),chip(T4),the tumor excision(T5) and the end of surgery(T6) were recorded. And the total of propofol was recorded. Results:MAP at T3,T4 and T5 of groupⅡdecreased obviously compared to that of groupⅠ(P
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Objective:To examine the feasibility of using cerebral state index(CSI)for monitoring the sedation depth during target-controlled infusion(TCI)with propofol and remifentanil.Methods:Forty-four consenting ASAⅠorⅡpatients(aged 18-60 years)undergoing elective surgery under general anesthesia were randomly divided into 4 groups(n=11 each)according to the target effect-site concentrations of remifentanil administered by TCI during induction of anesthesia.The target effect-site concentrations of remifentanil of R_0,R_2,R_4,and R_6 groups were 0,2 ng?ml~(-1),4 ng?ml~(-1),and 6 ng?ml~(-1),respectively. Anesthesia was induced by TCI with remifentanil and propofol.CSI and bispectral index(BIS)were used to measure the sedation depth.The initial effect-site propofol concentration(PCe)was 1.5?g?ml~(-1),which was increased by 0.5?g?ml~(-1) every 4 min.The modified OAA/S score(5=alert,1=does not respond to prodding),loss of eyelash reflex(LOR eyelash)and loss of response to electric tetanie stimulation(LOR tetanic)were compared against CSI,BIS and PCe(calculated effect-site propofol concentration).Correlation coefficients were calculated between CSI and other parameters.Results:The 4 groups were comparable with respect to the ages and bodyweights.CSI and BIS values were higher but PCe value were lower at LOR eyelash and LOR tetanic in R_2,R_4,and R_6 than those in the R_0 group(P