Bispectral index monitoring correlates with the level of consciousness in brain injured patients / 대한마취과학회지

BACKGROUND: In general, measuring the level of consciousness in neurological patients is important. To assess the patient's mental status, the Glasgow Coma Scale (GCS) and the level of consciousness (drowsiness, stupor, and coma) have been used in clinical situations. The aim of the present study was to identify the correlation between bispectral index (BIS) and level of consciousness in brain injured patients. METHODS: Eighty-nine adult patients of both sexes were included in the study. A blinded observer evaluated the mental status (GCS and level of consciousness) of a patient who is admitted in intensive care unit with brain injury, while an investigator noted the patient's BIS. The BIS was measured using a BIS monitor, Model A-3000 vista(TM) with Sensor Bis quatro(TM) (Aspect Medical Systems, Norwood, USA). A Spearman's rank correlation coefficient was used to determine if the level of consciousness correlated with the BIS. RESULTS: In 89 patients, the BIS was found to be significantly correlated with the level of consciousness (r = 0.723, P < 0.01) and GCS (r = 0.646, P < 0.01). The BIS values increased with an increasing level of consciousness. Mean BIS values of coma, semicoma, stupor and drowsiness were 0.14 +/- 0.23, 38.9 +/- 18.0, 60.3 +/- 14.5, and 73.6 +/- 16.5, respectively. CONCLUSIONS: In the present study, a significant correlation existed between level of consciousness and BIS. These findings suggest that BIS may be used for assessing the level of consciousness in brain injured patients. However, the scatter of BIS values for any level of consciousness limited the worth of BIS in predicting mentality except in coma patients.

Epidural catheterization with a subcutaneous injection port for the long-term administration of opioids and local anesthetics to treat zoster-associated pain: a report of two cases / 대한마취과학회지

Continuous epidural analgesia has been used for decades to treat acute herpes zoster pain and to prevent postherpetic neuralgia. However, many technical problems can arise during chronic treatment with epidural medications. These complications include catheter dislodgement, infection, injection pain, leakage, and occlusion. Epidural catheter placement utilizing subcutaneous injection port implantation has gained widespread acceptance as a method to overcome such complications. The technique reduces the risk of infection, the most feared complication, compared to the use of a percutaneous epidural catheter. Herein, we present 2 cases in which the continuous thoracic epidural administration of opioids and local anesthetics through an implantable subcutaneous injection port for over 2 months successfully treated zoster-associated pain without any technique- or medication-related complications in patients with risk factors for epidural abscess.