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Determination of loss of consciousness: a comparison of clinical assessment, bispectral index and electroencephalogram: An observational study
Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping. Linköping University, Department of Medical and Health Sciences, Division of Drug Research.
Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
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2016 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 33, no 12, 922-928 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUNDComputer-processed algorithms of encephalographic signals are widely used to assess the depth of anaesthesia. However, data indicate that the bispectral index (BIS), a processed electroencephalography monitoring system, may not be reliable for assessing the depth of anaesthesia.OBJECTIVEThe aim of this study was to evaluate the ability of the BIS monitoring system to assess changes in the level of unconsciousness, specifically during the transition from consciousness to unconsciousness, in patients undergoing total intravenous anaesthesia with propofol. We compared BIS with the electroencephalogram (EEG), and clinical loss of consciousness (LOC) defined as loss of verbal commands and eyelash reflex.DESIGNThis was an observational cohort study.SETTINGUniversity Hospital Linkoping, University Hospital orebro, Finspang Hospital and Kalmar Hospital, Sweden from October 2011 to April 2013.PATIENTSA total of 35 ASA I patients aged 18 to 49 years were recruited.INTERVENTIONSThe patients underwent total intravenous anaesthesia with propofol and remifentanil for elective day-case surgery. Changes in clinical levels of consciousness were assessed by BIS and compared with assessment of stage 3 neurophysiological activity using the EEG. The plasma concentrations of propofol were measured at clinical LOC and 20 and 30min after LOC.MAIN OUTCOME MEASURESThe primary outcome was measurement of BIS, EEG and clinical LOC.RESULTSThe median BIS value at clinical LOC was 38 (IQR 30 to 43), and the BIS values varied greatly between patients. There was no correlation between BIS values and EEG stages at clinical LOC (r=-0.1, P=0.064). Propofol concentration reached a steady state within 20min.CONCLUSIONThere was no statistically significant correlation between BIS and EEG at clinical LOC. BIS monitoring may not be a reliable method for determining LOC.CLINICAL TRIALS REGISTRYThis trial was not registered because registration was not mandatory at the time of the trial.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2016. Vol. 33, no 12, 922-928 p.
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:liu:diva-132980DOI: 10.1097/EJA.0000000000000532ISI: 000387275500007PubMedID: 27606612OAI: oai:DiVA.org:liu-132980DiVA: diva2:1054752
Note

Funding Agencies|Medical Research Council of Southeast Sweden; Swedish Research Council; County Council in Ostergotland

Available from: 2016-12-09 Created: 2016-12-07 Last updated: 2017-04-24Bibliographically approved

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The full text will be freely available from 2017-12-10 16:17
Available from 2017-12-10 16:17

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Zetterlund, Eva-LenaGreen, HenrikOscarsson, AnnaVikingsson, SvanteVrethem, MagnusLindholm, Maj-LisEintrei, Christina
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Division of Drug ResearchFaculty of Medicine and Health SciencesDepartment of Anaesthesiology and Intensive Care in NorrköpingDivision of Neuro and Inflammation ScienceDepartment of NeurologyDepartment of Anaesthesiology and Intensive Care in Linköping
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European Journal of Anaesthesiology
Anesthesiology and Intensive Care

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