Background: The vasoactive-inotropic score (VIS) predicts mortality and morbidity after paediatric cardiac surgery. Here we examined whether VIS also predicted outcome in adults after cardiac surgery, and compared predictive capability between VIS and three widely used scoring systems. Methods: This single-centre retrospective cohort study included 3213 cardiac surgery patients. Maximal VIS (VIS max ) was calculated using the highest doses of vasoactive and inotropic medications administered during the first 24 h postsurgery. We established five VIS max categories: 0e5, >5e15, >15e30, >30e45, and >45 points. The predictive accuracy of VIS max was evaluated for a composite outcome, which included 30-day mortality, mediastinitis, stroke, acute kidney injury, and myocardial infarction. Results: VIS max showed good prediction accuracy for the composite outcome [area under the curve (AUC), 0.72; 95% confidence interval (CI), 0.69e0.75]. The incidence of the composite outcome was 9.6% overall and 43% in the highest VIS max group (>45). VIS max predicted 30-day mortality (AUC, 0.76; 95% CI, 0.69e0.83) and 1-yr mortality (AUC, 0.70; 95% CI, 0.65e0.74). Prediction accuracy for unfavourable outcome was significantly better with VIS max than with Acute Physiology and Chronic Health Evaluation II (P¼0.01) and Simplified Acute Physiological Score II (P¼0.048), but not with the Sequential Organ Failure Assessment score (P¼0.32). Conclusions: In adults after cardiac surgery, VIS max predicted a composite of unfavourable outcomes and predicted mortality up to 1 yr after surgery.

The cEEG can be considered as the primary monitoring technique in the assessment of the depth of anesthesia in the treatment of RSE. If cEEG is not available, the BIS monitor can be used to guide the level of anesthesia, targeting BS in patients with RSE.

Leucine-rich-alpha-2-glykoprotein (LRG) is suggested as a potential biomarker for idiopathic normal pressure hydrocephalus (iNPH). Our goal was to compare the cerebrospinal fluid (CSF) LRG levels between 119 iNPH patients and 33 age-matched controls and with the shunt responses and the brain biopsy Alzheimer’s disease (AD) pathology among the iNPH patients. CSF LRG, Aβ1-42, P-tau181, and T-tau were measured by using commercial ELISAs. The LRG levels in the CSF were significantly increased in the iNPH patients (p < 0.001) as compared to the controls, regardless of the AD pathology. However, CSF LRG did not correlate with the shunt response in contrast to the previous findings. The CSF AD biomarkers, i.e., Aβ1-42, T-tau, and P-tau correlated with the brain biopsy AD pathology as expected but were systematically lower in the iNPH patients when compared to the controls (<0.001). Our findings support that the LRG levels in the CSF are potentially useful for the diagnostics of iNPH, independent of the brain AD pathology, but contrary to previous findings, not for predicting the shunt response. Our findings also suggest a need for specific reference values of the CSF AD biomarkers for the diagnostics of comorbid AD pathology in the iNPH patients.

Monitoring the level of consciousness during general anesthesia with processed electroencephalogram (EEG) monitors has become an almost routine practice in the operating room, despite ambiguous research results regarding its potential benefits. For the patient as well as the anesthesiologist, the primary concern with respect to general anesthesia is that there will be a lack of awareness and recall during surgery. Using EEG signals to monitor the depth of anesthesia should reduce the incidence of intraoperative awareness, lead to a reduction in drug consumption, prevent anesthesia-related adverse events, and enable faster recovery. These benefits have been associated with depth-of-anesthesia monitoring in small clinical trials, but larger studies of EEG-based monitoring have failed to confirm the results of the smaller studies. The results of recent studies that investigated the emergence of consciousness after general anesthesia and the mechanism of action of anesthetic drugs on the central nervous system may help us to understand the limitations of EEG-based monitors and why they do not perform better in large clinical trials. In this article, we review the current status of monitoring the hypnotic component of general anesthesia and discuss the results of recent studies and guidelines that pertain to depth-of-anesthesia monitoring.