Benefits and boundaries of processed electroencephalography (pEEG) monitors when they do not concur with standard anesthetic clinical monitoring: lights and shadows

Dahaba, Ashraf A.

doi:10.23736/s0375-9393.19.13959-4

Cited by 6 publications

(5 citation statements)

References 89 publications

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“…15 The need for controlling frontalis electrical muscle activity is just one among numerous factors that can give a BIS index which does not always accurately reflect an accurate level of consciousness. 4,39 This raises the question of the justification for using the BIS as our measure of brain effect among the numerous available pEEG monitors despite the fact that BIS might not always precisely predict anesthetic depth and/or effect. Among more recently described depth of anesthesia algorithms of 10 commercially available pEEGs 39 ; we chose the BIS as this was the first pEEG available since 1994 and by far the most extensively studied and widely published compared with the other new pEEG monitors.…”

Section: Discussionmentioning

confidence: 99%

“…4,39 This raises the question of the justification for using the BIS as our measure of brain effect among the numerous available pEEG monitors despite the fact that BIS might not always precisely predict anesthetic depth and/or effect. Among more recently described depth of anesthesia algorithms of 10 commercially available pEEGs 39 ; we chose the BIS as this was the first pEEG available since 1994 and by far the most extensively studied and widely published compared with the other new pEEG monitors. Having said that, we have to always keep in mind what are we monitoring with pEEG monitors or “are we just chasing the numbers?” 40…”

Section: Discussionmentioning

confidence: 99%

“…Electromyographic activities fall within bispectrum's "range of interest"; as EMG 30-300 Hz overlaps the EEG 0-50 Hz , 37 in the BIS component descriptor BetaRatio EEG [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] Hz . The BIS algorithm would then misinterpret that as EEG activity indicating lightening of anesthesia.…”

Section: Electromyographic Activitiesmentioning

confidence: 99%

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Propofol–Bispectral Index (BIS) Electroencephalography (EEG) Pharmacokinetic-Pharmacodynamic Model in Patients With Post–Cerebral Hemorrhage Hydrocephalus

Dahaba

Lin

et al. 2020

Clin EEG Neurosci

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Background. Titrating hypnotic agents for patients who suffer from a cerebral insult is a challenging task. To date there is no real gold standard to precisely quantify electroencephalography (EEG) response in a fashion that could be utilized for patients with post–cerebral hemorrhage hydrocephaly. While we must administer “as per usual” analgesics for noxious stimuli, we have to administer the hypnotic agents more “sparingly” due to lack of objective monitoring. Methods. We compared 15 adult post–cerebral hemorrhage hydrocephalus patients undergoing ventriculo-peritoneal shunt placement with 15 controls matched for gender and approximate age. We set propofol target controlled infusion estimated plasma concentrations (Cp) to gradually reach 4 µg/mL over 4 minutes. To precisely quantify post–cerebral hemorrhage mental dysfunction, we used electronically retrieved bispectral index (BIS) and propofol Cp data points to create individual inhibitory monophasic mathematical model for each patient that incorporates an independent hysteresis “lag” function. Results. In post–cerebral hemorrhage patients Cp-BIS curve, C50 (propofol concentration associated with inhibitory 50% BIS response) cutoff point was significantly shifted to the left by 39%. Whereas before infusion and at stable propofol 4 µg/mL aneurismal surgical sides ipsilateral (75 ± 13, 25 ± 9) and contralateral (73 ± 15, 27 ± 9) mean ± SD BIS values were significantly lower than ipsilateral (95 ± 3, 46 ± 12) and contralateral (94 ± 3, 46 ± 12) matched controls. Conclusions. Using BIS as surrogate marker of propofol hypnotic effect, BIS monitoring in patients with post–cerebral hemorrhage hydrocephaly showed a pattern of change and trend that was similar albeit 39% significantly lower than subjects without.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Electromyographic Activitiesmentioning

confidence: 99%

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Propofol–Bispectral Index (BIS) Electroencephalography (EEG) Pharmacokinetic-Pharmacodynamic Model in Patients With Post–Cerebral Hemorrhage Hydrocephalus

Dahaba

Lin

et al. 2020

Clin EEG Neurosci

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“…Los cambios sobre actividad eléctrica cerebral y organización en distintos patrones de ondas del EEG asociados con la administración de fármacos que actúan sobre el sistema nervioso central (SNC) se han descrito durante décadas (15,16) , por lo que el neuromonitoreo con EEG intraoperatorio se considera el enfoque más factible para el seguimiento de estados cerebrales bajo AG (Figura 1). Desde la década de 1990, se ha introducido una variedad de monitores de pEEG que muestran índices de probable profundidad anestésica, basados en algoritmos de análisis cuantitativo que permiten evaluar, titular y optimizar objetivamente el efecto de los anestésicos sobre la actividad cortical a través de un índice numérico derivado del análisis y procesamiento del EEG (12,17) . La base matemática para el procesamiento de señales, amplificación, análisis, filtrado, eliminación de artefactos, conversión digital y procesamiento es la transformada rápida de Fourier, que deconstruye e identifica las formas de onda del dominio del tiempo original en un espectro de ondas sinusoidales individuales de diferentes frecuencias, amplitudes y fase (3) .…”

Section: Electroencefalograma Procesado (Peeg)unclassified

Neuromonitoreo con electroencefalograma procesado, más que profundidad anestésica

Martínez-de los Santos,

Ramírez-Sánchez,

Guillén-Ramírez

et al. 2024

Revista Mexicana De Anestesiología

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RESUMEN.El neuromonitoreo intraoperatorio con electroencefalograma (EEG) y electroencefalograma procesado (pEEG) permite la evaluación de cambios en la actividad eléctrica cerebral generados por los anestésicos, además de prevenir eventos adversos como recuerdo intraoperatorio, sobredosis farmacológica, compromiso hemodinámico y/o neurológico, delirio y disfunción cognitiva postoperatoria. Sin embargo, la actividad eléctrica cortical puede estar modulada y ser afectada por alteraciones fisiopatológicas, independientemente del efecto de los fármacos anestésicos, por lo que, tanto el EEG como el pEEG pueden ser auxiliares en el diagnóstico oportuno de trastornos metabólicos, hipóxicos, supresión de la actividad eléctrica cerebral, estados epilépticos no convulsivos, hipertensión intracraneal, hipoperfusión o isquemia cerebral. El neuromonitoreo de rutina con el monitor disponible es recomendable con el fin de mejorar nuestra experiencia en su uso para una anestesia personalizada y de precisión, estableciendo estado de profundidad anestésica y dosis farmacológica óptima para el mantenimiento de los mecanismos implicados en la autorregulación de la perfusión cerebral, mejor comprensión de la fisiología, función cerebral y su interacción con los anestésicos e impacto hemodinámico del paciente neuroquirúrgico y no neuroquirúrgico, identificando signos precoces de posibles complicaciones derivadas del procedimiento o por efecto farmacológico y su rápida resolución.

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“…Інструментальна об'єктивізація оцінки рівня свідомості може проводитись за допомогою необов'язкового на сьогоднішній день енцефалографічного моніторингу з конверсією показників у прості значення (Processed electroencephalography, pEEG). При його врахуванні у процесі прийняття клінічних рішень, варто пам'ятати про велику кількість факторів, які можуть вплинути на результуючий індекс, зокрема вибір препарату для анестезії [9].…”

Section: стандарти моніторингуunclassified

Patient Monitoring During Procedural Sedation: Are the Modern Standards Implemented in Ukraine?

BIELKA¹,

FRANK²,

KUCHYN³

et al. 2023

Pain Anaesth Int Care

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The purpose of the study was to review modern recommendations regarding the monitoring of patients during procedural sedation and analgesia as well as to assess its conformity to the modern standards in Ukraine. Materials and methods. Recommendations from European, American, British and Australian organizations which cover the topic of procedural sedation and analgesia or levels of anesthesia that conform to the procedural sedation corresponding to ASA, the standard monitoring during anesthesia, and were published between 2003 and 2023 have been reviewed. From 17 till 20th of March a survey has been conducted. Throughout the survey, participants have anonymously filled a questionnaire via Google-Form. The link to the questionnaire was shared by the Department of Anesthesiology and Intensive Care of the Institute of Postgraduate Education of Bogomolets National University with support provided by Association of Anesthesiologists of Ukraine through social networks such as Facebook and Instagram on the official pages of the Department of Surgery, Anesthesiology, and Intensive Care of the Institute of Postgraduate Education of the Bogomolets National Medical University. Results. A total of 284 doctors took part in the survey. Among them 280 (98.5 %) have been working in Ukraine during the survey, 4 (1.5 %) have been excluded from the analysis. Pulse oximetry was regularly used by 278 (99.2 %), automatic arterial pressure measurement by 222 (79.4 %), manual measurement of arterial pressure by 35 (12.5 %), ECG-monitoring by 95 (34.2 %), capnography by 35 (12.5 %), thermometry by 10 (3.5 %), electroencephalography by 4 (1.6 %) of the doctors (Fig. 3). 36 (12.8 %) of the respondents have informed about the absence of technical means to conduct ECG-monitoring, 172 (62.5 %) have conducted it in a selective manner. The results are presented in form of descriptive statistics and diagrams. Conclusion. Procedural sedation is a safe method provided that modern safety standards are systematically followed. Full monitoring is a prerequisite for timely response to critical events and mitigation of their consequences. Reporting problems of any degree of criticality that occurred during sedation helps to optimize local practices and has a positive effect on the quality of medical care. Introduction of routine capnography, electrocardiography and thermometry are prioritized goals when it comes to increasing the quality of monitoring in Ukraine.

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Benefits and boundaries of processed electroencephalography (pEEG) monitors when they do not concur with standard anesthetic clinical monitoring: lights and shadows

Cited by 6 publications

References 89 publications

Propofol–Bispectral Index (BIS) Electroencephalography (EEG) Pharmacokinetic-Pharmacodynamic Model in Patients With Post–Cerebral Hemorrhage Hydrocephalus

Propofol–Bispectral Index (BIS) Electroencephalography (EEG) Pharmacokinetic-Pharmacodynamic Model in Patients With Post–Cerebral Hemorrhage Hydrocephalus

Neuromonitoreo con electroencefalograma procesado, más que profundidad anestésica

Patient Monitoring During Procedural Sedation: Are the Modern Standards Implemented in Ukraine?

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