BIS-guided Anesthesia Decreases Postoperative Delirium and Cognitive Decline

Chan, Matthew T. V.; Cheng, Benny C P; Lee, Tatia M.C.; Gin, Tony

doi:10.1097/ana.0b013e3182712fba

Cited by 606 publications

(576 citation statements)

References 49 publications

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“…In this context, strategies such as minimally invasive surgery, guiding anaesthetic depth with BIS monitoring,93, 94 adequate pain relief, limited use of benzodiazepines95, 96 and opioids, a quiet environment to facilitate sleep and accelerated discharge home have been proposed as effective measures which need to be confirmed in large trials.…”

Section: Surgery and Cognitive Dysfunctionmentioning

confidence: 99%

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

Scott

Baldini

Fearon

et al. 2015

Acta Anaesthesiol Scand

339

198

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BackgroundThe present article has been written to convey concepts of anaesthetic care within the context of an Enhanced Recovery After Surgery (ERAS) programme, thus aligning the practice of anaesthesia with the care delivered by the surgical team before, during and after surgery.MethodsThe physiological principles supporting the implementation of the ERAS programmes in patients undergoing major abdominal procedures are reviewed using an updated literature search and discussed by a multidisciplinary group composed of anaesthesiologists and surgeons with the aim to improve perioperative care.ResultsThe pathophysiology of some key perioperative elements disturbing the homoeostatic mechanisms such as insulin resistance, ileus and pain is here discussed.ConclusionsEvidence‐based strategies aimed at controlling the disruption of homoeostasis need to be evaluated in the context of ERAS programmes. Anaesthesiologists could, therefore, play a crucial role in facilitating the recovery process.

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Section: Surgery and Cognitive Dysfunctionmentioning

confidence: 99%

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

Scott

Baldini

Fearon

et al. 2015

Acta Anaesthesiol Scand

339

198

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“…These problems can affect from 4% to 70% of patients up to two years after the traumatic event 5,[7][8][9][10][11] . On the other hand, too deep a level of anesthesia can increase the incidence of postoperative cognitive decline, postoperative delirium, time of hospitalization and accelerate the onset of senile dementia [12][13][14][15] . Analysis of the proper level of anesthesia is based on assessment of clinical parameters, autonomic and somatic reflexes 16 .…”

Section: Introductionmentioning

confidence: 99%

Non-instrumental clinical monitoring does not guarantee an adequate course of general anesthesia. A prospective clinical study

Szostakiewicz¹,

Rybicki²,

Tomaszewski³

2018

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Clinical monitoring is the most common method of adjusting the appropriate level of general anesthesia. However, episodes of intraoperative awareness (AWR) are still reported, suggesting that clinical observations may not be sufficient in some cases. The objective of this study was to compare the efficacy of clinical and instrumental neuromonitoring with auditory evoked potentials (AEP) in an intraoperative analysis of the proper level of general anesthesia. Methods. Patients scheduled for elective surgery were randomly divided into two groups. Subjects in the first group underwent intravenous, in the second group volatile anesthesia. The adequacy of anesthesia was analyzed using clinical parameters. All the participants were instrumentally monitored with the autoregressive AEP index (AAI). After the anesthesia, patients filled out a questionnaire on possible AWR. Results. Data of 208 patients (87 in the first, and 121 in the second group) were analyzed. Before surgery there were no changes in AAI values between groups (80 vs. 78, P=0.5192). The mean values of clinical parameters changed, but five minutes after the nociceptive stimuli. The mean values of AAI at analyzed time points were specific for general anesthesia. In patients under intravenous anesthesia, we found more episodes of too low (46/608 vs.15/847, P<0.000) anesthesia. One case of AWR was found in the TIVA group. Conclusions. AAI index is good indicator of patients' level of consciousness during general anesthesia. Standard clinical monitoring provides appropriate level of the procedure. However, it is insufficient during TIVA and does not prevent episodes of AWR.

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“…Although the BIS monitor is in common use and may play a role in the prevention of intraoperative awareness and possibly other outcomes, [7][8][9][10] it is a limited measure of anesthetic-induced unconsciousness and brain function in general. It is well known that the BIS is relatively insensitive to the effects of anesthetics such as ketamine and nitrous oxide.…”

Section: Bispectral Index Is a Limited Index Of Brain Functionmentioning

confidence: 99%