Changes in the cerebral state index (CSI) during intraoperative cardiac arrest

Abstract

through the compressed or narrowed portion of the trachea [2]. For this reason, fibreoptic endotracheal intubation is advisable.Ljunghall and colleagues showed that patients with HPT who were apparently asymptomatic preoperatively did not have defects of their neuromuscular transmission that were of clinical significance [5]. In asymptomatic pHPT neither consistent abnormality of neuromuscular transmission nor abnormal muscle structure was found [6]. On the contrary, Al Mohaya and colleagues reported a decreased response to both succinylcholine and atracurium in a patient with parathyroid adenoma [3].In patients there was a decreased duration of action of cis-atracurium. There was recovery of T1 to 25% of control at 26.9 min and repeated doses of cis-atracurium (0.03 mg kg 21 ) administered to maintain relaxation during surgery provided a clinical duration 10.2 6 0.8 min. Wuffel and colleagues reported that recovery index 25-75% and time to a TOF ratio of 0.70 of cis-atracutium were prolonged significantly by sevoflurane compared with total intravenous anaesthesia [7]. However, in our patient, increased minimum alveolar concentration (MAC) of sevoflurane did not result in significant effects on duration of or recovery from the block. On the contrary, recovery was considerably shorter in our patient. Intraoperative electrolytes and acid-base balance status were normal and normothermia was maintained.In conclusion, special attention should be paid to neuromuscular function monitoring in patients with pHPT. References1. Aguilera IM, Vaughan RS. Calcium and the anaesthetist.

Electroencephalography during Out-of-hospital Cardiopulmonary Resuscitation

“…And different cases of successful EEG-based cerebral neuromonitoring during CPR with external chest compressions as well as internal cardiac massages have been reported (2)(3)(4)(5)(6)(7). As most of these recordings were not accompanied by simultaneous raw EEG recordings, the devices might have misinterpreted the mechanical artifact caused by chest compressions.…”

“…In the last few years, various attempts have been described to use electroencephalography (EEG)-based cerebral neuromonitoring to assess the effectiveness of cardiopulmonary resuscitation (CPR) with internal as well as external chest compressions (2)(3)(4)(5)(6)(7)(8)(9)(10).…”

“…The Cerebral State Index (CSI) is a non-dimensional index scaled between 0 and 100 that corresponds to level of consciousness, used for the assessment of depth of sedation during anesthesia (11,12). Furthermore, there are reports suggesting that the CSI can objectively observe the increase of electrical brain activity after optimal and sustained chest compressions during resuscitation maneuvers (2,3).…”