Combined use of Bispectral Index™ and A-Line™ Autoregressive Index™ to assess anti-nociceptive component of balanced anaesthesia during lumbar arthrodesis

Bonhomme, Vincent; Llabres, Vinciane; Dewandre, Pierre-Yves; Brichant, Jean-François; Hans, Pol

doi:10.1093/bja/ael004

Cited by 27 publications

(9 citation statements)

References 26 publications

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“…Second, the BIS increase observed in the present study was associated with an increase in EEG amplitude and a decrease in EEG suppression ratio, reflecting EEG activation, as already observed by Visser et al 10 in their study on the patterns of spectral EEG changes during carotid clamping. Third, the BIS increase was associated with an increase in AAI, which may be indicative of impaired control of nociception, 19 or lightening of the hypnotic state. In addition, it was also associated with a shorter delay between induction of anesthesia and CXC.…”

Section: Increase In Bismentioning

confidence: 99%

Bispectral Index Profile During Carotid Cross Clamping

Bonhomme¹,

Désiron

Lemineur³

et al. 2007

Journal of Neurosurgical Anesthesiology

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This study aimed at investigating the Bispectral Index (BIS) profile during carotid cross clamping (CXC). The study involved a pilot group of 10 patients undergoing routine carotid endarterectomy with shunt insertion under total intravenous anesthesia, and a study group of 26 additional patients. In all patients, rates of propofol and remifentanil providing a steady-state level of hypnosis (BIS: 40-60) were maintained constant throughout a recording period ranging from 3 minutes before CXC to shunt insertion. BIS was recorded throughout this period and the internal carotid backflow observed at the time of shunt insertion was graded as good, moderate, or poor. In addition, A-Line Autoregressive Index (AAI) and processed electroencephalogram (EEG) parameters were recorded in patients of the study group. All parameters were averaged over 1 minute before CXC, at CXC, 1, 2, and 3 minutes after CXC, and at shunt insertion. Statistical analysis was performed using chi2, Friedman, and Spearman correlation tests. For technical reasons, reliable AAI, BIS monitor-derived, and other processed EEG data were obtained in 24, 25, and 18 patients of the study group, respectively. During the first 3 minutes after CXC, BIS increased over 60 [68.8 (6.1)] in 47%, decreased below 40 [34.9 (4.4)] in 25%, and remained in the 40 to 60 range in 28% of all recruited patients. A BIS increase was more frequently observed in patients with moderate or poor than in those with good internal carotid backflow (78, 67, and 29%, respectively). It was significantly correlated to an increase in AAI and EEG amplitude, a decrease in EEG suppression ratio, and a shorter time between induction of anesthesia and CXC. A BIS decrease was significantly correlated to an increase in suppression ratio and a longer time between induction and CXC. In conclusion, during CXC under a constant level of intravenous anesthesia, BIS may increase, decrease, or remain unchanged. The paradoxical BIS increase could be related to borderline ischemia, a change in brain anesthetic agent concentration, or a change in the nociceptive-antinociceptive balance associated with a CXC-elicited painful stimulation. Caution should be used when interpreting BIS value during CXC.

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Section: Increase In Bismentioning

confidence: 99%

Bispectral Index Profile During Carotid Cross Clamping

Bonhomme¹,

Désiron

Lemineur³

et al. 2007

Journal of Neurosurgical Anesthesiology

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“…Effective regional techniques in the hands of skilled clinicians can ablate the peak noxious barrage (Bonhomme et al, 2006; Wennervirta et al, 2011) of pain in the perioperative period and potentially minimize pathological neural plasticity implicated in the genesis of chronic pain (Woolf and Salter, 2000; Scholz and Woolf, 2007; Harvey and Dickenson, 2008; Ivani et al, 2011). Unsurprisingly, the majority of the trials included in this review found regional analgesia to be beneficial for reducing perioperative pain and subsequent chronic symptoms.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of therapeutic interventions to reduce acute and chronic post‐surgical pain after amputation, thoracotomy or mastectomy

Humble

Dalton

2014

European Journal of Pain

186

150

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BackgroundPerioperative neuropathic pain is under-recognized and often undertreated. Chronic pain may develop after any routine surgery, but it can have a far greater incidence after amputation, thoracotomy or mastectomy. The peak noxious barrage due to the neural trauma associated with these operations may be reduced in the perioperative period with the potential to reduce the risk of chronic pain.Databases and data treatmentA systematic review of the evidence for perioperative interventions reducing acute and chronic pain associated with amputation, mastectomy or thoracotomy.ResultsThirty-two randomized controlled trials met the inclusion criteria. Gabapentinoids reduced pain after mastectomy, but a single dose was ineffective for thoracotomy patients who had an epidural. Gabapentinoids were ineffective for vascular amputees with pre-existing chronic pain. Venlafaxine was associated with less chronic pain after mastectomy. Intravenous and topical lidocaine and perioperative EMLA (eutectic mixture of local anaesthetic) cream reduced the incidence of chronic pain after mastectomy, whereas local anaesthetic infiltration appeared ineffective. The majority of the trials investigating regional analgesia found it to be beneficial for chronic symptoms. Ketamine and intercostal cryoanalgesia offered no reduction in chronic pain. Total intravenous anaesthesia (TIVA) reduced the incidence of post-thoracotomy pain in one study, whereas high-dose remifentanil exacerbated chronic pain in another.ConclusionsAppropriate dose regimes of gabapentinoids, antidepressants, local anaesthetics and regional anaesthesia may potentially reduce the severity of both acute and chronic pain for patients. Ketamine was not effective at reducing chronic pain. Intercostal cryoanalgesia was not effective and has the potential to increase the risk of chronic pain. TIVA may be beneficial but the effects of opioids are unclear.

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“…AEP provides information about the function of the brainstem and subcortical and cortical components, showing the overall anesthetic state. [9] Because BIS measures cortical function, it is only able to monitor hypnotic state and is a poor indicator of the sensitiveness to pain. [10] Therefore, the AAI and not the BIS increased by intubation in the present study as in our previous studies.…”

Section: Discussionmentioning

confidence: 99%

Composite auditory evoked potentials index is not a good indicator of depth of anesthesia in propofol-fentanyl anesthesia: Randomized comparative study

Nishiyama¹

2013

J Anaesthesiol Clin Pharmacol

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Background:The composite auditory evoked potentials index (cAAI) was considered a measure of overall balance between noxious stimulation, analgesia, and hypnosis; while bispectral index (BIS) shows only hypnosis, and auditory evoked potentials index (AAI) shows response to stimuli. The present study compared the performance of cAAI, BIS, and AAI in propofol-fentanyl anesthesia.Materials and Methods:Forty-five patients for abdominal surgery aged 30-65 years with ASA physical status I or II were randomly divided into three groups by an envelope method. Anesthesia was induced with midazolam, propofol, and fentanyl alongwith an epidural block. When hemodynamics were stable during surgery, propofol infusion rate was fixed at 4 mg/kg/h for 10 min, then increased to 6 mg/kg/h and kept it for 10 min. AAI (AEP version 1.4), cAAI (AEP version 1.6), or BIS (A-2000) was monitored in each 15 patients, and the performance of three indices was compared.Results:All three indices decreased significantly before intubation. Only the AAI increased significantly by intubation. During anesthesia except for at propofol 6 mg/kg/h, the cAAI was significantly higher than the AAI. Only the AAI was significantly lower at propofol 6 mg/kg/h than at 4 mg/kg/h. The cAAI had the largest and AAI had the smallest inter-individual variations. The cAAI was higher than the manufacturer's recommended range of general anesthesia.Conclusion:In propofol-fentanyl anesthesia, AAI might be better to discriminate anesthetic depth than cAAI and BIS.

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Combined use of Bispectral Index™ and A-Line™ Autoregressive Index™ to assess anti-nociceptive component of balanced anaesthesia during lumbar arthrodesis

Cited by 27 publications

References 26 publications

Bispectral Index Profile During Carotid Cross Clamping

Bispectral Index Profile During Carotid Cross Clamping

A systematic review of therapeutic interventions to reduce acute and chronic post‐surgical pain after amputation, thoracotomy or mastectomy

Composite auditory evoked potentials index is not a good indicator of depth of anesthesia in propofol-fentanyl anesthesia: Randomized comparative study

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