Evaluation of patient state index, bispectral index, and entropy during drug induced sleep endoscopy with dexmedetomidine

Han, Lei; Drover, David R.; Chen, Marianne C; Saxena, Amit; Eagleman, Sarah L.; Nekhendzy, Vladimir; Capasso, Robson

doi:10.1007/s10877-022-00952-9

Cited by 4 publications

(4 citation statements)

References 25 publications

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“…& , 19,20]. Taken together, it is certainly possible to study the applicability of monitors for the reduction of AUA with further drug combinations and anesthesia protocols, but it seems safe to deduce clinical value for a set of rather prevalent drugs and protocols, but not so for other drugs and protocols.…”

Section: Introduction (The Original Goal Of Eeg-based Monitors For Th...mentioning

confidence: 99%

“…For some time now, evidence suggests that in certain conditions, e.g. sedation, the currently-used markers are affected significantly by changes in EMG and therefore might not differentiate well in such settings between the effects of anesthesia and muscle activity [13,14–16,17 ▪ ,18 ▪ ,19,20]. Taken together, it is certainly possible to study the applicability of monitors for the reduction of AUA with further drug combinations and anesthesia protocols, but it seems safe to deduce clinical value for a set of rather prevalent drugs and protocols, but not so for other drugs and protocols…”

Section: Introduction (The Original Goal Of Eeg-based Monitors For Th...mentioning

confidence: 99%

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Intraoperative EEG-based monitors: are we looking under the lamppost?

Baron Shahaf,

Shahaf

2024

Current Opinion in Anaesthesiology

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Purpose of review While electroencephalogram (EEG)-based depth of anesthesia monitors have been in use clinically for decades, there is still a major debate concerning their efficacy for detecting awareness under anesthesia (AUA). Further utilization of these monitors has also been discussed vividly, for example, reduction of postoperative delirium (POD). It seems that with regard to reducing AUA and POD, these monitors might be applicable, under specific anesthetic protocols. But in other settings, such monitoring might be less contributive and may have a ‘built-it glass ceiling’. Recent advances in other venues of electrophysiological monitoring might have a strong theoretical rationale, and early supporting results, to offer a breakthrough out of this metaphorical glass ceiling. The purpose of this review is to present this possibility. Recent findings Following previous findings, it might be concluded that for some anesthesia protocols, the prevailing depth of anesthesia monitors may prevent incidences of AUA and POD. However, in other settings, which may involve other anesthesia protocols, or specifically for POD – other perioperative causes, they may not. Attention-related processes measured by easy-to-use real-time electrophysiological markers are becoming feasible, also under anesthesia, and might be applicable for more comprehensive prevention of AUA, POD and possibly other perioperative complications. Summary Attention-related monitoring might have a strong theoretical basis for the prevention of AUA, POD, and potentially other distressing postoperative outcomes, such as stroke and postoperative neurocognitive disorder. There seems to be already some initial supporting evidence in this regard.

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Section: Introduction (The Original Goal Of Eeg-based Monitors For Th...mentioning

confidence: 99%

Section: Introduction (The Original Goal Of Eeg-based Monitors For Th...mentioning

confidence: 99%

Intraoperative EEG-based monitors: are we looking under the lamppost?

Baron Shahaf,

Shahaf

2024

Current Opinion in Anaesthesiology

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“…Drug‐induced sleep endoscopy (DISE) is currently regarded as the most appropriate method to detect the level and patterns of obstruction in patients with sleep‐disordered breathing 1–4 . Different sedative drugs (propofol, midazolam, dexmedetomidine) and patterns of application (bolus injection, sedation depth‐controlled, target‐controlled infusion [TCI]) are commonly performed and the obtained results of DISE vary between the applied drugs and patterns 3,5–7 . Even when using a single drug like propofol, the results of the DISE may vary depending on the dose and flow rate of the applied propofol.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] Different sedative drugs (propofol, midazolam, dexmedetomidine) and patterns of application (bolus injection, sedation depth-controlled, targetcontrolled infusion [TCI]) are commonly performed and the obtained results of DISE vary between the applied drugs and patterns. 3,[5][6][7] Even when using a single drug like propofol, the results of the DISE may vary depending on the dose and flow rate of the applied propofol.…”

Section: Introductionmentioning

confidence: 99%

The influence of different application patterns of propofol on the sedation courses during drug‐induced sleep endoscopy

Polievoi,

Grafmans,

Skliar

et al. 2024

Laryngoscope Investig Oto

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ObjectiveThe course of sedation during drug‐induced sleep endoscopy (DISE) depends on the application pattern of the sedative drug. The depth of sedation should imitate light and deep sleep as well. Moreover, there should be as many breathing cycles as possible available for observation during light and deep sedation. The aim of the study was to evaluate different rates of propofol application with respect to the achieved depth and length of the course of sedation.MethodsSixty‐three consecutive patients with obstructive sleep apnea and/or snoring undergoing DISE were randomly sedated by propofol perfusion at seven different application patterns: 14, 16, 18, 19, 20, 22 mg/kg/h (0.233, 0.267, 0.3, 0.317, 0.333, 0.367 mg/kg/min) per perfusor and individual bolus application 10 mg each. Sedation depth was monitored by BiSpectral Index™ (BIS). The influence of baseline parameters and the courses of sedation were analyzed.ResultsThe application rate was the only factor that influenced the depth of sedation. Basic parameters (gender, age, body mass index, apnea‐hypopnea index) had no influence on the depth of sedation. The sedation depth was dependent on the rate of propofol application. Regimes at 14 and 16 mg/kg/h as well as bolus application did not reach BIS levels below 50 representing deep sleep. Propofol doses of more than 20 mg/kg/h led to rapid decreases of sedation levels below deep sleep niveau. Propofol rates between 18 and 20 mg/kg/h enable BIS levels below 50 representing deep sleep and providing enough breathing cycles for observation.ConclusionLower application rates of propofol provide slower courses of sedation and shallower depths of sedation. A rate of 14 mg/kg/h might be appropriate to reach a sedation plateau at light sleep. A rate of 18 mg/kg/h leads to a sedation, corresponding to deep sleep. The combination of both rates might be a suitable pattern for performing sedation‐controlled DISE.Level of evidence2: Randomized trial.

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