Modelling the PSI response in general anesthesia

Pérez, Gerardo Alfonso; Pérez, José Andrés Moreno; Torres, Santiago; Morales, José Antonio Reboso; Fragoso, Ana María León

doi:10.1007/s10877-020-00558-z

Cited by 7 publications

(8 citation statements)

References 27 publications

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“…In previous publications [ 24 , 28 , 29 ], an inhibitory sigmoidal model was used to describe the relationship between PSI and propofol dose in humans. However, other investigations performed under inhalant anaesthesia found that the dose-effect relationship of EEG-derived variables obtained from BIS and Narcotrend devices was better described with the combination of two fractional sigmoid E max models [ 26 , 27 , 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

Correlation of Sedline-generated variables and clinical signs with anaesthetic depth in experimental pigs receiving propofol

2022

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Most of currently available electroencephalographic (EEG)-based tools to assess depth of anaesthesia have not been studied or have been judged unreliable in pigs. Our primary aim was to investigate the dose-effect relationship between increasing propofol dose and variables generated by the EEG-based depth of anaesthesia monitor Sedline in pigs. A secondary aim was to compare the anaesthetic doses with clinical outcomes commonly used to assess depth of anaesthesia in this species. Sixteen juvenile pigs were included. Propofol infusion was administered at 10 mg kg-1 h-1, increased by 10 mg kg-1 h-1 every 15 minutes, and stopped when an EEG Suppression ratio >80% was reached. Patient state index, suppression ratio, left and right spectral edge frequency 95%, and outcomes from commonly used clinical methods to assess depth of anaesthesia in pigs were recorded. The best pharmacodynamic model was assessed for Patient state index, suppression ratio, left and right spectral edge frequency 95% in response to propofol administration. The decrease of Patient state index best fitted to an inhibitory double-sigmoid model (including a plateau phase). The increase of suppression ratio fitted a typical sigmoid Emax model. No relevant relationship could be identified between spectral edge frequency 95% values and propofol administration. A large variability in clinical outcomes was observed among pigs, such that they did not provide a reliable evaluation of propofol dose. The relationship between propofol dose and Patient state index/suppression ratio described in the present study can be used for prediction in future investigations. The evaluation of depth of anaesthesia based on common clinical outcomes was not reliable.

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Section: Discussionmentioning

confidence: 99%

Correlation of Sedline-generated variables and clinical signs with anaesthetic depth in experimental pigs receiving propofol

2022

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“…It can collect information from both sides of the brain to detect asymmetry in the patient's electrical activity. Next, this algorithm is improved by considering individual background differences and brain responses of different patients to different anesthetics [12,31]. Finally, less impact of the shock device on the PSI value during surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Electroencephalography (EEG) is considered to be an important part of monitoring organs in anesthesia management [11]. The patient state index (PSI, SedLine® Root, Masimo Inc., Irvine, CA, USA) [12] is a reference index provided by the SedLine Brain Monitor, with a reference range of 0-100 and an ideal anesthetic depth of 25-50 (compared to 40-60 recommended by other monitors). It has been shown to be similar to the change of the bispectral index (BIS, Medtronic, Minneapolis, Minnesota, USA) during induction, maintenance and wake-up [13,14].…”

Section: Introductionmentioning

confidence: 99%

The optimal effect-site concentration of remifentanil and propofol for keeping proper anesthesia and promoting early recovery during patient state index-guided anesthesia.

Han

et al. 2022

Preprint

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Backgroud: To determine the most suitable effect-site concentration of remifentanil and propofol for keeping proper anesthesia depth and early recover quickly under guidance of patient state index (PSI). Methodsː Elective gynecological laparoscopic surgery patients received concentration of propofol in high concentration (3 ug/mL, N = 25), middle concentration (2.5 ug/mL, N = 24), low concentration (2 ug/mL, N = 28) during maintenance. After finished intubation, propofol was adjusted to the target concentration by grouping, the concentration of remifentanil relied on the reaction of the formerly tested patient using 0.4 ng/mL as a step size began with 3.5ng/mL under PSI monitored. The primary measurements were the concentration of remifentanil, the change of intra-procedural data, and post-operation data including times to handle the change of the depth of anesthesia, blood pressure (BP) and heart rate (HR), extubation time, duration in PACU, hospital day, VAS score in the first day after sugery. Secondary measurements were density spectral array, intra-operative awareness, postoperative delirium. Results: The group of middle concentration required the minimum time for extubation and staying in PACU, kept steady process of anesthesia (P<0.05), the EC50 of remifentanil to suppression irritation from incision were 2.96 ng/mL (95% CI 2.75 to 3.14 ng/mL) in this group. Besides, low doses of remifentanil were more obvious than high doses in alpha wave of Density spectral array. Conclusions: With PSI guided anesthesia, the effect-site concentration of propofol was 2.5 ug/mL, keep stable anesthesia process and effective early postoperative recovery, meanwhile, EC50 of remifentanil was 2.96 ng/mL.

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“… 8 21 30 33) It is important to carefully monitor and titrate the depth of sedation by medical professional with expertise in TBI management, as over-sedation can result in negative outcomes such as prolonged cognitive dysfunction, hemodynamic instability, and ventilator-associated pneumonia. 36 37 41 49) Bispectral index (BIS) and patient state index (PSI) based on electroencephalogram are the most widely used devices for measuring sedation depth. 2) As neurological examination can be challenging in patients with TBI undergoing deep sedation, it is crucial to utilize monitoring devices like pupilometer or intracranial pressure (ICP) measurement to supplement the assessment of neurological function.…”

Section: Introductionmentioning

confidence: 99%

Deep Sedation in Traumatic Brain Injury Patients

Choo

Seo

2023

Korean J Neurotrauma

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Traumatic brain injury (TBI) is one of the leading causes of mortality and disability in adults. In cases of severe TBI, preventing secondary brain injury by managing intracranial hypertension during the acute phase is a critical treatment challenge. Among surgical and medical interventions to control intracranial pressure (ICP), deep sedation can provide comfort to patients and directly control ICP by regulating cerebral metabolism. However, insufficient sedation does not achieve the intended treatment goals, and excessive sedation can lead to fatal sedative-related complications. Therefore, it is important to continuously monitor and titrate sedatives by measuring the appropriate depth of sedation. In this review, we discuss the effectiveness of deep sedation, techniques to monitor the depth of sedation, and the clinical use of recommended sedatives, barbiturates, and propofol in TBI.

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Modelling the PSI response in general anesthesia

Cited by 7 publications

References 27 publications

Correlation of Sedline-generated variables and clinical signs with anaesthetic depth in experimental pigs receiving propofol

Correlation of Sedline-generated variables and clinical signs with anaesthetic depth in experimental pigs receiving propofol

The optimal effect-site concentration of remifentanil and propofol for keeping proper anesthesia and promoting early recovery during patient state index-guided anesthesia.

Deep Sedation in Traumatic Brain Injury Patients

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