Mortality Within 2 Years After Surgery in Relation to Low Intraoperative Bispectral Index Values and Preexisting Malignant Disease

Lindholm, Maj-Lis; Träff, Stefan; Granath, Fredrik; Greenwald, Scott; Ekbom, Anders; Lennmarken, C.; Sandin, R.

doi:10.1213/ane.0b013e31818f603c

Cited by 179 publications

(105 citation statements)

References 3 publications

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“…Low intraoperative Bispectral Index (BIS) values have been associated with increased mortality in several studies, [1][2][3][4] although this finding has not been confirmed universally. 5 Because few randomized trials of BIS-targeted anesthesia have been reported, it is unclear whether low BIS values are simply a marker of poor prognosis, or whether targeting anesthetic management based on BIS monitoring could reduce mortality.…”

Section: Introductionmentioning

confidence: 99%

Sedation Depth During Spinal Anesthesia and Survival in Elderly Patients Undergoing Hip Fracture Repair

Brown¹,

Azman²,

Gottschalk³

et al. 2014

Survey of Anesthesiology

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Section: Introductionmentioning

confidence: 99%

Sedation Depth During Spinal Anesthesia and Survival in Elderly Patients Undergoing Hip Fracture Repair

Brown¹,

Azman²,

Gottschalk³

et al. 2014

Survey of Anesthesiology

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“…9 Thus, relatively deep general anesthesia is the norm in routine clinical practice. [10][11][12] Nevertheless, recent research suggests an association between deep general anesthesia and poorer outcomes in surgical patients. 4,5,11,[13][14][15][16][17][18][19][20][21] The dilemma is whether this evidence is strong enough for clinicians to change their practice.…”

Section: Résumémentioning

confidence: 99%

Anesthetic depth and long-term survival: an update

Leslie

Short

2015

Can J Anesth/J Can Anesth

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Purpose The purpose of this paper is to review the current evidence relating anesthetic depth to long-term survival after surgery. Source Using PubMed as the principal source, this review included published studies in all languages comparing mortality in patients with low-and highprocessed electro-encephalo-graphic index values. Principal findings All published studies used the bispectral index (BIS) monitor to measure anesthetic depth. The majority of the published observational studies were post hoc analyses of studies undertaken for other purposes. Most of these studies report a statistically significant association between deep general anesthesia (i.e., BIS values\45) and death. Some studies also suggest an association between deep general anesthesia and myocardial infarction or postoperative cognitive decline. The combination of low BIS values and low delivered anesthetic concentrations (thus defining increased anesthetic sensitivity) may identify patients at particularly high risk. One of the three available randomized controlled trials reports worse outcomes in the BIS = 50 group compared with the BIS[80 group, and two report no difference in mortality between the BIS = 35 and BIS = 50-55 groups. Conclusions The available evidence on anesthetic depth and long-term survival is inconclusive. Randomized controlled trials with carefully controlled arterial blood pressure are required.

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“…If anesthesia is achieved using high doses of hypnotic agents and low doses of anti-nociceptive agents, one may expect that EEG-guided titration will be less efficient at limiting hypnotic agent consumption than in situations with tightly controlled anti-nociception. 57 Controlling for overdosage may prove important, since an association has been found between prolonged time with low EEG indices during anesthesia, and long-term outcome, [58][59][60][61] but not with absolute amount of anesthetic agent received. However, this may reflect an intrinsic sensitivity of the brain to the effect of anesthetic agents in vulnerable patients.…”

Section: Other Clinical Utilitiesmentioning

confidence: 99%

How Electroencephalography Serves the Anesthesiologist

et al. 2014

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Major clinical endpoints of general anesthesia, such as the alteration of consciousness, are achieved through effects of anesthetic agents on the central nervous system, and, more precisely, on the brain. Historically, clinicians and researchers have always been interested in quantifying and characterizing those effects through recordings of surface brain electrical activity, namely electroencephalography (EEG). Over decades of research, the complex signal has been dissected to extract its core substance, with significant advances in the interpretation of the information it may contain. Methodological, engineering, statistical, mathematical, and computer progress now furnishes advanced tools that not only allow quantification of the effects of anesthesia, but also shed light on some aspects of anesthetic mechanisms. In this article, we will review how advanced EEG serves the anesthesiologist in that respect, but will not review other intraoperative utilities that have no direct relationship with consciousness, such as monitoring of brain and spinal cord integrity. We will start with a reminder of anesthestic effects on raw EEG and its time and frequency domain components, as well as a summary of the EEG analysis techniques of use for the anesthesiologist. This will introduce the description of the use of EEG to assess the depth of the hypnotic and anti-nociceptive components of anesthesia, and its clinical utility. The last part will describe the use of EEG for the understanding of mechanisms of anesthesia-induced alteration of consciousness. We will see how, eventually in association with transcranial magnetic stimulation, it allows exploring functional cerebral networks during anesthesia. We will also see how EEG recordings during anesthesia, and their sophisticated analysis, may help corroborate current theories of mental content generation.

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Mortality Within 2 Years After Surgery in Relation to Low Intraoperative Bispectral Index Values and Preexisting Malignant Disease

Cited by 179 publications

References 3 publications

Sedation Depth During Spinal Anesthesia and Survival in Elderly Patients Undergoing Hip Fracture Repair

Sedation Depth During Spinal Anesthesia and Survival in Elderly Patients Undergoing Hip Fracture Repair

Anesthetic depth and long-term survival: an update

How Electroencephalography Serves the Anesthesiologist

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