Relationship Between Intraoperative Bispectral Index and Consciousness Recovery in Patients With Hepatic Encephalopathy Undergoing Liver Transplant: A Retrospective Analysis

Kim, D.; Shin, B.S.; Song, In-beom; Han, Seok Joo; Gwak, Mi Sook; Kim, G.S.; Kim, J.M.; Choi, Gyu‐Seong; Ko, Justin Sangwook

doi:10.1016/j.transproceed.2018.10.031

Cited by 8 publications

(10 citation statements)

References 28 publications

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“…In the comparison of EEG based monitors versus MAC as a marker of anesthetic depth, one paper showed no difference in incidence of postoperative cognitive dysfunction when utilizing BIS versus control 13 ; one reference assessed BIS versus MAC in patients with hepatic encephalopathy, however no difference in time to return of consciousness was found 22 . While there are some referenced potential benefits to EEG based anesthetic depth monitoring in the surgical population 26 its practice may be limited by availability and cost internationally.…”

Section: Discussionmentioning

confidence: 99%

Optimal anesthetic conduct regarding immediate and short‐term outcomes after liver transplantation – Systematic review of the literature and expert panel recommendations

Chadha

Patel

Bhangui

et al. 2022

Clinical Transplantation

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Section: Discussionmentioning

confidence: 99%

Optimal anesthetic conduct regarding immediate and short‐term outcomes after liver transplantation – Systematic review of the literature and expert panel recommendations

Chadha

Patel

Bhangui

et al. 2022

Clinical Transplantation

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“…[ 25 ] The basic patient factors include age, sex, genetic factors, and preoperative combined underlying diseases. [ 26 ] Some authors [ 27 , 28 ] hypothesize that there is a clear relationship between age and the occurrence of DR. The elderly are more likely to experience DR after surgery.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of delayed recovery from general anesthesia in patients undergoing radical biliary surgery

Zhang¹,

Pan²,

Tan³

et al. 2021

Medicine

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Delayed recovery (DR) is very commonly seen in the patients undergoing laparoscopic radical biliary surgery, we aimed to investigate the potential risk factors of DR in the patients undergoing radical biliary surgery, to provide evidences into the management of DR. Patients who underwent radical biliary surgery from January 1, 2018 to August 31, 2020 were identified. The clinical characteristics and treatment details of DR and no-DR patients were compared and analyzed. Multivariable logistic regression analyses were conducted to identify the potential influencing factors for DR in patients with laparoscopic radical biliary surgery. We included a total of 168 patients with laparoscopic radical biliary surgery, the incidence of postoperative DR was 25%. There were significant differences on the duration of surgery, duration of anesthesia, and use of intraoperative combined sevoflurane inhalation (all P < .05), and there were not significant differences on American Society of Anesthesiologists, New York Heart Association, tumor-lymph node- metastasis, and estimated blood loss between DR group and control group (all P > .05). Multivariable logistic regression analyses indicated that age ≥70 years (odd ratio [OR] 1.454, 95% confidence interval [CI] 1.146–1.904), body mass index ≥25 kg/m 2 (OR 1.303, 95% CI 1.102–1.912), alcohol drinking (OR 2.041, 95% CI 1.336–3.085), smoking (OR 1.128, 95% CI 1.007–2.261), duration of surgery ≥220 minutes (OR 1.239, 95% CI 1.039–1.735), duration of anesthesia ≥230 minutes (OR 1.223, 95% CI 1.013–1.926), intraoperative combined sevoflurane inhalation (OR 1.207, 95% CI 1.008–1.764) were the independent risk factors for DR in patients with radical biliary surgery (all P < .05). It is clinically necessary to take early countermeasures against various risk factors to reduce the occurrence of DR, and to improve the prognosis of patients.

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“…The BIS monitor is a non-invasive and simple device that digitizes the level of consciousness, and that was originally used to monitor the depth of general anesthesia. Previous reports have described increased clinical indications of BIS monitoring, including for assessing the severity of encephalopathy in adults [ 3 , 4 ]. In this case, the BIS monitor was employed as a neurological monitor rather than anesthesia monitor, because the patient’s preoperative EEG showed an abnormal pattern and her consciousness had already deteriorated due to ALF and might have worsened during surgery.…”

Section: Discussionmentioning

confidence: 99%

“…3 a). This was considered to reflect the severity of HE [ 4 ]. Since rocuronium was administered continuously as a bolus, the effect of electromyography on BIS monitoring was excluded.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, another report suggested that BIS could be used to assess recovery of consciousness in patients with HE during peritransplant intensive care [ 10 ]. On the other hand, another report declared no correlation between BIS and postoperative neurological outcomes [ 4 ]. One case report reported dramatic BIS changes along with recovery of consciousness perioperatively in an adult patient with ALF who had altered mental function caused by HE [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

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Bispectral Index™ variation during living donor liver transplantation in a child with hepatic encephalopathy: a case report

et al. 2021

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Background It is unclear whether perioperative Bispectral Index™ (BIS) monitoring in pediatric cases with acute liver failure (ALF) is effective for evaluation of neurological function. We describe a pediatric patient with hepatic encephalopathy (HE) in whom the BIS value increased from low levels to the normal range during liver transplantation (LT). Case presentation Electroencephalography in a 6-year-old comatose girl diagnosed with ALF and HE who was unresponsive to pain and auditory stimuli revealed continuous slow waves, and hence, emergency LT was performed. Intraoperatively, BIS values remained low until reperfusion. However, BIS value variability increased after reperfusion. She was subsequently discharged without any neurological sequelae. Conclusions Low BIS values were considered to reflect the severity of HE. It is possible that improvement of the BIS value and waveform was a reflection of graft function. BIS monitoring might be a good indicator of neurological recovery after LT.

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Relationship Between Intraoperative Bispectral Index and Consciousness Recovery in Patients With Hepatic Encephalopathy Undergoing Liver Transplant: A Retrospective Analysis

Cited by 8 publications

References 28 publications

Optimal anesthetic conduct regarding immediate and short‐term outcomes after liver transplantation – Systematic review of the literature and expert panel recommendations

Optimal anesthetic conduct regarding immediate and short‐term outcomes after liver transplantation – Systematic review of the literature and expert panel recommendations

Risk factors of delayed recovery from general anesthesia in patients undergoing radical biliary surgery

Bispectral Index™ variation during living donor liver transplantation in a child with hepatic encephalopathy: a case report

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