Use of the Patient State Index (PSI) to Assist in the Diagnosis of Perioperative Neurological Injury and Brain Death

Jacobsohn, Eric; Wet, Charl De; Tymkew, Heidi; Hill, Laureen L.; Avidan, Michael S.; Levy, N; Bruemmer-Smith, Stephanie

doi:10.1007/s10877-005-3546-9

Cited by 6 publications

(5 citation statements)

References 10 publications

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“…27 The PSA-4000 continually documents and adjusts the PSI by accounting for forehead electromyelographic activity in the algorithm, thus providing a measure of sedation. 28 …”

Section: Methodsmentioning

confidence: 99%

Autonomic Nervous System Function and Depth of Sedation in Adults Receiving Mechanical Ventilation

Unoki¹,

Grap²,

Sessler³

et al. 2009

American Journal of Critical Care

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Background The effect of the depth of sedation on the function of the autonomic nervous system is not well known. Objectives To describe the effect of level of sedation on heart rate variability as a marker of the function of the autonomic nervous system in patients receiving mechanical ventilation. Methods This pilot study was part of a larger study in which sedation level was measured continuously for up to 24 hours. The sample consisted of 14 patients receiving mechanical ventilation. The R-R interval was measured continuously via electrocardiography. Sedation level was determined by using the Patient State Index and was categorized as deep (<60) or light (≥60). Continuous heart rate data of 5 to 10 minutes for each sedation level for each patient were analyzed. Results Parasympathetic activity as indicated by root mean square of successive difference of the R-R interval, the high-frequency component, and the percentage of differences of successive N-N intervals (intervals due to normal sinus depolarization) that differed more than 50 milliseconds was significantly lower for deep sedation than for light sedation. The markers indicating sympathetic activity, including the low-frequency component and the ratio of the low-frequency component to the high-frequency component, did not differ significantly between the 2 levels of sedation. Most patients were receiving benzodiazepines. Conclusions Deep sedation may be associated with depression of parasympathetic function in patients receiving mechanical ventilation. Use of benzodiazepines most likely contributed to this finding.

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“…27 The PSA-4000 continually documents and adjusts the PSI by accounting for forehead electromyelographic activity in the algorithm, thus providing a measure of sedation. 28 …”

Section: Methodsmentioning

confidence: 99%

Autonomic Nervous System Function and Depth of Sedation in Adults Receiving Mechanical Ventilation

Unoki¹,

Grap²,

Sessler³

et al. 2009

American Journal of Critical Care

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“…Unlike BIS, PSI is built on statistical processing of EEG data, independent from medication and chemical reagent. As such, clinical sedation assessment using these two measures may yield different results [ 7 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of bispectral index and patient state index as measures of sedation depth during surgeries using remimazolam tosilate

et al. 2023

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Background The Bispectral Index (BIS) and the Patient State Index (PSI) are commonly used measures to assess intraoperative sedation depth. However, model differences lead to different results, which in turn interferes with clinicians’ judgment on the depth of anesthesia. Remimazolam tosilate (RT) for injection is a new benzodiazepine used in sedation. In its clinical application, there are few effective indicators for sedation depth monitoring. To close this gap, this study aims to compare BIS and PSI in measuring the sensitivity and specificity of intraoperative RT and to explore the safety of RT for intraspinal anesthesia in elderly patients. Methods This study included 40 patients undergoing elective electro-prostatectomy with intraspinal anesthesia, who were monitored by BIS and PSI simultaneously during operation. Remimazolam tosylate 0.1 mg/kg was intravenously administered after the intraspinal anesthesia when patients were in a completely painless status. Then BIS, PSI, the Modified Observer’s Assessment of Alertness and Sedation (MOAA/S) scores and vital signs were observed and recorded per minute for 10 min. Pearson’s correlation analysis and linear regression model were used to compare BIS and PSI sedation scores, and to test their associations with the MOAA/S score, respectively. ROC curves were drawn to compare the sensitivity and specificity of BIS and PSI. Changes of vital signs were presented as mean ± standard deviation. Perioperative liver and kidney function indicators were analyzed using a paired t-test to evaluate the safety of RT for intraspinal anesthesia in the elderly patients. Results According to Pearson’s correlation analysis, a significant (P < 0.01) correlation between BIS and PSI was found when used to monitor intraoperative sedation of RT (r = 0.796). Significant associations between BIS and MOAA/S (r = 0.568, P < 0.01), and between PSI and MOAA/S (r = 0.390, P < 0.01) were also found. The areas under the ROC curves of BIS and PSI were 0.801 ± 0.022 and 0.734 ± 0.026, respectively, suggesting that both measures may predict patients’ state of consciousness and BIS was more accurate than PSI. Vital signs remained stable throughout the study. No abnormal changes of clinical significance were found based on laboratory test results of liver and kidney function. Conclusion BIS and PSI are strongly associated for monitoring the sedation of RT intraoperatively. Both methods can accurately reflect sedation depth. According to correlation analyses with MOAA/S scale and ROC curves, BIS is more accurate than PSI during such intraoperative monitoring. In addition, RT can be safely used in elderly patients under intraspinal anesthesia for supportive sedation, with stable vital signs and sound kidney and liver safety profiles. Trial registration http://www.chictr.org.cn (ChiCTR2100051912).

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“…Unlike BIS, PSI does not rely on any sedative drugs but rather on a large collection of EEGs from people in different states of consciousness, forming a huge database from which different PSI scores can be obtained based on the existing image information. The information of the images in the database can be used to obtain different PSI scores in order to assess the state of consciousness of the subjects [14][15][16][17][18]. The PSI scores are obtained by using the image information already in the database.…”

Section: Advances In the Use Of Psi For Intraoperative Sedation With ...mentioning

confidence: 99%

Advances in The Assessment of the Sedative Effect of Remimazolam

Zhao

2024

Asp Biomed Clin Case Rep

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Purpose of Review: Remimazolam is a new short-acting benzodiazepine in the final stages of clinical development. The methods of monitoring sedation and assessing the depth of anesthesia for benzodiazepine sedative drugs have been fraught with controversy in clinical work. As a newly released short-acting anesthetic sedative drug that can be continuously pumped, appropriate anesthetic monitoring and sedation depth assessment tools can better help anesthesiologists make clinical decisions and reduce the emergence of perioperative complications in patients. Recent Findings: Clinical trials of remimazolam have been completed at home and abroad in various phases, and much progress has been made, but the effective sedation monitoring means of remimazolam are still not conclusive. Summary: Remimazolam has a rapid onset of action and a high rate of metabolism in the body; tissue accumulation and delayed awakening are rare. At the same time, it can be safely applied to elderly patients with a low cardiopulmonary function inhibition rate, accurate anesthesia effect, and satisfactory quality of awakening. By comparing various methods of sedation depth monitoring, the data correlation is high, which can be of significant importance for remimazolam sedation depth monitoring.

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Use of the Patient State Index (PSI) to Assist in the Diagnosis of Perioperative Neurological Injury and Brain Death

Cited by 6 publications

References 10 publications

Autonomic Nervous System Function and Depth of Sedation in Adults Receiving Mechanical Ventilation

Autonomic Nervous System Function and Depth of Sedation in Adults Receiving Mechanical Ventilation

Comparison of bispectral index and patient state index as measures of sedation depth during surgeries using remimazolam tosilate

Advances in The Assessment of the Sedative Effect of Remimazolam

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