Depth of anaesthesia monitoring
Authors:
J. Divák 1,2; M. Frelich 1,2; R. Kula 1,2
Authors‘ workplace:
Klinika anesteziologie, resuscitace a intenzivní medicíny, FN Ostrava
1; Lékařská fakulta, OU v Ostravě, Ostrava
2
Published in:
Anest. intenziv. Med., 27, 2016, č. 6, s. 349-357
Category:
Anesthesiology - Review Article
Overview
Monitoring in the course of general anaesthesia (GA) may be divided into the monitoring of individual GA components (hypnotic, analgesic and muscle relaxation), and monitoring of the function of organ systems, which also includes monitoring of the depth of GA.
Depth of GA is defined as a decrease of the central nervous system (CNS) activity, and a decrease of the CNS ability to react to external stimuli. Insufficient GA depth is associated with a high risk of perioperative awareness and can lead to serious consequences for the patient, including the post-traumatic stress reaction and serious post-operative psychological consequences. The incidence of perioperative awareness is reported between 0.1 and 0.2%; the condition is associated with a number of risk factors which can be divided into patient factors, surgical procedure factors and risk factors related to the GA management. Recent studies suggest that excessively deep GA may be associated with worsened postoperative prognosis as well.
The aim of the article is to provide the reader with a basic overview of the depth of GA monitoring options. The authors mention recommendations regarding depth of GA monitoring, and recommendations for the management of perioperative awareness.
The review article has been prepared using PubMed/Medline databases, with the following keywords: depth of general anaesthesia, monitor, monitoring and awareness.
Keywords:
monitoring the depth of general anaesthesia – depth of general anaesthesia – perioperative awareness – EEG – evoked potentials
Sources
1. Ševčík, P., Matějovič, M. (eds.). Intenzivní medicína. 3., přepracované a rozšířené vyd. Praha: Galén, c2014. ISBN 978-80-7492-066-0.
2. Larsen, R. Anestezie. Vyd. 2. české. Překlad Jarmila Drábková. Praha: Grada, 2004. ISBN 80-247-0476-5.
3. Handl, Z. Monitorování pacientů v anesteziologii, resuscitaci a intenzivní péči – vybrané kapitoly. Brno: Institut pro další vzdělávání pracovníků ve zdravotnictví, 1999. ISBN 80-7013-291-4.
4. Guignard, B. Monitoring analgesia. Best Practice & Research Clinical Anaesthesiology, 2006, 20, 1, p. 161–180.
5. Gašparec, P. Princípy detskej anestézie. Martin: Osveta, 2010. ISBN 978-80-8063-340-0.
6. Apfelbaum, J. L. et al. American Society of Anesthesiologists Task Force on Intraoperative Awarenes. Practice advisory for intraoperative awareness and brain function monitoring: a report by the American Society of Anesthesiologists task force on intraoperative awareness. Anesthesiology, 2006, 104, p. 847–864.
7. Sinha, P. et al. Monitoring devices for measuring the depth of anaesthesia – An overview. Indian Journal of Anaesthesia, 2007, 51, 5, p. 365.
8. Shanks, A. M. et al. Alerting thresholds for the prevention of intraoperative awareness with explicit recall: a secondary analysis of the Michigan Awareness Control Study. Eur. J. Anaesth. (EJA), 2015, 32, 5, p. 346–353.
9. Borzova, V., Smith, C. Monitoring and prevention of awareness in trauma anesthesia. The Internet Journal of Anestshesiology, 2010, 23, 2.
10. Ghoneim, M. M. et al. Awareness during anesthesia: risk factors, causes and sequelae: a review of reported cases in the literature. Anesth. Analg., 2009, 108, 2, p. 527–535.
11. Bruhn, J. et al. Depth of anaesthesia monitoring: what‘s available, what‘s validated and what‘s next?. Brit. J. Anaesth., 2006, 97, 1, p. 85–94.
12. Sessler, D. I. et al. Hospital stay and mortality are increased in patients having a “triple low” of low blood pressure, low bispectral index, and low minimum alveolar concentration of volatile anesthesia. J. Am. Soc. Anesth., 2012, 116, 6, p. 1195–1203.
13. Kertai, M. D. et al. Bispectral index monitoring, duration of bispectral index below 45, patient risk factors, and intermediate-term mortality after noncardiac surgery in the B-Unaware Trial. J. Am. Soc. Anesth., 2011, 114, 3, p. 545–556.
14. Kertai, M. D., White, W. D., Gan, T. J. Cumulative duration of “triple low” state of low blood pressure, low bispectral index, and low minimum alveolar concentration of volatile anesthesia is not associated with increased mortality. J. Am. Soc. Anesth., 2014, 121, 1, p. 18–28.
15. Evans, J. M., Davies, W. L. Monitoring anaesthesia. Clin Anesth., 1984, 2, p. 243–262.
16. Rahul, R., Sowmya, M. J., Rangalakshmi, S., Roshan Kumar, B. N., Karthik, G. S. Monitoring Depth of Anaesthesia Using PRST Score and Bispectral Index. Journal of Evolution of Medical and Dental Sciences, 2015, 4, 25, p. 4282–4292. doi: 10.14260/jemds/2015/619.
17. Smajic, J. et al. Assessment of depth of anesthesia: PRST score versus bispectral index. Medical Archives, 2011, 65, 4, p. 216.
18. Sobotka, P. Patologická fyziologie: praktikum. 4., upr. vyd. Praha: Karolinum, 2012. ISBN 978-80-246-2128-9.
19. Goddard, G. F. A pilot study of the changes of skin electrical conductance in patients undergoing general anaesthesia and surgery. Anaesthesia, 1982, 37, 4, p. 408–415.
20. Russell, I. F. Isolated forearm technique. Anaesthesia, 1990, 45, 8, p. 687.
21. Herregods, L. et al. EEG and SEMG monitoring during induction and maintenance of anesthesia with propofol. Int. J. Clin. Monitor. Comput., 1989, 6, 2, p. 67–73.
22. Evans, J. M., Davies, W. L., Wise, C. C. Lower oesophageal contractility: a new monitor of anaesthesia. The Lancet, 1984, 323, 8387, p. 1151–1154.
23. Healy, T. E. J., Bellman, M. H., Pomfrett, C. J. D. Respiratory sinus arrhythmia indicates light anesthesia during cesarean-section. Anesth. Analg.,1994, p. U91.
24. Pomfrett, C. J. D., Barrie, J. R., Healy, T. E. J. Respiratory sinus arrhythmia reflects surgical stimulation during light enflurane anesthesia. Anesth. Analg., 1994, p. U185.
25. Kotur, P. F. Entropy: A new measure of anaesthetic depth. Indian J. Anaesth., 2004, 48, p. 170–171.
26. Gao, J. D. et al. Evaluation of entropy for monitoring the depth of anesthesia compared with bispectral index: a multicenter clinical trial. Chinese Med. J., 2012, 125, 8, p. 1389–1392.
27. Schultz, B. et al. Sleeping stage based systems (Narcotrend). New aspects of high technology in medicine, 2000, p. 285–291.
28. Maynard, D. E., Jenkinson, J. L. The cerebral function analysing monitor Initial clinical experience, application and further development. Anaesthesia, 1984, 39, 7, p. 678–690.
29. Lukášková, J., Tomšíková, Z., Kokštein, Z. Význam monitorování mozkové aktivity pomocí integrované amplitudy EEG aktivity u novorozenců s časným asfyktickým syndromem. Neonatologické listy, 2012.
30. Cassingham, S. F. et al. The Physiometrix PSA 4000 decreases propofol usage and hastens discharge in gynecological day surgery procedures. Anesthesiology, 2002, 96, p. A5.
31. Wong, C. A. et al. A comparison of the SNAP II™ and BIS XP™ indices during sevoflurane and nitrous oxide anaesthesia at 1 and 1.5 MAC and at awakening. Brit. J. Anaesth., 2006, 97, 2, p. 181–186.
32. Wong, C. A. et al. The Association Between Propofol-Induced Loss of Consciousness and the SNAP™ Index. Anesth. Analg., 2005, 100, 1, p. 141–148.
33. Pilge, S. et al. Time Delay of Index CalculationAnalysis of Cerebral State, Bispectral, and Narcotrend Indices. J. Am. Soc. Anesth., 2006, 104, 3, p. 488–494.
34. Rani, D. D. et al. Depth of general anaesthesia monitors. Indian J. Anaesth., 2012, 56, 5, p. 437.
35. Høymork, S. C. Assessing the depth-of-hypnosis. Tidsskrift for den Norske laegeforening: tidsskrift for praktisk medicin, ny raekke, 2010, 130, 6, p. 633–637.
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Anaesthesiology, Resuscitation and Inten Intensive Care MedicineArticle was published in
Anaesthesiology and Intensive Care Medicine
2016 Issue 6
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