Effect of Mild Hypothermic Cardiopulmonary Bypass on the Amplitude of Somatosensory-evoked Potentials

Zanatta, Paolo; Bosco, Enrico; Comin, Alessandra; Mazzarolo, Anna Paola; Pasquale, P. Di; Forti, Alessandro; Longatti, Pierluigi; Polesel, Elvio; Stecker, Michael S.; Sorbara, Carlo

doi:10.1097/ana.0000000000000016

Cited by 14 publications

(2 citation statements)

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“…Preservation of cortical synaptic transmission is the most critical factor in early recovery; however, specificity is not high (73 % for consciousness and 75 % for CPC), probably because of brain ischemia rather than TTM or sedation, based on early (33 h from CA) recordings [ 9 , 10 , 13 , 15 ]. Indeed, our data showed that TTM (33–34 °C) and sedation did not change EEG and SSEP at all, reinforcing the fact that the greatest determinant of brain dysfunction both in intensive care [ 47 ] and in the operating room [ 48 ] is brain ischemia. Moreover, hypnotic sedation (e.g., midazolam and propofol) does not attenuate pain-related ML-SSEPs (like opioids do), as ML-SSEPs seem to be the neurophysiological expression of the activation of the brain-area network involved both in pain perception [ 11 , 32 ] and other salient sensory input [ 33 ].…”

Section: Discussionsupporting

confidence: 65%

Pain-related Somato Sensory Evoked Potentials: a potential new tool to improve the prognostic prediction of coma after cardiac arrest

et al. 2015

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IntroductionEarly prediction of a good outcome in comatose patients after cardiac arrest still remains an unsolved problem. The main aim of the present study was to examine the accuracy of middle-latency SSEP triggered by a painful electrical stimulation on median nerves to predict a favorable outcome.MethodsNo- and low-flow times, pupillary reflex, Glasgow motor score and biochemical data were evaluated at ICU admission. The following were considered within 72 h of cardiac arrest: highest creatinine value, hyperthermia occurrence, EEG, SSEP at low- (10 mA) and high-intensity (50 mA) stimulation, and blood pressure reactivity to 50 mA. Intensive care treatments were also considered. Data were compared to survival, consciousness recovery and 6-month CPC (Cerebral Performance Category).ResultsPupillary reflex and EEG were statistically significant in predicting survival; the absence of blood pressure reactivity seems to predict brain death within 7 days of cardiac arrest. Middle- and short-latency SSEP were statistically significant in predicting consciousness recovery, and middle-latency SSEP was statistically significant in predicting 6-month CPC outcome. The prognostic capability of 50 mA middle-latency-SSEP was demonstrated to occur earlier than that of EEG reactivity.ConclusionsNeurophysiological evaluation constitutes the key to early information about the neurological prognostication of postanoxic coma. In particular, the presence of 50 mA middle-latency SSEP seems to be an early and reliable predictor of good neurological outcome, and its absence constitutes a marker of poor prognosis. Moreover, the absence 50 mA blood pressure reactivity seems to identify patients evolving towards the brain death.

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Section: Discussionsupporting

confidence: 65%

Pain-related Somato Sensory Evoked Potentials: a potential new tool to improve the prognostic prediction of coma after cardiac arrest

et al. 2015

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“…Post-cardiac arrest and moribund patients, patients in whom cerebral death was suspected or for whom withdrawal of life-sustaining therapies had been decided, and patients suffering from preexisting of acquired neuropathies were not included. Hypothermia may influence evoked potentials’ conduction times [30–33]. To avoid any confounding effect related to temperature, no evoked potential was recorded while body temperature was below 35 °C.…”

Section: Methodsmentioning

confidence: 99%

Early impairment of intracranial conduction time predicts mortality in deeply sedated critically ill patients: a prospective observational pilot study

Azabou

Rohaut

Heming

et al. 2017

Ann. Intensive Care

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BackgroundSomatosensory (SSEP) and brainstem auditory (BAEP) evoked potentials are neurophysiological tools which, respectively, explore the intracranial conduction time (ICCT) and the intrapontine conduction time (IPCT). The prognostic values of prolonged cerebral conduction times in deeply sedated patients have never been assessed. Sedated patients are at risk of developing new neurological complications, undetected. In this prospective observational bi-center pilot study, we investigated whether early impairment of SSEP’s ICCT and/or BAEP’s IPCT could predict in-ICU mortality or altered mental status (AMS), in deeply sedated critically ill patients.MethodsSSEP by stimulation of the median nerve and BAEP were assessed in critically ill patients receiving deep sedation on day 3 following ICU admission. Deep sedation was defined by a Richmond Assessment sedation Scale (RASS) <−3. Mean left- and right-side ICCT and IPCT were measured for each patient. Primary and secondary outcomes were, respectively, in-ICU mortality and AMS defined as the occurrence of delirium and/or delayed awakening after discontinuation of sedation.ResultsEighty-six patients were studied of which 49 (57%) were non-brain-injured and 37 (43%) were brain-injured. Impaired ICCT was a predictor of in-ICU mortality after adjustment on the global Sequential Organ Failure Assessment score (SOFA) [OR (95% CI) = 2.69 (1.05–6.85); p = 0.039] and on the non-neurological SOFA components [2.67 (1.05–6.81); p = 0.040]. IPCT was more frequently delayed in the subgroup of patients who developed post-sedation AMS (24%) compared those without AMS (0%). However, this difference did not reach statistical significance (p = 0.053). Impairment rates of ICCT and IPCT were not found to be significantly different between non-brain- and brain-injured subgroups of patients.ConclusionIn critically ill patients receiving deep sedation, early ICCT impairment was associated with mortality. Somatosensory and brainstem auditory evoked potentials may be useful early warning indicators of brain dysfunction as well as prognostic markers in deeply sedated critically ill patients.

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Central Nervous System Anesthesia: Asleep Approach

Mizumoto

2022

Intraoperative Monitoring

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Effect of Mild Hypothermic Cardiopulmonary Bypass on the Amplitude of Somatosensory-evoked Potentials

Cited by 14 publications

References 35 publications

Pain-related Somato Sensory Evoked Potentials: a potential new tool to improve the prognostic prediction of coma after cardiac arrest

Pain-related Somato Sensory Evoked Potentials: a potential new tool to improve the prognostic prediction of coma after cardiac arrest

Early impairment of intracranial conduction time predicts mortality in deeply sedated critically ill patients: a prospective observational pilot study

Central Nervous System Anesthesia: Asleep Approach

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