Effects of Goal-Directed Hemodynamic Therapy Using a Noninvasive Finger-Cuff Monitoring Device on Intraoperative Cerebral Oxygenation and Early Delayed Neurocognitive Recovery in Patients Undergoing Beach Chair Position Shoulder Surgery: A Randomized Controlled Trial

Lee, Chen-Tse; Lin, Chih-Peng; Chan, Kuang-Cheng; Wu, Yi-Luen; Teng, Hsiao-Chun; Wu, Chun-Yu

doi:10.1213/ane.0000000000006200

Cited by 3 publications

(2 citation statements)

References 45 publications

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“…Neurophysiological monitoring techniques were used to enhance surgical safety. The fourth-generation Vigileo/ FloTrac system (Edwards Lifesciences) was regularly employed to enhance intraoperative cardiac index; this was grounded in our prior positive outcomes with goal-directed fluid therapy for craniotomy [1,21], involving the iterative administration of 250 ml colloid infusions (Voluven ® Fresenius Kabi) [1,22].…”

Section: Anesthesiamentioning

confidence: 99%

Electroencephalographic spectrogram–guided total intravenous anesthesia using dexmedetomidine and propofol prevents unnecessary anesthetic dosing during craniotomy: a propensity score–matched analysis

Lin¹,

Shih²,

Sung³

et al. 2024

Korean J Anesthesiol

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Background: The bispectral index (BIS) may be unreliable to gauge anesthetic depth when dexmedetomidine is administered. By comparison, the electroencephalogram (EEG) spectrogram enables the visualization of the brain response during anesthesia and may prevent unnecessary anesthetic consumption. Methods: This retrospective study included 140 adult patients undergoing elective craniotomy who received total intravenous anesthesia using a combination of propofol and dexmedetomidine infusions. Patients were equally matched to the spectrogram group (maintaining the robust EEG alpha power during surgery) or the index group (maintaining the BIS score between 40 and 60 during surgery) based on the propensity score of age and surgical type. The primary outcome was the propofol dose. Secondary outcome was the postoperative neurological profile.Results: Patients in the spectrogram group received significantly less propofol (1585 ± 581 vs. 2314 ± 810 mg, P < 0.001). Fewer patients in the spectrogram group exhibited delayed emergence (1.4% vs. 11.4%, P = 0.033). The postoperative delirium profile was similar between the groups (profile P = 0.227). Patients in the spectrogram group exhibited better in-hospital Barthel’s index scores changes (admission state: 83.6 ± 27.6 vs. 91.6 ± 17.1; discharge state: 86.4 ± 24.3 vs. 85.1 ± 21.5; group–time interaction P = 0.008). However, the incidence of postoperative neurological complications was similar between the groups.Conclusions: EEG spectrogram–guided anesthesia prevents unnecessary anesthetic consumption during elective craniotomy. This may also prevent delayed emergence and improve postoperative Barthel index scores.

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Section: Anesthesiamentioning

confidence: 99%

Electroencephalographic spectrogram–guided total intravenous anesthesia using dexmedetomidine and propofol prevents unnecessary anesthetic dosing during craniotomy: a propensity score–matched analysis

Lin¹,

Shih²,

Sung³

et al. 2024

Korean J Anesthesiol

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“…These hemodynamic changes occur more prominently in patients under general anesthesia [4]. Hemodynamic deterioration may adversely affect postoperative outcomes, such as delayed neurological recovery [5,6]. Research has been conducted to minimize hemodynamic changes and improve the postoperative prognosis through fluid preloading or remote ischemic preconditioning [7,8].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Hemodynamic Parameters Based on the Administration of Remimazolam or Sevoflurane in Patients under General Anesthesia in the Beach Chair Position: A Single-Blinded Randomized Controlled Trial

Lee,

Seo,

Kim

et al. 2024

JCM

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Background: We aimed to evaluate whether the administration of remimazolam as a maintenance agent for general anesthesia affects the occurrence of hypotension compared with sevoflurane when switching to the beach chair position (BCP). Methods: We conducted a prospective randomized controlled trial from June 2023 to October 2023 in adult patients undergoing orthopedic surgery under general anesthesia in the BCP. A total of 78 participants were randomly allocated to the remimazolam (R) or sevoflurane (S) groups. The primary outcome was the incidence of hypotension that occurred immediately after switching to a BCP. The secondary outcomes included differences between the study groups in perioperative blood pressure (BP), heart rate (HR), endotracheal tube extubation time, postoperative complications, and hospital length of stay (LOS). Results: The incidence of hypotension immediately after switching to a BCP was significantly higher in the S group. The risk factors associated with hypotension included sevoflurane administration and a high baseline systolic BP. In the receiver operating characteristic curve analysis for the occurrence of hypotension after the transition to a BCP, the cutoff value for systolic BP was 142 mmHg. The perioperative BP and HR were higher in the R group at several timepoints. Postoperative endotracheal tube extubation time was shorter in the R group. There were no significant differences in the postoperative complications or hospital LOS between the two groups. Conclusions: Remimazolam should be considered as an anesthetic agent to prevent hypotension when switching to BCP, and hypotension may occur frequently in patients with high baseline BP.

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Effects of nonintubated thoracoscopic surgery on postoperative neurocognitive function: a randomized controlled trial

Hsiung,

Shih,

et al. 2024

European Journal of Cardio-Thoracic Surgery

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OBJECTIVE Postoperative neurocognitive disorder following thoracoscopic surgery with general anaesthesia may be linked to reduced intraoperative cerebral oxygenation and perioperative inflammation, which can potentially be exacerbated by mechanical ventilation. However, nonintubated thoracoscopic surgery, which utilizes regional anaesthesia and maintains spontaneous breathing, provides a unique model for studying the potential benefits of avoiding mechanical ventilation. This approach allows investigation into the impact on perioperative neurocognitive profiles, inflammatory responses, and intraoperative cerebral oxygen levels. METHODS In total, 110 patients undergoing thoracoscopic surgery were randomly equally assigned to the intubated group and nonintubated group. Regional cerebral oxygenation (rSO2) was monitored during surgery. Serum neuroinflammatory biomarkers, including interleukin (IL)-6 and glial fibrillary acidic protein (GFAP), were measured at baseline (before surgery) and 24 h after surgery. Postoperative complication severity was compared using the Comprehensive Complication Index. The primary outcome was perioperative changes in neurocognitive test score, which was assessed at baseline, 24 h, and 6 months after surgery. RESULTS Patients in the nonintubated group had higher neurocognitive test scores at 24 h (69.9 ± 10.5 vs 65.3 ± 11.8; P = 0.03) and 6 months (70.6 ± 6.7 vs 65.4 ± 8.1; P < 0.01) after surgery and significantly higher rSO2 over time during one-lung ventilation (P = 0.03). Patients in the intubated group revealed a significantly higher postoperative serum IL-6 level (group by time interaction, P = 0.04) and a trend towards a significantly higher serum GFAP level (group by time interaction, P = 0.11). Furthermore, patients in the nonintubated group had a significantly lower Comprehensive Complication Index (9.0 ± 8.2 vs 6.1 ± 7.1; P < 0.05). CONCLUSION Nonintubated thoracoscopic surgery was associated with improved postoperative neurocognitive recovery, more stable intraoperative cerebral oxygenation, ameliorated perioperative inflammation, and attenuated postoperative complication severity.

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Effects of Goal-Directed Hemodynamic Therapy Using a Noninvasive Finger-Cuff Monitoring Device on Intraoperative Cerebral Oxygenation and Early Delayed Neurocognitive Recovery in Patients Undergoing Beach Chair Position Shoulder Surgery: A Randomized Controlled Trial

Cited by 3 publications

References 45 publications

Electroencephalographic spectrogram–guided total intravenous anesthesia using dexmedetomidine and propofol prevents unnecessary anesthetic dosing during craniotomy: a propensity score–matched analysis

Electroencephalographic spectrogram–guided total intravenous anesthesia using dexmedetomidine and propofol prevents unnecessary anesthetic dosing during craniotomy: a propensity score–matched analysis

Comparison of Hemodynamic Parameters Based on the Administration of Remimazolam or Sevoflurane in Patients under General Anesthesia in the Beach Chair Position: A Single-Blinded Randomized Controlled Trial

Effects of nonintubated thoracoscopic surgery on postoperative neurocognitive function: a randomized controlled trial

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