Falsely increased bispectral index values by convective air warming system during kidney transplantation

Kim, Se Hun; Lee, Byeong-Cheol; Kim, Yong Han

doi:10.12669/pjms.323.9858

Cited by 4 publications

(5 citation statements)

References 10 publications

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“…The EMG activity interference is recognized as one of the most important limitations of the BIS monitoring, as it can elevate its values [48]. Indeed, the EEG is recorded from surface electrodes that collect electrical signals not only from the brain, but also from the muscles and other sources of artefacts (noises arising from movements, electrical devices, and other ambient noises) [49][50][51]. As the EMG frequency (30-300 Hz) overlaps the EEG one (0.5-47 Hz for the BIS monitoring) [5] it can lead to an incorrect interpretation of the signal [48,52].…”

Section: Discussionmentioning

confidence: 99%

“…In our study, neuromuscular blocking agents were not administered, and despite a clinically adequate anesthetic level was achieved, high EMG activity was detected by the BIS. This could have been related to the surgical manipulations, very close to the head, external electrical interference (e.g., warming system [51]) or spontaneous muscle activity. However, due to the adequate depth of anesthesia achieved during all procedures, the latter option is less likely.…”

Section: Discussionmentioning

confidence: 99%

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Usefulness and Reliability of the Bispectral Index during Balanced Anesthesia for Neurovascular Surgery in New Zealand White Rabbits

et al. 2023

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Few data about the electroencephalogram and its calculated indices, such as the bispectral index (BIS), have been reported in rabbits. We aimed to evaluate whether a clinically stable anesthesia was mirrored by consistent and stable BIS values and to investigate the effects of modified cerebral blood supply, due to bilateral carotid clamping and re-opening, on BIS values. We also investigated the effects of fentanyl, as an antinociceptive drug, on the BIS. Sixty-eight rabbits undergoing general anesthesia for surgical creation of carotid bifurcation aneurysms were enrolled. The BIS values were recorded at nine selected time points (TPs) during each procedure and before and after fentanyl administration. The BIS values over time were compared with two-way repeated-measures analysis of variance followed by Tukey test, while the Wilcoxon signed rank test was performed to compare values at clamping and re-opening of the carotids as well as before and after fentanyl administration. The BIS values were significantly lower during anesthesia than at the end of anesthesia and at tracheal extubation; no significant differences were found among other TPs. Adequate depth of anesthesia was mirrored by consistent BIS values among rabbits, and alteration of cerebral blood supply did not modify BIS values, except once. Following fentanyl, BIS values did not change in a clinically relevant way.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Usefulness and Reliability of the Bispectral Index during Balanced Anesthesia for Neurovascular Surgery in New Zealand White Rabbits

et al. 2023

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“…Based on the original artifact sites, they are classified into three major categories: (1) artifacts from outside the head; (2) artifacts from within the head but outside the brain, EMG; and (3) artifacts from within the brain, atypical or pathologic EEGs [ 14 ]. Artifacts from outside the head have been reported to result from atrial pacers [ 15 ], warming blanket/convective air-warming systems [ 16 – 18 ], endoscopic shavers [ 19 ], electromagnetic systems [ 11 ], and laryngeal electromyography monitoring with an EMG endotracheal tube [ 20 ]. Most of these papers reported increased BIS during or after ECT and are clinical case reports of one or two patients’ findings.…”

Section: Discussionmentioning

confidence: 99%

Influence of electrocautery-induced electromagnetic interference on quantitative electroencephalographic monitoring of hypnosis during general anesthesia: comparison between the ADMS® and the BIS VISTATM

Kim

Yoo

Kim

et al. 2018

Korean J Anesthesiol

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BackgroundHypnosis monitors analyze small-amplitude electrical signals transmitted from the brain that could be exposed to the electromagnetic field that occurs around the body during electrocautery (ECT). We investigated the influence of ECT on hypnosis monitoring during anesthesia.MethodsWe simultaneously monitored BIS and uCON during 50 gynecologic oncology surgeries. During the episodes of ECT, we compared the absolute difference (a-Diff) between the baseline index and the most deviated index after ECT over either 30–60 s (ECT30–60) or more than 60 s (ECT > 60) between the monitors. We also investigated the bias and the limits of agreement between the monitors.ResultsBetween the two monitors, the a-Diff of ECT30–60 was 1.4 ± 1.1 for the BIS, which was significantly greater than 0.6 ± 0.9 for the uCON (P = 0.003), and the a-Diff of ECT > 60 was 16.5 ± 8.2 for the BIS, which was also significantly greater than 1.4 ± 1.3 for uCON (P < 0.001). The intra-monitor index differences showed that the BIS during ECT > 60 was significantly greater than that during ECT30–60 (P < 0.001), but the uCON showed no significant difference between ECT30–60 and ECT > 60 (P = 0.056). The estimated bias between the monitors was 6.3 ± 9.8 and 95% limits agreement was –12.3 to 25.0.ConclusionsProlonged ECT intervention might lead to spurious estimations of quantitative EEG indexes. Therefore, hypnosis should be clinically assessed in combination with scrutinized judgment of relevant clinical symptoms and signs for hypnosis.

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“…BIS readings may be artifactually elevated by common exposures such as nearby electrocautery, 35 train-of-four monitoring, 36 and forced-air warming devices. 37,38 In addition, paradoxical increases in BIS values after ketamine administration have been documented. 39,40 Furthermore, BIS may be very sensitive to neuromuscular blocking agents.…”

Section: Con: Eeg Should Not Be Used To Reduce Postoperative Delirium...mentioning

confidence: 99%

Pro-Con Debate: Electroencephalography-Guided Anesthesia for Reducing Postoperative Delirium

Hao,

Fritz,

Saddawi-Konefka

et al. 2023

Anesthesia &Amp; Analgesia

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Postoperative delirium (POD) has significant implications on morbidity, mortality, and health care expenditures. Monitoring electroencephalography (EEG) to adjust anesthetic management has gained interest as a strategy to mitigate POD. In this Pro-Con commentary article, the pro side supports the use of EEG to reduce POD, citing an empiric reduction in POD with processed EEG (pEEG)-guided general anesthesia found in several studies and recent meta-analysis. The Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) trial is the exception to this, and issues with methods and achieved depths are discussed. Meanwhile, the Con side advocates that the use of EEG to reduce POD is not yet certain, citing that there is a lack of evidence that associations between anesthetic depth and POD represent causal relationships. The Con side also contends that the ideal EEG signatures to guide anesthetic titration are currently unknown, and the potential benefits of reduced anesthesia levels may be outweighed by the risks of potentially insufficient anesthetic administration. As the public health burden of POD increases, anesthesia clinicians will be tasked to consider interventions to mitigate risk such as EEG. This Pro-Con debate will provide 2 perspectives on the evidence and rationales for using EEG to mitigate POD.

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Falsely increased bispectral index values by convective air warming system during kidney transplantation

Cited by 4 publications

References 10 publications

Usefulness and Reliability of the Bispectral Index during Balanced Anesthesia for Neurovascular Surgery in New Zealand White Rabbits

Usefulness and Reliability of the Bispectral Index during Balanced Anesthesia for Neurovascular Surgery in New Zealand White Rabbits

Influence of electrocautery-induced electromagnetic interference on quantitative electroencephalographic monitoring of hypnosis during general anesthesia: comparison between the ADMS® and the BIS VISTATM

Pro-Con Debate: Electroencephalography-Guided Anesthesia for Reducing Postoperative Delirium

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