Predicting ischemic brain injury after intraoperative cardiac arrest during cardiac surgery using the BIS monitor

Goodman, Patrick; Mehta, Anand; Castresana, Manuel R.

doi:10.1016/j.jclinane.2009.01.014

Cited by 13 publications

(5 citation statements)

References 15 publications

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“…Global surges in electroencephalogram (EEG) gamma activity and functional and effective connectivity were found after abrupt asystole CA in rodents (Borjigin et al, 2013). In addition, a surge of the bispectral index or patient state index was seen after CA in hospitalized patients on end-of-life care (Chawla et al, 2009; Goodman et al, 2009). Electrophysiological studies on CA, therefore, may potentially serve as a model to explore the mechanisms underlying reports of consciousness while near death.…”

Section: Introductionmentioning

confidence: 99%

Neural Correlates of Consciousness at Near-Electrocerebral Silence in an Asphyxial Cardiac Arrest Model

Lee

Siu

et al. 2017

Brain Connectivity

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Recent electrophysiological studies have suggested surges in electrical correlates of consciousness (i.e., elevated gamma power and connectivity) after cardiac arrest (CA). This study examines electrocorticogram (ECoG) activity and coherence of the dying brain during asphyxial CA. Male Wistar rats (n = 16) were induced with isoflurane anesthesia, which was washed out before asphyxial CA. Mean phase coherence and ECoG power were compared during different stages of the asphyxial period to assess potential neural correlates of consciousness. After asphyxia, the ECoG progressed through four distinct stages (asphyxial stages 1–4 [AS1-4]), including a transient period of near-electrocerebral silence lasting several seconds (AS3). Electrocerebral silence (AS4) occurred within 1 min of the start of asphyxia, and pulseless electrical activity followed the start of AS4 by 1–2 min. AS3 was linked to a significant increase in frontal coherence between the left and right motor cortices (p < 0.05), with no corresponding increase in ECoG power. AS3 was also associated with a significant posterior shift of ECoG power, favoring the visual cortices (p < 0.05). Although the ECoG during AS3 appears visually flat or silent when viewed with standard clinical settings, our study suggests that this period of transient near-electrocerebral silence contains distinctive neural activity. Specifically, the burst in frontal coherence and posterior shift of ECoG power that we find during this period immediately preceding CA may be a neural correlate of conscious processing.

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Section: Introductionmentioning

confidence: 99%

Neural Correlates of Consciousness at Near-Electrocerebral Silence in an Asphyxial Cardiac Arrest Model

Lee

Siu

et al. 2017

Brain Connectivity

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“…It was observed that the patient had low blood pressure at this instant, and after the restoration of normal hemodynamics, the BIS values returned to the values of 50 within 1 min, which is in agreement with our findings. In the report of Goodman et al [28], a BIS monitor was used during intraoperative cardiac arrest in two patients undergoing cardiothoracic surgery. In both patients during the cardiac arrest, the BIS value decreased from 40-50 to near zero, and remained low i.e., 10-20 after the resuscitation.…”

Section: Discussionmentioning

confidence: 99%

Spectral Entropy Parameters during Rapid Ventricular Pacing for Transcatheter Aortic Valve Implantation

Musialowicz

Valtola

Hippeläinen

et al. 2017

Entropy

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Abstract:The time-frequency balanced spectral entropy of the EEG is a monitoring technique measuring the level of hypnosis during general anesthesia. Two components of spectral entropy are calculated: state entropy (SE) and response entropy (RE). Transcatheter aortic valve implantation (TAVI) is a less invasive treatment for patients suffering from symptomatic aortic stenosis with contraindications for open heart surgery. The goal of hemodynamic management during the procedure is to achieve hemodynamic stability with exact blood pressure control and use of rapid ventricular pacing (RVP) that result in severe hypotension. The objective of this study was to examine how the spectral entropy values respond to RVP and other critical events during the TAVI procedure. Twenty one patients undergoing general anesthesia for TAVI were evaluated. The RVP was used twice during the procedure at a rate of 185 ± 9/min with durations of 16 ± 4 s (range 8-22 s) and 24 ± 6 s (range 18-39 s). The systolic blood pressure during RVP was under 50 ± 5 mmHg. Spectral entropy values SE were significantly declined during the RVP procedure, from 28 ± 13 to 23 ± 13 (p < 0.003) and from 29 ± 12 to 24 ± 10 (p < 0.001). The corresponding values for RE were 29 ± 13 vs. 24 ± 13 (p < 0.006) and 30 ± 12 vs. 25 ± 10 (p < 0.001). Both SE and RE values returned to the pre-RVP values after 1 min. Ultra-short hypotension during RVP changed the spectral entropy parameters, however these indices reverted rapidly to the same value before application of RVP.

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“…Most of these reports have involved haemodynamic derangements preceding the reduction in BIS, suggesting that severe hypoperfusion to the brain was a probable cause. In these reports, even though resuscitation was successful, the BIS could not be restored to the pre-incident levels, likely due to the adverse neurologic outcomes 4 . Our case was different in that there was no hypotension preceding the reduction in BIS values.…”

Section: Intraoperative Subarachnoid Haemorrhage Associated With a Reduction In Bispectral Index During Cardiopulmonary Bypassmentioning

confidence: 95%

Intraoperative Subarachnoid Haemorrhage Associated with a Reduction in Bispectral Index during Cardiopulmonary Bypass

Jw¹,

Jh²,

Kim³

et al. 2016

Anaesth Intensive Care

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Predicting ischemic brain injury after intraoperative cardiac arrest during cardiac surgery using the BIS monitor

Cited by 13 publications

References 15 publications

Neural Correlates of Consciousness at Near-Electrocerebral Silence in an Asphyxial Cardiac Arrest Model

Neural Correlates of Consciousness at Near-Electrocerebral Silence in an Asphyxial Cardiac Arrest Model

Spectral Entropy Parameters during Rapid Ventricular Pacing for Transcatheter Aortic Valve Implantation

Intraoperative Subarachnoid Haemorrhage Associated with a Reduction in Bispectral Index during Cardiopulmonary Bypass

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