Sensitivity and specificity of bispectral index for classification of overt hepatic encephalopathy: a multicentre, observer blinded, validation study

Dahaba, Ashraf A.; Worm, Harald C.; Zhu, Shengmei; Bao, Feichao; Salah, Ayman; Zakaria, S.; Bornemann, Helmar; Stadlbauer, Vanessa; Rehak, Peter; Metzler, H.; Stauber, Rudolf

doi:10.1136/gut.2007.129130

Cited by 34 publications

(26 citation statements)

References 23 publications

(34 reference statements)

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“…Foley et al (1950) first reported that the delta activity of the visual electroencephalogram (EEG) correlated well with the conscious state of patients with hepatic coma. Dahaba et al (2008) The results of the present study suggest that patients with hepatic encephalopathy are more sensitive to hypnotic drugs. A disorder between excitatory and inhibitory synaptic transmission in the parahippocampal gyrus might provide a possible explanation (Jenkins et al, 1996;Franks and Lieb, 1998;Mennerick et al, 1998;Yamakura and Harris, 2000).…”

Section: Fig 1 Probability Of Unconsciousness Versus the Bis Values supporting

confidence: 48%

“…Therefore, BIS is widely used to quantify the hypnotic effects of anesthetics and can serve as a tool to monitor and titrate the pharmacodynamic effects of anesthetic drugs (Sandin et al, 2008). Dahaba et al (2008) graded encephalopathy using the West Haven criteria in a multicenter study, and demonstrated that the BIS can be used to grade the degree of hepatic encephalopathy in patients with chronic liver disease. They also found that BIS displayed a weak to moderate correlation with the serum concentration of ammonia and the Child-Pugh score.…”

Section: Introductionmentioning

confidence: 99%

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Effect of hepatic function on the EC50 of midazolam and the BIS50 at the time of loss of consciousness

Ruan

2014

J. Zhejiang Univ. Sci. B

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Abstract:Objective: To explore the effect of hepatic function on loss of consciousness (LOC) and bispectral index (BIS) during sedation with midazolam (MDZ). Methods: Forty-five patients were assigned to three groups according to their liver function. Thirty of these patients with diagnoses of cholelithiasis were scheduled laparoscopic cholecystectomy, including 15 patients with normal liver function (normal group), and 15 patients with moderately abnormal liver function based on the results of ultrasonic diagnosis of a moderately fatty liver and elevated alanine transaminase levels of less than three times normal (moderate group). The other 15 patients with end-stage liver disease (severe group) underwent liver transplantation. Each patient was administered MDZ by way of target-controlled infusion to increase the concentration gradually. At the time of LOC, the BIS was recorded and a blood sample was withdrawn for measurement of the concentration of MDZ. The concentration of MDZ (EC 50 ) and the BIS value (BIS 50 ) at which 50% of patients lose consciousness were calculated using logistic regression. Results: At the time of LOC, the EC 50 of MDZ and the BIS 50 were similar in the normal and moderate groups (P>0.05). LOC occurred at a lower EC 50 of MDZ and at a higher BIS 50 in the severe group, compared with the normal and moderate groups (P<0.01). Conclusions: Patients with end-stage liver disease were more sensitive to MDZ and this affected the prediction of their time of LOC following MDZ administration. There were no changes in response in patients with moderately abnormal hepatic function.

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Section: Fig 1 Probability Of Unconsciousness Versus the Bis Values supporting

confidence: 48%

Section: Introductionmentioning

confidence: 99%

Effect of hepatic function on the EC50 of midazolam and the BIS50 at the time of loss of consciousness

Ruan

2014

J. Zhejiang Univ. Sci. B

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“…The notion of "anesthetic depth" is usually associated with training experiences or memories during surgery, in which anesthesia does not prevent consciousness or even wakingup during general anesthesia. Although EEG is the gold standard used to determine electrical activity in comatose patients, standard EEG monitoring may not be feasible for all patients who require intensive care during pretransplant [55,56] . Studies show that monitoring by BIS, which was developed in order to assist with the clinical evaluation of the degree of hypnosis with anesthesia, is useful for monitoring cases of FHF [5557] .…”

Section: Bispectral Indexmentioning

confidence: 99%

Multimodal brain monitoring in fulminant hepatic failure

Paschoal¹,

Nogueira²,

Ronconi³

et al. 2016

WJH

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Acute liver failure, also known as fulminant hepatic failure (FHF), embraces a spectrum of clinical entities characterized by acute liver injury, severe hepatocellular dysfunction, and hepatic encephalopathy. Cerebral edema and intracranial hypertension are common causes of mortality in patients with FHF. The management of patients who present acute liver failure starts with determining the cause and an initial evaluation of prognosis. Regardless of whether or not patients are listed for liver transplantation, they should still be monitored for recovery, death, or transplantation. In the past, neuromonitoring was restricted to serial clinical neurologic examination and, in some cases, intracranial pressure monitoring. Over the years, this monitoring has proven insufficient, as brain abnormalities were detected at late and irreversible stages. The need for real-time monitoring of brain functions to favor prompt treatment and avert irreversible brain injuries led to the concepts of multimodal monitoring and neurophysiological decision support. New monitoring techniques, such as brain tissue oxygen tension, continuous electroencephalogram, transcranial Doppler, and cerebral microdialysis, have been developed. These techniques enable early diagnosis of brain hemodynamic, electrical, and biochemical changes, allow brain anatomical and physiological monitoring-guided therapy, and have improved patient survival rates. The purpose of this review is to discuss the multimodality methods available for monitoring patients with FHF in the neurocritical care setting.

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“…A "profundidade anestésica" está associada à formação de experiências ou memórias durante uma cirurgia ou mesmo ao acordar durante uma anestesia geral. Embora o EEG seja o padrão-ouro usado para determinar atividade elétrica em pacientes comatosos, o monitoramento padrão do EEG pode não ser viável para todos os pacientes que requerem cuidados intensivos no pré-transplante (Vivien et al, 2002;Dahaba et al, 2008).…”

Section: íNdice Biespectralunclassified

“…Estudos demonstram que a monitoração por BIS, que foi desenvolvido para ajudar na avaliação clínica do grau de hipnose com anestesia, é útil para o monitoramento dos casos de IHF (Vivien et al, 2002;Dahaba et al, 2008). O monitor do BIS usa o sinal do EEG derivado de eletrodos localizados na região frontal, que fazem o monitoramento contínuo.…”

Section: íNdice Biespectralunclassified

Autorregulação encefálica na insuficiência hepática fulminante antes e após transplante hepático

Júnior¹,

Mendes²

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Sensitivity and specificity of bispectral index for classification of overt hepatic encephalopathy: a multicentre, observer blinded, validation study

Abstract: BIS is a useful measure for grading and monitoring the degree of involvement of the central nervous system in patients with chronic liver disease.

Cited by 34 publications

References 23 publications

Effect of hepatic function on the EC50 of midazolam and the BIS50 at the time of loss of consciousness

Effect of hepatic function on the EC50 of midazolam and the BIS50 at the time of loss of consciousness

Multimodal brain monitoring in fulminant hepatic failure

Autorregulação encefálica na insuficiência hepática fulminante antes e após transplante hepático

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