Time delay of electroencephalogram index calculation: analysis of cerebral state, bispectral, and Narcotrend indices using perioperatively recorded electroencephalographic signals

Zanner, Robert; Pilge, Stefanie; Kochs, Eberhard; Kreuzer, Matthias; Schneider, Gerhard

doi:10.1093/bja/aep198

Cited by 107 publications

(69 citation statements)

References 21 publications

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“…When there is a change in a patient's state (e.g., from unresponsive to awake), changes are apparent in the raw EEG trace about a minute before they are reflected in processed EEG indices like the BIS. 102 As with all monitoring techniques, the use of processed or raw EEG during cardiac surgery presents both advantages and disadvantages ( Table 4). The effectiveness of BIS monitoring in preventing intraoperative awareness with postoperative explicit recall remains controversial.…”

Section: Resultsmentioning

confidence: 99%

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Brain Monitoring With Electroencephalography and the Electroencephalogram-Derived Bispectral Index During Cardiac Surgery

Kertai¹,

Whitlock²,

Avidan³

2012

Survey of Anesthesiology

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Cardiac surgery presents particular challenges for the anesthesiologist. In addition to standard and advanced monitors typically used during cardiac surgery, anesthesiologists may consider monitoring the brain with raw or processed electroencephalography (EEG). There is strong evidence that a protocol incorporating the processed EEG Bispectral Index (BIS) decreases the incidence intraoperative awareness compared with standard practice. However there is conflicting evidence that incorporating the BIS into cardiac anesthesia practice improves "fast-tracking," decreases anesthetic drug use, or detects cerebral ischemia. Recent research, including many cardiac surgical patients, shows that a protocol based on BIS monitoring is not superior to a protocol based on end tidal anesthetic concentration monitoring in preventing awareness. There has been a resurgence of interest in the anesthesia literature in limited montage EEG monitoring, including nonproprietary processed indices. This has been accompanied by research showing that with structured training, anesthesiologists can glean useful information from the raw EEG trace. In this review, we discuss both the hypothesized benefits and limitations of BIS and frontal channel EEG monitoring in the cardiac surgical population.

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Section: Resultsmentioning

confidence: 99%

“…101,102 The time taken for the index to reflect the state change varies from 30 seconds to two minutes. This means that the value displayed by the BIS might reflect the patient's state of arousal a minute in the past, rather than their current state.…”

Section: Delay In Responsementioning

confidence: 99%

Brain Monitoring With Electroencephalography and the Electroencephalogram-Derived Bispectral Index During Cardiac Surgery

Kertai¹,

Whitlock²,

Avidan³

2012

Survey of Anesthesiology

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“…These include influence of electromyographic (EMG) activity [5,14,18], electrical or mechanical artifacts from medical devices [23,38,81], time delay [113], specific clinical conditions such as hypovolaemia, hypotension, cerebral ischaemia, hypoglycaemia and hypothermia [23], inter-individual variability of baseline EEG characteristics [68,111] and types of drugs [44]. In addition, opioids may interfere with the EEG-signal during administration of the hypnotic agent [26,50,63,67,84,88] thus rendering the reliability of indices during multidrug administration questionable.…”

Section: Controlled Variablesmentioning

confidence: 99%

Automation of anaesthesia: a review on multivariable control

Chang

Syafiie

Kamil

et al. 2014

J Clin Monit Comput

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Anaesthesia is a multivariable problem where a combination of drugs are used to induce desired hypnotic, analgesia and immobility states. The automation of anaesthesia may improve the safety and cost-effectiveness of anaesthesia. However, the realization of a safe and reliable multivariable closed-loop control of anaesthesia is yet to be achieved due to a manifold of challenges. In this paper, several significant challenges in automation of anaesthesia are discussed, namely model uncertainty, controlled variables, closed-loop application and dependability. The increasingly reliable measurement device, robust and adaptive controller, and better fault tolerance strategy are paving the way for automation of anaesthesia.

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“…Using perioperatively recorded EEG data from their database, Zanner et al [99] found time delays for all indices between 24 and 122 s before the new state was indicated. They conclude that due to different time delays for ascending and descending values, the results of pharmacodynamic studies may be influenced by this phenomenon.…”

Section: Pharmacodynamic Modellingmentioning

confidence: 99%

Limitations of anaesthesia depth monitoring

Lobo

Schraag

2011

Current Opinion in Anaesthesiology

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Time delay of electroencephalogram index calculation: analysis of cerebral state, bispectral, and Narcotrend indices using perioperatively recorded electroencephalographic signals

Abstract: Our results may show a limitation of the value of electronic EEG indices in prevention of awareness with recall. Furthermore, due to different time delays for ascending and descending values, the results of pharmacodynamic studies may be influenced by this phenomenon.

Cited by 107 publications

References 21 publications

Brain Monitoring With Electroencephalography and the Electroencephalogram-Derived Bispectral Index During Cardiac Surgery

Brain Monitoring With Electroencephalography and the Electroencephalogram-Derived Bispectral Index During Cardiac Surgery

Automation of anaesthesia: a review on multivariable control

Limitations of anaesthesia depth monitoring

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