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S. S. Murthy - One of the best experts on this subject based on the ideXlab platform.
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Bispectral Index Monitoring in patients undergoing cardiac surgery under cardiopulmonary bypass.
European journal of anaesthesiology, 2003Co-Authors: G. D. Puri, S. S. MurthyAbstract:Summary Background and objective: Monitoring the depth of anaesthesia by the Bispectral Index facilitates the titration of anaesthetic drugs during operation as well as assisting in early recovery. We planned to use this Index to control the administration of anaesthetic agents in order to stabilize haemodynamics and promote recovery from anaesthesia in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods: Thirty adult patients undergoing valve replacement or coronary artery grafting under cardiopulmonary bypass were studied in a prospective, randomized, controlled study. Bispectral Index Monitoring was used in all patients. Patients received isoflurane anaesthesia and boluses of morphine: in the study group, anaesthetic depth was controlled using the Bispectral Index and clinical variables. In the control group, the Bispectral Index Monitor could not be viewed by the anaesthesiologist. Bispectral Index, mean arterial pressure and heart rate were noted every 5 min, and the incidence of hypotension, hypertension, tachycardia and bradycardia also noted. The time to recovery, when patients started obeying commands, was also recorded. Results: Patients in the study group had significantly less hypertension and tachycardia ( P P > 0.05). The Bispectral Index rose significantly in the control group at the time of institution and termination of cardiopulmonary bypass ( P Conclusions: Anaesthesia controlled by Bispectral Index Monitoring decreases the incidence of haemodynamic disturbances and facilitates titration of anaesthetic agents during cardiopulmonary bypass and thus may assist recovery from anaesthesia.
Mehernoor F. Watcha - One of the best experts on this subject based on the ideXlab platform.
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validation of the Bispectral Index Monitor for measuring the depth of sedation in children
Anesthesia & Analgesia, 2006Co-Authors: Senthilkumar Sadhasivam, Arjunan Ganesh, Amy Robison, Robin D Kaye, Mehernoor F. WatchaAbstract:The Bispectral Index (BIS) is an empirically calibrated number derived from adult electroencephalograph data that correlates with the depth of sedation in adults. We tested the hypothesis that the BIS score is a valid measure of the depth of pediatric sedation in a study designed to avoid limitations of a previously published report. BIS values from 96 healthy ASA physical status I-II children aged 1-12 yr undergoing sedation were continually recorded and electronically transferred to a computer. Two independent observers blinded as to BIS score evaluated sedation using the Observer's Assessment of Alertness/Sedation (OAA/S) and the University of Michigan Sedation Scale (UMSS) at 3-5 min intervals. There was a significant correlation between BIS and UMSS and between BIS and OAA/S by both the Spearman's rank correlation test and by prediction probability (P < 0.001). In children <6 yr, there was a significant correlation between BIS and the clinical sedation scores for subgroups undergoing invasive and noninvasive procedures (P < 0.001). There was also good agreement between the 2 independent observers who assessed clinical sedation scores (kappa = 0.51, P < 0.001). We conclude that the BIS Monitor is a quantitative, nondisruptive and easy to use depth of sedation Monitor in children.
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Bispectral Index Monitoring in pediatric anesthesia.
Current opinion in anaesthesiology, 2004Co-Authors: Arjunan Ganesh, Mehernoor F. WatchaAbstract:PURPOSE OF REVIEW Anesthetic management guided by Bispectral Index Monitoring has been demonstrated to facilitate earlier recovery in adults. Recent preliminary data also suggest that titration of drugs to achieve a specific Bispectral Index value may reduce the incidence of intraoperative awareness in high-risk adults. It is unclear, however, if this technology will benefit children as it is based on an algorithm developed from adults. This article reviews the literature on the use of the Bispectral Index Monitor in children. RECENT FINDINGS In recent studies, Bispectral Index scores were shown to correlate well with sedation scores during conscious and deep sedation in pediatric patients, and also with end-tidal concentrations of inhalation agents in children, although Bispectral Index values may differ with equipotent doses of different agents. Other studies have shown that titrating anesthetic agents to a specific Bispectral Index value during general anesthesia in the pediatric age group is associated with the use of lower amounts of anesthetic agents and faster recovery from anesthesia in children over 2 years old. However, the utility of Bispectral Index Monitoring in infants, particularly those less than 6 months old, is questionable, as there is little correlation between Bispectral Index values and other measures of the depth of anesthesia in this subset of patients. SUMMARY Bispectral Index Monitoring may be used to guide anesthetic administration in older children, but its use as a tool for guiding sedation in the younger pediatric patient needs further investigation. It may be necessary to develop a different Bispectral Index algorithm for children in the younger age groups.
G. D. Puri - One of the best experts on this subject based on the ideXlab platform.
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Bispectral Index Monitoring in patients undergoing cardiac surgery under cardiopulmonary bypass.
European journal of anaesthesiology, 2003Co-Authors: G. D. Puri, S. S. MurthyAbstract:Summary Background and objective: Monitoring the depth of anaesthesia by the Bispectral Index facilitates the titration of anaesthetic drugs during operation as well as assisting in early recovery. We planned to use this Index to control the administration of anaesthetic agents in order to stabilize haemodynamics and promote recovery from anaesthesia in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods: Thirty adult patients undergoing valve replacement or coronary artery grafting under cardiopulmonary bypass were studied in a prospective, randomized, controlled study. Bispectral Index Monitoring was used in all patients. Patients received isoflurane anaesthesia and boluses of morphine: in the study group, anaesthetic depth was controlled using the Bispectral Index and clinical variables. In the control group, the Bispectral Index Monitor could not be viewed by the anaesthesiologist. Bispectral Index, mean arterial pressure and heart rate were noted every 5 min, and the incidence of hypotension, hypertension, tachycardia and bradycardia also noted. The time to recovery, when patients started obeying commands, was also recorded. Results: Patients in the study group had significantly less hypertension and tachycardia ( P P > 0.05). The Bispectral Index rose significantly in the control group at the time of institution and termination of cardiopulmonary bypass ( P Conclusions: Anaesthesia controlled by Bispectral Index Monitoring decreases the incidence of haemodynamic disturbances and facilitates titration of anaesthetic agents during cardiopulmonary bypass and thus may assist recovery from anaesthesia.
Joseph D Tobias - One of the best experts on this subject based on the ideXlab platform.
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the correlation of the Bispectral Index Monitor with clinical sedation scores during mechanical ventilation in the pediatric intensive care unit
Anesthesia & Analgesia, 2002Co-Authors: John W Berkenbosch, Christopher R Fichter, Joseph D TobiasAbstract:UNLABELLED In patients who are mechanically ventilated in the pediatric intensive care unit (PICU), sedative and/or analgesic medications are routinely provided and titrated to effect based on clinical assessment of the patient. The Bispectral Index (BIS) Monitor uses a modified electroencephalogram to quantify the effects of central nervous system-acting drugs on the level of consciousness. To evaluate the usefulness of the BIS Monitor to predict clinical sedation levels in the PICU, we compared BIS values with simultaneously obtained clinical sedation scores in 24 mechanically ventilated pediatric patients aged 5.7 plus minus 6.1 yr. For each sedation scale used, the BIS value correlated with increasing depth of sedation (P < 0.0001) and was independent of the drug(s) used for sedation. To differentiate adequate from inadequate sedation, a BIS value <70 had a sensitivity of 0.87--0.89 and a positive predictive value of 0.68--0.84. To differentiate adequate from excessive sedation, a BIS value <50 had a sensitivity of 0.67--0.75 and a positive predictive value of 0.07--0.52. We conclude that the BIS Monitor may be a useful adjunct for the assessment of sedation in PICU patients. IMPLICATIONS We demonstrate the usefulness of the Bispectral Index Monitor for assessing sedation in pediatric intensive care unit patients. The Bispectral Index Monitor correlated with clinically assessed sedation levels and was useful for differentiating adequate from inadequate sedation, which would be of value when the clinical examination is unavailable.
Frederick E Sieber - One of the best experts on this subject based on the ideXlab platform.
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design considerations of a randomized controlled trial of sedation level during hip fracture repair surgery a strategy to reduce the incidence of postoperative delirium in elderly patients
Clinical Trials, 2017Co-Authors: Susan L Wieland, Karin J Neufeld, Nae Yuh Wang, Kay Dickersin, Frederick E SieberAbstract:Background Delirium is an acute change in mental status characterized by sudden onset, fluctuating course, inattention, disorganized thinking, and abnormal level of consciousness. The objective of the randomized controlled trial "A STrategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients" (STRIDE) is to assess the effectiveness of light versus heavy sedation on delirium and other outcomes in elderly patients undergoing hip fracture repair surgery. Our goal is to describe the design considerations and lessons learned in planning and implementing the STRIDE trial. Methods Discussed are challenges encountered including (1) how to ensure that we quickly identify, assess the eligibility of, and randomize traumatic hip fracture patients; (2) how to implement interventions that involve continuous Monitoring and adjustment during the surgery; and (3) how to measure and ascertain the primary outcome, delirium. Results To address the first challenge, we Monitored the operating room schedule more actively than anticipated. We constructed and organized eligibility assessment data collection forms by purpose and by source of information needed to complete them. We decided that randomization needs to take place in the operating room. To address the second challenge, we designed and implemented a treatment protocol and covered the Bispectral Index Monitor to prevent the Anesthesiologist/Anesthetist from being influenced by the Bispectral Index reading while administering the intervention. Finally, clinical assessment of delirium consisted of standardized interviews of the patient using validated instruments, interviews of those caring for the patient, and review of the medical record. A consensus panel made the final determination of a delirium diagnosis. We note that STRIDE is a single-center trial. The decisions we took may have different implications for multi-center trials. Conclusions Lessons learned are likely to provide useful information to others designing trials in emergency and surgical setting and for those who are interested in unbiased assessment of delirium.