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Bispectral index variations in patients with neurological deficits during awake carotid endarterectomy.
MedLine Citation:
PMID:  20035229     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND OBJECTIVE: The bispectral index (BIS) is derived from the EEG and therefore may be useful to diagnose intraoperative cerebral ischaemia. This study was undertaken to investigate BIS changes in awake patients with and without neurological deficits during carotid endarterectomy under regional anaesthesia. METHODS: Seventy consecutive carotid endarterectomies under regional anaesthesia were divided into two surgical groups: patients with and patients without neurological deficits. Patients' neurological status was evaluated and neurological deficits were compared with BIS values. Measurements were made at different surgical stages: baseline, after sedation, at the beginning of surgery, at preclamping, at the 3 min clamping test, during shunt insertion, at declamping, 15 min after declamping and at the end of surgery. We performed intergroup and intragroup comparisons of BIS values. A decrease in BIS of at least 10 associated with neurological deficits was taken as the cut-off point for the classification of patients with logistic regression models (crude and adjusted for potential confounders). RESULTS: Thirteen patients (18.6% of the total) developed clinical cerebral ischaemia, though BIS values decreased in 10 of these patients (76.9%). The mean BIS values were 92.5+/-5.6 and 84.7+/-12.3 for patients without and with neurological deficits, respectively (P value<0.05). The odds ratios of a BIS decrease associated with neurological deficits were 8.5 (95% confidence interval 2.1-35.1) and 5.4 (95% confidence interval 1.2-24.3) adjusted for contralateral stenosis. CONCLUSION: Our results describe a relationship between BIS reductions and neurological deficits during carotid surgery in awake patients.
María J Estruch-Pérez; Manuel Barberá-Alacreu; Alicia Ausina-Aguilar; Juan Soliveres-Ripoll; Cristina Solaz-Roldán; María M Morales-Suárez-Varela
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of anaesthesiology     Volume:  27     ISSN:  1365-2346     ISO Abbreviation:  Eur J Anaesthesiol     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-11     Completed Date:  2010-11-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8411711     Medline TA:  Eur J Anaesthesiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  359-63     Citation Subset:  IM    
Anesthesiology and Critical Care Department, Dr Peset University Hospital, and Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Valencia, Spain.
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MeSH Terms
Anesthesia / methods*
Brain Ischemia / diagnosis*,  etiology
Endarterectomy, Carotid / methods*
Middle Aged
Nervous System Diseases / surgery*
Prospective Studies
Treatment Outcome

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