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Bispectral index during asleep-awake craniotomies.
Valeria Conte1, Camilla L'Acqua, Stefano Rotelli
1Neuroscience ICU, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan University, Milan, Italy. v.conte@policlinico.mi.it
Journal of Neurosurgical Anesthesiology
|April 23, 2013
Summary
Bispectral Index (BIS) monitoring during asleep-awake craniotomies can shorten anesthesia recovery time. Higher BIS values at the end of the asleep phase correlate with faster laryngeal mask airway removal and predict consciousness recovery for brain mapping.
Area of Science:
- Anesthesiology
- Neuroscience
- Surgical Monitoring
Background:
- Asleep-awake craniotomies pose challenges for anesthetists balancing sedation and patient cooperation for neurological testing.
- Bispectral Index (BIS) monitoring was investigated for its potential to expedite patient awakening and predict consciousness recovery during these procedures.
Purpose of the Study:
- To evaluate the utility of BIS monitoring in managing anesthesia during asleep-awake craniotomies.
- To determine if BIS can predict the recovery of consciousness for intraoperative brain mapping.
Main Methods:
- An observational prospective study involving 27 asleep-awake craniotomies with offline BIS data collection.
- Analysis of BIS values at nine critical intraoperative time points, including hypnotic drug termination, eye opening, and brain mapping initiation.
Main Results:
- Higher BIS values upon hypnotic drug termination were associated with shorter laryngeal mask airway (LMA) removal times (P=0.016).
- BIS values returned to preinduction levels by the initiation of brain mapping (P<0.0001).
- BIS >85 predicted brain mapping initiation with 44% sensitivity and 74% specificity.
Conclusions:
- Elevated BIS levels at the end of the asleep phase may shorten anesthesia recovery, facilitating earlier LMA removal.
- The return of BIS to preinduction values during the awake phase indicates full consciousness recovery, enabling reliable intraoperative neurological testing.
