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The effect of hypothermia during cardiopulmonary bypass on three electro-encephalographic indices assessing analgesia and hypnosis during anesthesia: consciousness index, nociception index, and bispectral index

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机构: [1]Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China [2]National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China [3]Department of Cardiac surgery, Tiantan Hospital, Capital Medical University, Beijing, China [4]Department of Medical Informatics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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关键词: BIS cardiopulmonary bypass consciousness index hypothermia nociception index qCON qNOX

摘要:
The depth of anesthesia is commonly assessed in clinical practice by the patient’s clinical signs. However, during cardiopulmonary bypass and hypothermia, common symptoms of nociception such as tachycardia, hypertension, sweating, or movement have low sensitivity and specificity in the description of the patient nociception and hypnosis, in particular, detecting nociceptive stimuli. Better monitoring of the depth of analgesia during hypothermia under cardiopulmonary bypass will avoid underdosage or overdosage of analgesia, especially opioids. Induced hypothermia has a multifactorial effect on the level of analgesia and hypnosis. Thermoregulatory processes appear essential for the activation of analgesic mechanisms, ranging from a physiological strong negative affiliation between nerve conduction velocity and temperature, until significant repercussions on the pharmacological dynamics of the analgesic drugs, the latter decreasing the clearance rate with a subsequent increase in the effect-site concentrations. Under the hypothesis that deep hypothermia induces massive effects on the analgesia and hypnosis levels of the patient, we studied whether hypothermia effects were mirrored by several neuromonitoring indices: two hypnosis indices, consciousness index and bispectral index, and a novel nociception index designed to evaluate the analgesic depth. In this clinical trial, 39 patients were monitored during general anesthesia with coronary atherosclerosis cardiopathy who were elective for on-pump coronary artery bypass graft surgery under hypothermia. The changes and correlation between the consciousness index, bispectral index, and nociception index with respect to the temperature were compared in different timepoints at basic state, during cardiopulmonary bypass and after cardiopulmonary bypass. While the three neuromonitoring indices showed significant correlations with respect to the temperature, the nociception index and consciousness index showed the strongest sensitivities, indicating that these two indices could be an important means of intraoperative neuromonitoring during induced hypothermia under cardiopulmonary bypass. © The Author(s) 2019.

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出版当年[2019]版:
大类 | 4 区 医学
小类 | 4 区 心脏和心血管系统 4 区 外周血管病
最新[2023]版:
大类 | 4 区 医学
小类 | 4 区 心脏和心血管系统 4 区 外周血管病
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出版当年[2018]版:
Q4 PERIPHERAL VASCULAR DISEASE Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
最新[2023]版:
Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Q4 PERIPHERAL VASCULAR DISEASE

影响因子: 最新[2023版] 最新五年平均 出版当年[2018版] 出版当年五年平均 出版前一年[2017版] 出版后一年[2019版]

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第一作者机构: [1]Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China [2]National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
通讯作者:
通讯机构: [1]Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China [2]National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China [*1]Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China. [*2]National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
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