Awareness o despertar intraoperatorio generalidades acerca de este fenómeno. Rev Med Cos Cen ; 69 (). Language: Español References: The use of cerebral monitoring for intraoperative awareness*. Uso de monitorizacion cerebral para el despertar intraoperatorio. Karina Castellon- Lariosa. Transcript of DESPERTAR INTRAOPERATORIO. DIO Factores: * Anestesia insuficiente * Falla de vaporizadores * Pacientes Obstétricas * Politraumatizados.
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Uso de monitorizacion cerebral para el despertar intraoperatorio.
DESPERTAR INTRAOPERATORIO by José Luis Ayala on Prezi
Uso de monitorizacion cerebralpara el despertar intraoperatorio. Article info Article history: This novelty allowed both the surgeon and the anesthesiologist to have a more objective perception of anesthesia depth. The algorithm is based on different EEG parameters, including time, frequency, and spectral wave. This provides a non-dimensional number, which varies from zero to ; with optimal levels being between 40 and Perform an analysis of the advantages and limitations of the anesthetic management with the bispectral index monitoring, specifically for the management and prevention of intraoperative awareness.
A non-systematic review was made from literature available in PubMed between the years andusing keywords such as “BIS”, “bispectral monitoring”, “monitoreo cerebral”, “despertar intraoperatorio”, “recall” and “intraoperative awareness”. A total of articles were found, from which only the ones containing both bispectral monitoring and intraoperative awareness information were taken into consideration.
A total of 68 articles were used for this review. It also prevents intraoperative awareness and its complications. Consciousness monitors, Intraoperative awareness, Anesthesia, Mental recall, Review literature as topic. Measuring anesthetic depth has always been a substantial necessity, even from the beginning of anesthesia with ether in Currently, the Bispectral Index BIS is the most frequently used technology for monitoring anesthetic depth. Its objective, based on a mathematical algorithm, is to measure the level of consciousness through the use of an EEG of the patient under general anesthesia to thereby evaluate its effects directly at a cerebral level.
Among the advantages of its use are anesthetic titration based on brain activity by which the incidence of intraoperative awareness 1A and anesthetic consumption are reduced; this leads to quick recovery.
The beta wave 0 is related to awareness at BIS values between and 80 and to a state of sedation with general anesthesia in the range of Deep anesthesia is reflected with delta waves 8 and a range between 40 and 20 on the BIS monitor, while burst suppression is reflected by a range of 0 and An isoelectric line on the encephalogram corresponds to a value of 0 on the monitor.
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The meta-analysis carried out by Punjasawadwong et al. However, this was not associated with an increase in the total dosage of anesthetics. One of the most important retrospective studies in the United States was developed by Sessler et al.
These patients experienced a intraoperwtorio hospitalization and mortality increased by two. It was concluded that mortality after 30 deepertar increased when the duration of the “triple low” was greater than 30 min. In cardiovascular surgeries, the monitoring of anesthetic depth is a challenge for the anesthesiologist. The use of cardiopulmonary bypass CPB predisposes the patient to presenting IA for different reasons: As such, anesthetic depth is difficult to correlate.
Intraoperatoroi depth monitored with BIS during heart surgery does not appear to have a significant impact in terms of a reduction of extubation time, time in the ICU, and hospital stay.
The use of cerebral activity monitors becomes essential in these circumstances. Another of the advantages of using BIS is the possible reduction of delirium and cognitive decline, both immediate 1 week and late 3 months. Memory is the capacity to retain and relive impressions or to recognize previous experiences. It is characterized by four steps: In chronological order, sensory stimuli are converted in memory codificationfollowed by transfer from short term memory to more stable long term memory prior to entrance into neocortical areas consolidation.
Later, memory is represented by an interconnected neuron network through the neocortex that join together for storage and finally recovery.
cespertar There are two types of memory, both of which have been widely studied. First, explicit memory also know as controlled or declarative memory that makes use of structures in the medial temporal lobe, like the hippocampus and cortical structures, that are essential for formation, reorganization, consolidation, and storage.
The amygdalae modulate emotional learning in the cortex and the hippocampus, being necessary for the storage and recovery of memories Fig.
Anesthetics do not affect implicit memory, but it is thought that they due have an influence on explicit memory during general anesthesia, usually due to an improper anesthetic levels.
IA is defined as the experience and specific memory of a sensory perception during despedtar. The most important causes of IA are as follows. The use of medications like preoperative benzodiazepines could help, by inhibiting the formation of anterograde memory. Surveys and interviews like the “modified Brice protocol” MBP evaluate the characteristics of the events that occur before, during, and after anesthesia and are useful for the diagnosis of IA. The diagnosis od IA can be subdivided into six categories Table 1.
Its classification is inraoperatorio for preventing sequelae in the long term, such as post-traumatic stress syndrome that usually manifests itself as alterations intraoperatrio sleep patterns, recurring nightmares, flashbacks, and anxiety. Different characteristics exist that can make a certain individual more susceptible to IA: The “B-aware” study also study patients with a intraoperatori risk of presenting IA.
Perioperative care and deepertar use of anesthetics were not modified. Patients could be monitored with BIS during the surgery or following the standard protocol of each hospital. A previously structured questionnaire was applied h, h, and 30 days after surgery. Of those patients that had IA, the ranges in the monitor ranged between 55 and 82 and so it was concluded that constant attention to the monitor is vital.
Intraoperatorjo contrast with the previous results, the study B-Unaware found no difference in the incidence of IA in patients with a high risk of presenting it.
The use of cerebral monitoring for intraoperative awareness
Many other studies have been carried out, proposing the same type of approach as in the MBP study, in which no difference has been demonstrated between the group under BIS-guided anesthesia and the group managed with the standard protocol.
There are three basic aspects necessary to prevent IA: These medications block the anterograde memory and cognitive processes in a way that is proportional to the dose and speed of administration. An oral dosage of 0.
The controversy that exists in the multiple studies that have been performed still leaves much to be studied when it comes to this complex theme of intraoperative monitoring. What is certain is that a clear advance in the medical field has been seen from the introduction of this method for guiding anesthesia.
It does not only help the patient as an individual, improves their outcomes and minimizes post-operative complications, it also is a clear advance in the maximization of resources in hospital networks, reduces costs, and lowers rates of morbidity and mortality due to surgical interventions. At the time of pre-anesthetic evaluations, all risk factors that the individual presents or that make him more susceptible to IA -or if they have experiences IA before- should be taken into account so that effective preventative measures can be taken in order to avoid this complication.
Clinical effectiveness and cost-effectiveness of depth of anaesthesia monitoring E-Entropy Bispectral Index and Narcotrend: Li TN, Li Y.
Depth of anaesthesia monitors and the latest algorithms. Asian Pac J Trop Med. Best Pract Res Clin Anaesthesiol. Estimation of the bispectral index by anesthesiologists: Bispectral index monitoring correlates with the level of consciousness in brain injured patients.
Depth of anaesthesia monitors. Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev. Anesthetic management and one-year mortality after noncardiac surgery.
The effect of bispectral index monitoring on long-term survival in the B-aware trial. Association of perioperative risk factors and cumulative duration of low bispectral index with intermediate-term mortality after cardiac surgery in the B-Unaware Trial. Prevention of intraoperative awareness in a high-risk surgical population. N Engl J Med.
Hospital stay and mortality are increased in patients having a “triple low” of low blood pressure, low bispectral index, and low minimum alveolar concentration of volatile anesthesia. Cumulative duration of “triple low” state of low blood pressure, low bispectral index, and low minimum alveolar concentration of volatile anesthesia is not associated with increased mortality.
Duration of hypotension still matters.
Untangling the triple low: Brain monitoring with electroencephalography and the electroencephalogram-derived bispectral index during cardiac surgery. Intraoperative bispectral index monitoring and time to extubation after cardiac surgery: The impact of bispectral index versus end-tidal anesthetic concentration-guided anesthesia on time to tracheal extubation in fast-track cardiac surgery.
Effect of remifentanil on cardiovascular and bispectral index responses following the induction of anesthesia with midazolam and subsequent tracheal intubation. BIS-guided anesthesia decreases postoperative delirium and cognitive decline.
Intraoperative burst suppression is associated with postoperative delirium following cardiac surgery: Rationale and design of the balanced anesthesia study: Inhibition of learning and memory by general anesthetics. J Steroid Biochem Mol Biol. Does anesthetic regimen influence implicit memory during general anesthesia?
Pharmacologic approaches to the prevention of intraoperative awareness. Risk factor for intraoperative awareness. The incidence of awareness during anesthesia: Comparative effects of sevoflurane and propofol based general anaesthesia for elective surgery on memory.
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Br J Hosp Med Lond. Kotsovolis G, Komninos G. A national survey of anaesthetists NAP5 baseline to estimate an annual incidence of accidental awareness during general anaesthesia in the UK.