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Optimal bispectral index exists in healthy patients undergoing general anesthesia: A validation study

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Abstract

Purpose

Continuous cerebrovascular reactivity monitoring in both neurocritical and intra-operative care has gained extensive interest in recent years, as it has documented associations with long-term outcomes (in neurocritical care populations) and cognitive outcomes (in operative cohorts). This has sparked further interest into the exploration and evaluation of methods to achieve an optimal cerebrovascular reactivity measure, where the individual patient is exposed to the lowest insult burden of impaired cerebrovascular reactivity. Recent literature has documented, in neural injury populations, the presence of a potential optimal sedation level in neurocritical care, based on the relationship between cerebrovascular reactivity and quantitative depth of sedation (using bispectral index (BIS)) – termed BISopt. The presence of this measure outside of neural injury patients has yet to be proven.

Methods

We explore the relationship between BIS and continuous cerebrovascular reactivity in two cohorts: (A) healthy population undergoing elective spinal surgery under general anesthesia, and (B) healthy volunteer cohort of awake controls.

Results

We demonstrate the presence of BISopt in the general anesthesia population (96% of patients), and its absence in awake controls, providing preliminary validation of its existence outside of neural injury populations. Furthermore, we found BIS to be sufficiently separate from overall systemic blood pressure, this indicates that they impact different pathophysiological phenomena to mediate cerebrovascular reactivity.

Conclusions

Findings here carry implications for the adaptation of the individualized physiologic BISopt concept to non-neural injury populations, both within critical care and the operative theater. However, this work is currently exploratory, and future work is required.

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Acknowledgements

FAZ is supported through the Manitoba Public Insurance (MPI) Professorship in Neuroscience/TBI Research Endowment, NSERC, Canadian Institutes of Health Research (CIHR), the MPI Neuroscience Research Operating Fund, the Health Sciences Centre Foundation Winnipeg, the Canada Foundation for Innovation (CFI)(Project #: 38583), Research Manitoba (Grant #: 3906 and 5429) and the University of Manitoba VPRI Research Investment Fund (RIF). LF is supported through a Research Manitoba PhD Fellowship, the Brain Canada Thompkins Travel Scholarship, NSERC (ALLRP-576386-22) and the Graduate Enhancement of Tri-Council Stipends (GETS) – University of Manitoba. AG is supported through a CIHR Fellowship (Grant #: 472,286). ASS is supported through the University of Manitoba Graduate Fellowship (UMGF) – Biomedical Engineering, NSERC (RGPIN-2022-03621), and the Graduate Enhancement of Tri-Council Stipends (GETS) – University of Manitoba. KYS is supported through the University of Manitoba R.G. and E.M. Graduate Fellowship (Doctoral) in Biomedical Engineering and the University of Manitoba MD/PhD program. NV is supported by NSERC (RGPIN-2022-03621).

Funding

This work was directly supported through the Manitoba Public Insurance (MPI) Professorship in Neuroscience, and the Natural Sciences and Engineering Research Council of Canada (NSERC) (DGECR-2022-00260, RGPIN-2022-03621, ALLRP-576386-22, ALLRP-578524-22).

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Authors and Affiliations

  1. Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada

    Logan Froese, Amanjyot Singh Sainbhi, Nuray Vakitbilir, Kevin Y. Stein & Frederick A. Zeiler

  2. Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada

    Alwyn Gomez, Neil Berrington, Perry Dhaliwal & Frederick A. Zeiler

  3. Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada

    Alwyn Gomez & Frederick A. Zeiler

  4. Undergraduate Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada

    Izabella Marquez & Fiorella Amenta

  5. Undergraduate Medical Education, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada

    Kangyun Park & Kevin Y. Stein

  6. Division of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

    Frederick A. Zeiler

  7. Division of Anaesthesia, Department of Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK

    Frederick A. Zeiler

  8. Centre on Aging, University of Manitoba, Winnipeg, MB, Canada

    Frederick A. Zeiler

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  1. Logan Froese
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  2. Alwyn Gomez
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Contributions

LF prepared, analyzed and interpreted the patient data. AG, ASS, IM, FA, KP,NB and PD helped collect and interpret patient data. FAZ and LF formalized methods and main analysis for this manuscript and were major contributors in writing the first draft manuscript. All authors read and approved the final manuscript.

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Correspondence to Logan Froese.

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Data were collected following full approval by the University of Manitoba Biomedical Research Ethics Board (H2020:019 and H2020:104) and the Health Sciences Centre Research Impact Committee, which are renewed on an annual basis reconfirmed in 2022.

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Froese, L., Gomez, A., Sainbhi, A.S. et al. Optimal bispectral index exists in healthy patients undergoing general anesthesia: A validation study. J Clin Monit Comput (2024). https://doi.org/10.1007/s10877-024-01136-3

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