title: Cerebral state index response to incision: a clinical study in day-surgical patients.
abstract: BACKGROUND
  Inadequate anaesthesia, with somatic/autonomic response or awareness, is often revealed at intubation and surgical incision. Anaesthetic depth monitors should be able to prevent this risk. This explorative study examined the ability of the cerebral state monitor to predict autonomic/somatic responses to incision.
  
  
  METHODS
  Forty-two ASA I-II day-surgical patients [19 men and 23 females; mean age 52 (29-79) years, mean weight 77 (50-118) kg] were induced clinically with fentanyl/propofol with sevoflurane after placement of the laryngeal mask airway. The cerebral state index (CSI) was blindly recorded 4 min prior to and 4 min after incision.
  
  
  RESULTS
  During the 4 min prior to incision, the mean CSI was 45 (16-62) and increased by 9 (-13-40) when the mean value for the first 4 min after incision was subtracted from the value prior to incision, corresponding to a relative change of 21% (-21-118). The change in CSI did not show any consistent relation to the value before incision. Five patients showed minor movements after incision and six patients had > 25% increase in blood pressure. Neither CSI nor the change in index differed between patients who did or did not respond somatically or autonomically to incision. The last CSI value just prior to incision was 44 for non-responders and 40 and 42 for somatic and autonomic responders, respectively.
  
  
  CONCLUSIONS
  The CSI in the majority of patients was within acceptable ranges during clinically adjusted anaesthesia prior to incision but seems not to be able to reliably predict an autonomic or somatic response to incision.
authors.affiliation: Department of Cardiothoracic Anaesthetics and Intensive Care, Karolinska Hospital, Stockholm, Sweden.
authors.forename: R E
authors.initials: RE
authors.lastname: Anderson
authors.forename: J G
authors.initials: JG
authors.lastname: Jakobsson
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D001364:Awareness / Q000187:drug effects*; D001794:Blood Pressure / Q000187:drug effects; D001921:Brain / Q000187:drug effects*; D004569:Electroencephalography; D005260:Female; D005283:Fentanyl; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D017214:Laryngeal Masks; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D015742:Propofol; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D005283:Fentanyl; D015742:Propofol