title: Continuous peritransplant assessment of consciousness using bispectral index monitoring for patients with fulminant hepatic failure undergoing urgent liver transplantation.
abstract: BACKGROUND
  Rapid deterioration of consciousness is a critical situation for patients with fulminant hepatic failure (FHF). Bispectral (BIS) index was derived from electroencephalography parameters, primarily to monitor the depth of unconsciousness.
  
  
  OBJECTIVE
  To assess the usability of peritransplant BIS monitoring in patients with FHF.
  
  
  METHODS
  A prospective study using peritransplant BIS monitoring was performed in 26 patients with FHF undergoing urgent liver transplantation (LT).
  
  
  RESULTS
  Pre-transplant Child-Pugh score was 12.2 +/- 1.0; model for end-stage liver disease score was 32.4 +/- 4.4; Glasgow coma score (GCS) was 9.9 +/- 1.3; and BIS index was 44.0 +/- 6.7. Pre-transplant sedation significantly decreased BIS index. After LT, all patients having endotracheal intubation recovered consciousness within one to three d and showed progressive increase in BIS index, which appeared slightly earlier and was more evident than the increase in derived GCS score. There was a significant correlation between BIS index and derived GCS scores (r(2) = 0.648). Timing of eye opening to voice was matched with BIS index of 66.3 +/- 10.4 and occurred 12.7 +/- 8.3 h after passing BIS index of 50.
  
  
  CONCLUSIONS
  These results suggest that BIS monitoring is a non-invasive, simple, easy-to-interpret method, which is useful in assessing peritransplant state of consciousness. BIS monitoring may therefore be a useful tool during peritransplant intensive care for patients with FHF showing hepatic encephalopathy.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
authors.forename: Sung-Gyu
authors.initials: SG
authors.lastname: Lee
authors.forename: Jeong-Ik
authors.initials: JI
authors.lastname: Park
authors.forename: Gi-Won
authors.initials: GW
authors.lastname: Song
authors.forename: Jae-Ho
authors.initials: JH
authors.lastname: Ryu
authors.forename: Dong-Hwan
authors.initials: DH
authors.lastname: Jung
authors.forename: Gyu-Sam
authors.initials: GS
authors.lastname: Hwang
authors.forename: Sung-Moon
authors.initials: SM
authors.lastname: Jeong
authors.forename: Jun-Gol
authors.initials: JG
authors.lastname: Song
authors.forename: Suk-Kyung
authors.initials: SK
authors.lastname: Hong
authors.forename: Young-Suk
authors.initials: YS
authors.lastname: Lim
authors.forename: Kang-Mo
authors.initials: KM
authors.lastname: Kim
mesh_terms: D000328:Adult; D056805:Consciousness Monitors; D004569:Electroencephalography; D005260:Female; D015600:Glasgow Coma Scale; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006801:Humans; D017114:Liver Failure, Acute / Q000473:pathology / Q000523:psychology* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D014474:Unconsciousness / Q000175:diagnosis* / Q000209:etiology; D055815:Young Adult