title: [Postoperative surveillance in neurosurgical patients - usefulness of neurological assessment scores and bispectral index].
abstract: OBJECTIVE
  We examined the additive effect of the Ramsay scale, Canadian Neurological Scale (CNS), Nursing Delirium Screening Scale (Nu-DESC), and Bispectral Index (BIS) to see whether along with the assessment of pupils and Glasgow Coma Scale (GCS) it improved early detection of postoperative neurological complications.
  
  
  METHODS
  We designed a prospective observational study of two elective neurosurgery groups of patients: craniotomies (CG) and non-craniotomies (NCG). We analyze the concordance and the odds ratio (OR) of altered neurological scales and BIS in the Post-Anesthesia Care Unit (PACU) for postoperative neurological complications. We compared the isolated assessment of pupils and GCS (pupils-GCS) with all the neurologic assessment scales and BIS (scales-BIS).
  
  
  RESULTS
  In the CG (n=70), 16 patients (22.9%) had neurological complications in PACU. The scales-BIS registered more alterations than the pupils-GCS (31.4% vs. 20%; p<0.001), were more sensitive (94% vs. 50%) and allowed a more precise estimate for neurological complications in PACU (p=0.002; OR=7.15, 95% CI=2.1-24.7 vs. p=0.002; OR=9.5, 95% CI=2.3-39.4). In the NCG (n=46), there were no neurological complications in PACU. The scales-BIS showed alterations in 18 cases (39.1%) versus 1 (2.2%) with the pupils-GCS (p<0.001). Altered CNS on PACU admission increased the risk of neurological complications in the ward (p=0.048; OR=7.28, 95% CI=1.021-52.006).
  
  
  CONCLUSIONS
  Applied together, the assessment of pupils, GCS, Ramsay scale, CNS, Nu-DESC and BIS improved early detection of postoperative neurological complications in PACU after elective craniotomies.
authors.affiliation: Universidad de Barcelona, Hospital Clínic, Sala de Recuperación Pós-Anestésicos Villarroel, Barcelona, Espanha. Electronic address: sherrern@clinic.ub.es.
authors.forename: Silvia
authors.initials: S
authors.lastname: Herrero
authors.affiliation: Universidad de Barcelona, Hospital Clínic, Servicio de Anestesiología Villarroel, Barcelona, Espanha.
authors.forename: Enrique
authors.initials: E
authors.lastname: Carrero
authors.affiliation: Universidad de Barcelona, Hospital Clínic, Servicio de Anestesiología Villarroel, Barcelona, Espanha.
authors.forename: Ricard
authors.initials: R
authors.lastname: Valero
authors.affiliation: Universitat Autònoma de Barcelona, Laboratório de Bioestatística e Epidemiologia, Barcelona, Espanha; Hospital Clínic, IDIBAPS, Bioestadística y Plataforma de Gestión de Datos, Barcelona, Espanha.
authors.forename: Jose
authors.initials: J
authors.lastname: Rios
authors.affiliation: Universidad de Barcelona, Hospital Clínic, Servicio de Anestesiología Villarroel, Barcelona, Espanha.
authors.forename: Neus
authors.initials: N
authors.lastname: Fábregas
mesh_terms: D056805:Consciousness Monitors; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis*; D009460:Neurologic Examination; D019635:Neurosurgical Procedures; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis*; D011446:Prospective Studies
keywords: Bispectral index monitor; Complicações no pós‐operatório; Craniotomia eletiva; Craniotomy elective; Cuidados no pós‐operatório; Exame neurológico; Monitor BIS; Neurologic examination; Neurosurgical procedures; Postoperative care; Postoperative complications; Procedimentos neurocirúrgicos