Korean Journal of Hepato-Biliary-Pancreatic Surgery  2008;12(1):51-57

Continuous Peritransplant Assessment of Consciousness using Bispectral Index Monitoring for Patients with Fulminant Hepatic Failure.

Jeong Ik PARK 1 ; Shin HWANG ; Sung Gyu LEE ; Gyu Sam HWANG ; Ki Hun KIM ; Chul Soo AHN ; Deok bog MOON ; Tae Yong HA ; Gi Won SONG ; Dong Hwan JUNG ; Je Ho RYU ; Hyo Jun LEE ; Sung Moon JEONG ; Suk Kyung HONG

Affiliations

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Keywords

Fulminant hepatic failure; Living donor liver transplantation; Consciousness

Country

Republic of Korea

Language

Korean

Abstract

PURPOSE: Deterioration of consciousness is the most critical problem in patients with fulminant hepatic failure (FHF). Electroencephalography (EEG) is a standard procedure to determine the brain activity in unconscious patients. The bispectral (BIS) index derived from EEG was primarily developed to monitor the depth of unconsciousness. METHODS: A prospective study was performed to assess the clinical utility of peritransplant BIS monitoring in 11 fulminant hepatic failure (FHF) patients who were undergoing emergency living donor liver transplantation (LT) with using a right liver graft. All the patients recovered their consciousness after LT. RESULTS: There was a significant correlation between the BIS index values and the derived GCS score (r2=0.634, p <0.001). Timing of eye opening to voice command matched the BIS index value of 64+/-9.5, which was after 14+/-9.4 hours passing BIS index of 50. All the patients with endotracheal intubation during the early posttransplant period showed progressive increase of their BIS index, which appeared slightly earlier and more evident than the rise of derived GCS scores. CONCLUSION: BIS monitoring is a noninvasive, simple and easy-to-interpret method and it also appears to be a useful to assess and predict the recovery of a patient's consciousness level after LT. Therefore, we concluded that BIS monitoring can be an indispensable component of the peritransplant intensive care for patients with FHF and who require emergency LT.