Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지

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

응급 간이식이 요구되는 전격성 간부전 환자들에게서 Bispectral Index Monitoring을 이용한 이식 전후 의식상태의 지속적인 평가의 유용성

  • Park, Jeong-Ik (Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hwang, Shin (Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sung-Gyu (Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hwang, Gyu-Sam (Department of Anesthesiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Ki-Hun (Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ahn, Chul-Soo (Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Moon, Deok-Bog (Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ha, Tae-Yong (Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Song, Gi-Won (Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jung, Dong-Hwan (Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ryu, Je-Ho (Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Hyo-Jun (Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jeong, Sung-Moon (Department of Anesthesiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Suk-Kyung (Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • 박정익 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 황신 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 이승규 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 황규삼 (울산대학교 의과대학 서울아산병원 마취과학교실) ;
  • 김기훈 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 안철수 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 문덕복 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 하태용 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 송기원 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 정동환 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 유제호 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 이효준 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 정성문 (울산대학교 의과대학 서울아산병원 마취과학교실) ;
  • 홍석경 (울산대학교 의과대학 서울아산병원 외과학교실)
  • Published : 2008.03.30

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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 ($r^2$=0.634, p <0.001). Timing of eye opening to voice command matched the BIS index value of 64${\pm}$9.5, which was after 14${\pm}$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' 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.

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