Consciousness level monitoring using biespectral index and spectrogram in a patient with locked-in syndrome under general anesthesia: a case report
DOI:
https://doi.org/10.33448/rsd-v12i2.39833Keywords:
Anesthesia; Locked-in syndrome; Consciousness monitors.Abstract
Introduction: Locked-in syndrome is a neurological condition in which the patient develops tetraplegia and anarthria, becoming unable to perform limb movements and speak, however, maintains proprioception and consciousness, in addition to vertical eye movement, which is the main only way for the patient to communicate. Among the various types of intraoperative monitoring, the BIS and the spectrogram provide us with the analysis of the patient's level of consciousness, allowing the maintenance of an adequate anesthetic plane, reducing intraoperative awakening and the complications of a very deep anesthetic plane. Objective: To describe a case of a patient who developed locked-in syndrome due to a pons ischemic stroke and underwent general anesthesia with monitoring of the level of consciousness with the bispectral index (BIS) and spectrogram. Case report: A 50-year-old female patient, housewife, was admitted to the emergency room at UPA São Sebastião - Brasília DF, with a condition of lowered level of consciousness. Daughter reports that the patient complained of severe headache, followed by syncope. She was evaluated by the medical team, who opted for orotracheal intubation and transferred her to a reference service in neurology due to the suspicion of stroke. Conclusion: Despite the apparent state of coma, the patient with locked-in syndrome presents data from monitoring of anesthetic depth with BIS and spectrogram similar to the normal population, which makes its use important in the prevention of negative outcomes, such as intraoperative awareness.
References
Alcaide, S. M. G., Diéguez, R. D., Martínez, Y. H., Oliveros, A. A., Fradejas, A. B., & Tambo, T. B. (2021). Utilización del índice biespectral en la monitorización de la sedación. Revisión sistemática. Revista Sanitaria de Investigación, 2(12), 200.
Angelin, A. C., Binhardi, V. D. R., Bráz, G. M., de Nazaré Oliveira, F., da Silva, M. A. O., & Bianchin, M. A. (2020). Abordagem interdisciplinar na síndrome do encarceramento: relato de caso. Revista Brasileira de Neurologia e Psiquiatria, 24(1).
Bauer, G., Gerstenbrand, F., & Rumpl, E. (1979). Varieties of the locked-in syndrome. Journal of neurology, 221(2), 77-91.
Ferreira, A. L., Mendes, J. G., Nunes, C. S., & Amorim, P. (2019). Avaliação do tempo de atraso do índice bispectral na resposta à indução da anestesia: estudo observacional. Revista Brasileira de Anestesiologia, 69, 377-382.
Hayashi, K., Araki, R., & Tanaka, A. (2017). Electroencephalographic monitoring during sevoflurane anaesthesia in an amyotrophic lateral sclerosis patient with locked-in state. Journal of Clinical Neuroscience, 43, 126-128.
Hemmati, N., & Zokaei, A. H. (2015). Comparison of the effect of anesthesia with midazolam-fentanyl versus propofol-remifentanil on bispectral index in patients undergoing coronary artery bypass graft. Global Journal of Health Science, 7(5), 233.
Hobaika, A. B. S., Fantini, C. N. C., Figueiredo, C. L., Santos, P. R., & Alves, N. G. (2007). Monitorização dos níveis de consciência em anestesiologia. Rev Méd Minas Gerais, 17(1/2), 54-9.
Mahmood, S., Parchani, A., El-Menyar, A., Zarour, A., Al-Thani, H., & Latifi, R. (2014). Utility of bispectral index in the management of multiple trauma patients. Surgical neurology international, 5.
Moura, L.A., Cristo, R., Miranda, F.R., Pereira, A.L.G., Broch, F.N., Sierra, I.S. & Slavec, I.A.C. (2020). Síndrome do encarceramento (locked-in) por isquemia de região pontina, relato de caso. Frente Diagnóstica e Terapêutica na Neurologia, [s. l.]: 170-173.
Nunes, R. R., Fonseca, N. M., Simões, C. M., Rosa, D. M., Silva, E. D., Cavalcante, S. L., ... & Stefani, L. C. (2015). Consenso brasileiro sobre monitoração da profundidade anestésica. Revista Brasileira de Anestesiologia, 65, 427-436.
Nunes, R. R., Nunes Filho, R. R., Rodrigues, L. P., Araújo, B. K. C., & Feijó, D. K. A. (2019). Monitorização da Profundidade Anestésica e bis. Revista Potiguar de Anestesiologia. Natal/RN, VI , 6: 9-15.
Purdon, P. L., Sampson, A., Pavone, K. J., & Brown, E. N. (2015). Clinical electroencephalography for anesthesiologists: part I: background and basic signatures. Anesthesiology, 123(4), 937-960.
Queiroz, L.F., Arantes, L.J.; Arantes, L.J., Fonseca, N.M., Mandim, B.L.S., Ruzzi, R.A., Martins, N.A., Costa, P.R.R. Uso correto do monitor de consciência. (2011). Rev Med Minas Gerais; 21(2 Supl 3): S50-S58.
Rasheed, A. M., Amirah, M. F., Abdallah, M., Parameaswari, P. J., Issa, M., & Alharthy, A. (2019). Ramsay sedation scale and richmond agitation sedation scale: A Cross-sectional study. Dimensions of Critical Care Nursing, 38(2), 90-95.
Sanglard, M. P., de Macedo Machado Filho, G., Maciel, F. L. A., Machado, A. D. M. F., & Godoi, B. B. (2018). Síndrome do encarceramento (locked-in) clássica: relato de caso com recuperação funcional importante. Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery, 37(S 01), A2743.
Schuller, P. J., Newell, S., Strickland, P. A., & Barry, J. J. (2015). Response of bispectral index to neuromuscular block in awake volunteers. British journal of anaesthesia, 115(suppl_1), i95-i103.
Sociedade Brasileira de Anestesiologia. (2020). Recomendação da Sociedade Brasileira de Anestesiologia (SBA) para o uso racional de fármacos em anestesia e sedação durante a retomada de procedimentos eletivos. Rio de Janeiro. julho.
Svernling, K., Törnbom, M., Nordin, Å., & Sunnerhagen, K. S. (2019). Locked-in syndrome in Sweden, an explorative study of persons who underwent rehabilitation: a cohort study. BMJ open, 9(4), e023185.
Torres, T. D. P. C., Villegas, G. A. T., Arteaga, J. A. P., & Molina, P. A. C. (2019). Monitoreo del índice biespectral durante la anestesia general. RECIMUNDO, 3(3 ESP), 265-281.
Yoo, C., Ayello, E. A., Robins, B., Salamanca, V. R., Bloom, M. J., Linton, P., ... & O’Neill, D. K. (2014). Perioperative use of bispectral (BIS) monitor for a pressure ulcer patient with locked‐in syndrome (LIS). International wound journal, 11(5), 540-545.
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