Is the bispectral index a sensitive monitor for survival after living donor liver transplantation?
Amr M. Yassen1, Mohamed R. El Tahan2, Tarek Salah3, Mohamed El Shobary3, Ahmed Sultan3, Mohamed El Saadany4, Mohamed Abdel Wahab3
1 Department of Anesthesia and Intensive Care, College of Medicine, Mansoura University, Mansoura, Egypt
2 Department of Anesthesia and Intensive Care, College of Medicine, Mansoura University, Mansoura, Egypt; Department of Anesthesiology, King Fahd Hospital of the University of Dammam, Al Khubar, Saudi Arabia
3 Department of Surgery, Gastroenterology Surgical Center, College of Medicine, Mansoura University, Mansoura, Egypt
4 Department of Internal Medicine, College of Medicine, Mansoura University, Mansoura, Egypt
Mohamed R. El Tahan
MD, Department of Anesthesiology, King Fahd Hospital of the University of Dammam, Al Aqrabiah str., Al Khubar, P.O. Box 40289, 31952 Al Khubar, Saudi Arabia
Source of Support: None, Conflict of Interest: None
Bispectral index (BIS) monitoring has been established as a standard monitoring method for the assessment of the depth of anesthesia during living donor liver transplantation (LDLT). We tested the sensitivity and specificity of BIS readings during LDLT in predicting the postoperative 3-month survival.
After receiving ethical approval, 42 patients who had undergone LDLT under sevoflurane–fentanyl–rocuronium anesthesia were studied. Correlations between BIS readings and extubation time, postoperative liver function tests, intensive care unit stay, and 3-month mortality were tested. Receiver operating characteristic curves were generated to determine the sensitivity and specificity of the BIS readings during different phases of surgery in predicting the survival outcome.
The extubation time, liver function tests, coagulation factors V and VII, and intensive care unit stay were not statistically correlated with the BIS values. Receiver operating characteristic curve analyses showed reasonable sensitivity and specificity of mean BIS values during hepatic resection and neohepatic periods for predicting the 3-month mortality, with an unweighted accuracy of 76 and 73%, respectively. The nonsurvivors had significantly higher mean BIS values during the neohepatic phase (P<0.05).
The researchers concluded that the BIS monitoring during hepatic resection and neohepatic phases seems to be a suitable noninvasive monitoring tool with reasonable sensitivity and specificity for predicting the 3-month mortality after LDLT under sevoflurane–fentanyl anesthesia.