Title |
Postoperative surveillance in neurosurgical patients – usefulness of neurological assessment scores and bispectral index
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Published in |
Brazilian Journal of Anesthesiology, April 2016
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DOI | 10.1016/j.bjane.2015.09.003 |
Pubmed ID | |
Authors |
Silvia Herrero, Enrique Carrero, Ricard Valero, Jose Rios, Neus Fábregas |
Abstract |
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. 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). 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). 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. |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 45 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Bachelor | 7 | 16% |
Student > Master | 5 | 11% |
Student > Doctoral Student | 3 | 7% |
Professor | 3 | 7% |
Researcher | 3 | 7% |
Other | 8 | 18% |
Unknown | 16 | 36% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 16 | 36% |
Nursing and Health Professions | 6 | 13% |
Neuroscience | 3 | 7% |
Psychology | 2 | 4% |
Biochemistry, Genetics and Molecular Biology | 1 | 2% |
Other | 1 | 2% |
Unknown | 16 | 36% |