The Colour Density Spectral Array in the Perioperative Management of Urgent Craniectomy: Can We Identify Epileptiform Activity?. | [Anaesthesia, Pain and Intensive Care • 2017]

Author(s):

1. Joana Barroso Moreira: Department of Anesthesiology, Critical Care & Emergency Medicine, Centro Hospitalar do Porto, Porto, Portugal; Emergency Physician in Pre-Hospital Emergency Services at Instituto Nacional de Emergência Médica in Porto, Portugal

2. Ana Luisa Veigade S: Department of Anesthesiology, Critical Care & Emergency Medicine, Centro Hospitalar do Porto, Porto, Portugal

3. Manuel Antnio Fernandes Trailada Silva Campos: Department of Anesthesiology, Critical Care & Emergency Medicine, Centro Hospitalar do Porto, Porto, Portugal

Abstract:

Status epilepticus (SE) represents a diagnostic and treatment challenge in comatosed patients. This clinic report represents one of the first descriptions of the use of Bilateral BIS® monitor to depict the changes of colour density spectral array (CDSA) from the operating room to the intensive care unit (ICU), and allowed us to hypothesize about the presence of epileptiform activity. A 45 years old man submitted to an urgent craniotomy directed to decompress a malignant middle cerebral artery infarct. Initial CDSA panel showed a pattern of asymmetry, related to the left hemisphere, where the ischemic-hemorrhagic lesion was located. A pattern of high power at frequencies under the 12Hz range was observed, resulting in a plateau formation that can imply seizure presence. This pattern responded to changing of Ce of target controlled infusion (TCI) Propofol and to a bolus of thiopental. At encephalic decompression a global reduction of activity at all frequencies was observed. The patient was transferred to the ICU where the DSA panel showed a sudden loss of alpha and then delta band frequencies. Cerebral death was afterwards clinically diagnosed. CDSA can be used as a complementary tool to detect and monitor SE. It shows good correlation with surgical events and anesthetic depth making it possible to tailor anesthesia to each patient needs in the operating room and in the ICU.

Page(s): 79-86

DOI: DOI not available

Published: Journal: Anaesthesia, Pain and Intensive Care, Volume: 21, Issue: 1, Year: 2017

Keywords:

Keywords are not available for this article.

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