Continuous peritransplant assessment of consciousness using bispectral index monitoring for patients with fulminant hepatic failure undergoing urgent liver transplantation

Abstract

Background: Rapid deterioration of consciousness is a critical situation for patients with fulminant hepatic failure (FHF). Bispectral (BIS) index was derived from electroencephalography parameters, primarily to monitor the depth of unconsciousness. Aim: To assess the usability of peritransplant BIS monitoring in patients with FHF. Methods: A prospective study using peritransplant BIS monitoring was performed in 26 patients with FHF undergoing urgent liver transplantation (LT). Results: Pre-transplant Child-Pugh score was 12.2 ± 1.0; model for end-stage liver disease score was 32.4 ± 4.4; Glasgow coma score (GCS) was 9.9 ± 1.3; and BIS index was 44.0 ± 6.7. Pre-transplant sedation significantly decreased BIS index. After LT, all patients having endotracheal intubation recovered consciousness within one to three d and showed progressive increase in BIS index, which appeared slightly earlier and was more evident than the increase in derived GCS score. There was a significant correlation between BIS index and derived GCS scores (r2 = 0.648). Timing of eye opening to voice was matched with BIS index of 66.3 ± 10.4 and occurred 12.7 ± 8.3 h after passing BIS index of 50. Conclusion: These results suggest that BIS monitoring is a non-invasive, simple, easy-to-interpret method, which is useful in assessing peritransplant state of consciousness. BIS monitoring may therefore be a useful tool during peritransplant intensive care for patients with FHF showing hepatic encephalopathy. © 2009 John Wiley & Sons A/S.