Can Bispectral Index be a Point-of-care Monitor for Sleep Quality Assessment in Critically Ill Patients?

How to cite this article: Kapoor I, Prabhakar H. Can Bispectral Index be a Point-of-care Monitor for Sleep Quality Assessment in Critically Ill Patients? Indian J Crit Care Med 2023;27(11):782-783.

Anesthesia for minimally invasive neurosurgery.

PURPOSE OF REVIEW: With an ultimate aim of improving patients overall outcome and satisfaction, minimally invasive surgical approach is becoming more of a norm. The related anesthetic evidence has not expanded at the same rate as surgical and technological advancement. This article reviews the recent evidence on anesthesia and perioperative concerns for patients undergoing minimally invasive neurosurgery. RECENT FINDINGS: Minimally invasive cranial and spinal surgeries have been made possible only by vast technological development. Points of surgical interest can be precisely located with the help of stereotaxy and neuronavigation and special endoscopes which decrease the tissue trauma. The principles of neuroanethesia remain the same, but few concerns are specific for each technique. Dexmedetomidine has a favorable profile for procedures carried out under sedation technique. As the new surgical techniques are coming up, lesser known anesthetic concerns may also come into light. SUMMARY: Over the last year, little new information has been added to existing literature regarding anesthesia for minimally invasive neurosurgeries. Neuroanesthesia goals remain the same and less invasive surgical techniques do not translate into safe anesthesia. Specific concerns for each procedure should be taken into consideration.

Effect of posture on mouth opening and modified Mallampati classification for airway assessment.

Several bedside airway assessment methods have been proposed for preoperatively identifying patients who are difficult to intubate. To date, the Mallampati grading remains a time-tested technique for difficult airway assessment. Both Mallampati and the further modification by Samsoon and Young assessed patients in the seated position. During clinical practice, situations may arise where it may not be feasible for the patient to sit up for airway assessment. The aim of our prospective study was to determine whether there was any difference between the sitting and supine positions for the assessment of Mallampati grade. Eighty adult patients of American Society of Anesthesiologists (ASA) physical status I and II, aged 18-65 years, admitted to our neurosurgical ward were enrolled and assessed for airway. Our study revealed that change in posture produced a significant change in the mouth openings and Mallampati grades of the patients. This change was always toward a higher grade when the patient was turned supine from the sitting position.

An assessment of the predictors of difficult intubation in patients with acromegaly.

Various clinical signs have been used for assessing difficult intubation in patients with acromegaly. These signs include the modified Mallampati classification, measurement of thyromental distance and head and neck movements. Some authors have also tried to establish a relationship between growth hormone levels and difficult intubation. We hypothesized that duration of symptoms in patients with acromegaly may have an association with difficult airway and difficult laryngoscopy. In this prospective study we evaluated tests of airway assessment such as: (i) the Mallampati grade; (ii) the thyromental distance; and (iii) the laryngoscopic grade (Cormack-Lehane). The growth hormone levels and the duration of disease symptoms were also examined. Significant correlation was observed between the Cormack-Lehane and Mallampati gradings (p = 0.05; rho = 19.3%), and between the thyromental distance and the duration of the symptoms (p = 0.03; rho = 26.9%). The incidence of Mallampati III and IV grades was higher in patients with acromegaly. Increased thyromental distance was noted in patients with a long duration of disease. However, increased thyromental distance was not associated with difficult laryngoscopy.