Experience with "Fast track" postoperative care after deep brain stimulation surgery / Experiencia con el cuidado postoperatorio "Fast-Track" después de la cirugía de estimulación cerebral profunda

Background: A 24-h-stay in the post-anesthesia care unit (PACU) is a common postoperative procedure after deep brain stimulation surgery (DBS). Objective: We evaluated the impact of a fast-track (FT) postoperative care protocol. Methods: An analysis was performed on all patients who underwent DBS in 2 periods: 2006, overnight monitored care (OMC group), and 2007-2013, FT care (FT group). Results: The study included 19 patients in OMC and 95 patients in FT. Intraoperative complications occurred in 26.3% patients in OMC vs. 35.8% in FT. Post-operatively, one patient in OMC developed hemiparesis, and agitation in 2 patients. In FT, two patients with intraoperative hemiparesis were transferred to the ICU. While on the ward, 3 patients from the FT developed hemiparesis, two of them 48h after the procedure. Thirty eight percent of FT had an MRI scan, while the remaining 62% and all patients of OMC had a CT-scan performed on their transfer to the ward. One patient in OMC had a subthalamic hematoma. Two patients in FT had a pallidal hematoma, and 3 a bleeding along the electrode. Conclusions: A FT discharge protocol is a safe postoperative care after DBS. There are a small percentage of complications after DBS, which mainly occur within the first 6 h

Introducción: La estancia durante 24 h en una unidad de recuperación post-anestésica es una estrategia común de control post-operatorio después de la cirugía de estimulación cerebral profunda (DBS). Objetivo: Evaluamos el impacto de un protocolo Fast-track (FT) en el cuidado postoperatorio. Métodos: Analizamos todos los pacientes que se sometieron a cirugía DBS en 2 periodos: 2006, monitorización durante la noche (grupo OMC) y entre 2007 y 2013 (grupo FT). Resultados: Incluimos 19 pacientes en el grupo OMC y 95 pacientes en el FT. Se registraron incidentes intraoperatorios en el 26,3% de pacientes del grupo OMC vs. 35,8% del grupo FT. Postoperatoriamente, un paciente en el grupo OMC desarrollo hemiparesia y 2 pacientes agitación. En el grupo FT, 2 pacientes con hemiparesia intraoperatoria fueron trasladados a la UCI. Durante su ingreso en planta, 3 pacientes del grupo FT desarrollaron hemiparesia, 2 de ellos 48h después del procedimiento. Al 38% del FT se les realizó una resonancia, mientras que al 62% restante y a todos los pacientes del grupo OMC se les realizó un escáner antes del traslado a sala: un paciente del grupo OMC tuvo un hematoma subtalámico; 2 pacientes del grupo FT tuvieron un hematoma en el pálido y 3, sangrado en el trayecto del electrodo. Conclusiones: El protocolo FT es seguro después de la cirugía de DBS. Hay un pequeño porcentaje de complicaciones y la mayoría suceden en las primeras 6 h

Experience with "Fast track" postoperative care after deep brain stimulation surgery.

BACKGROUND: A 24-h-stay in the post-anesthesia care unit (PACU) is a common postoperative procedure after deep brain stimulation surgery (DBS). OBJECTIVE: We evaluated the impact of a fast-track (FT) postoperative care protocol. METHODS: An analysis was performed on all patients who underwent DBS in 2 periods: 2006, overnight monitored care (OMC group), and 2007-2013, FT care (FT group). RESULTS: The study included 19 patients in OMC and 95 patients in FT. Intraoperative complications occurred in 26.3% patients in OMC vs. 35.8% in FT. Post-operatively, one patient in OMC developed hemiparesis, and agitation in 2 patients. In FT, two patients with intraoperative hemiparesis were transferred to the ICU. While on the ward, 3 patients from the FT developed hemiparesis, two of them 48h after the procedure. Thirty eight percent of FT had an MRI scan, while the remaining 62% and all patients of OMC had a CT-scan performed on their transfer to the ward. One patient in OMC had a subthalamic hematoma. Two patients in FT had a pallidal hematoma, and 3 a bleeding along the electrode. CONCLUSIONS: A FT discharge protocol is a safe postoperative care after DBS. There are a small percentage of complications after DBS, which mainly occur within the first 6h.

Can bispectral index monitoring predict recovery of consciousness in patients with severe brain injury?

BACKGROUND: The probability of recovering consciousness in acute brain-injured patients depends on central nervous system damage and complications acquired during their stay in the intensive care unit. The objective of this study was to establish a relation between the Bispectral Index (BIS) and other variables derived from the analysis of the electroencephalographic signal, with the probability of recovering consciousness in patients in a coma state due to severe cerebral damage. METHODS: Twenty-five critically ill, unconscious brain-injured patients from whom sedative drugs were withdrawn at least 24 h before BIS recording were prospectively studied. BIS, 95% spectral edge frequency, burst suppression ratio, and frontal electromyography were recorded for 20 min. The neurologic condition of the patients was measured according to the Glasgow Coma Score (GCS). Patients were followed up for assessment of recovery of consciousness for 6 months after the injury. The studied variables were compared between the group of patients who recovered consciousness and those who did not recover. Their predictive ability was evaluated by means of the Pk statistic. Univariate and multivariate logistic regression was used to model the relation between variables and probability of recovery of consciousness. Cross-validation was used to validate the proposed model. RESULTS: There were statistically significant differences between the group of patients who recovered consciousness and those who did not with respect to BISmax, BISmin, BISmean, and BISrange, frontal electromyography, signal quality index values, and GCSBIS. The Pk (SE) values were 0.99 (0.01) for electromyelography, 0.96 (0.05) for BISmax, 0.92 (0.05) for BISmean, 0.92 (0.06) for BISrange, and 0.82 (0.09) for GCSBIS. The odds ratio for BISmax in the logistic regression model was 1.17 (95% confidence interval, 1.1-1.35). Cross-validation results reported a high-accuracy median absolute cross-validation performance error of 3.06% (95% confidence interval, 1-22.15%) and a low-bias median cross-validation performance error of 0.84% (0.56-2.12%). CONCLUSIONS: The study BIS and other electrophysiologic and clinical variables has enabled construction and cross-validation of a model relating BIS(max) to the probability of recovery of consciousness in patients in a coma state due to a severe brain injury, after sedation has been withdrawn.