Patients and methods
psychiatric
HEART, SKIN CONDITION, EMERGENCY, CEREBROVASCULAR DISEASE
This prospective cross-sectional study was performed at Tanta University Hospitals, Egypt from July 2022 to January 2023 on 12 patients older than 18, American society of anesthesiologists (ASA) I-III patients who planned for elective kidney surgeries. The study obtained approval from Tanta University ethical committee unit in June 2022 (ID:35,561/6/22) and registered at clinicaltrials.gov on 11/07/2022 (trial registration number: NCT05451823).The use of electrodes (BISTM Quatro Sensors, Aspect Medical Systems, Newton, MA, USA) over the forehead and post-auricular area is contraindicated in patients with incapacitating central nervous system or cerebrovascular disease, those who take psychiatric drugs now, those who have had neurosurgical intervention in the past, and those who have certain skin conditions, for example. These patients were excluded from the study. The patients gave their signed consent after being fully informed. To preserve participant privacy and data confidentiality, each patient received a description of the study’s goals, received a secret code number, and had images taken exclusively of the body parts related to the study. Standard monitoring was carried out as soon as the patients entered the operating room, including taking their temperature, blood pressure, electrocardiogram, oxygen saturation, end-tidal carbon dioxide tension, and inspired oxygen tension.An Infinity bispectral index (BISx SmartPod®) was utilized to monitor the level of anesthetic. (Aspect Medical Systems, Newton, MA, USA) and an Infinity® Delta XL monitor (Dräger Medical, Lübeck, Germany). The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the American Heart Association, and the Emergency Care Research Institute all set guidelines for this device (American Hospital Association). The forehead and post-auricular region each received a standard BISx Quatro® Sensor from Aspect Medical Systems. Two BIS sensors (BISTM Quatro Sensors, Aspect Medical Systems, Newton, MA, USA) were applied to each patient before the induction of anesthesia. One sensor was placed across the forehead, and the other along the post-auricular area (BIS-VistaTM monitors, Aspect Medical Systems, Newton, MA, USA).Patients were told to maintain a relaxed expression throughout induction (eyes closed, mouth closed, no facial expressions).After cleaning the forehead skin with an alcohol swab that contained 70% alcohol, the sensor leads were subjected to digital pressure for 2 to 5 s. Wet gel electrodes that are disposable make up the sensor. Lead 4, the ground electrode, also measures the electromyographic activity of the frontalis muscle.Lead 1 of the frontal sensors was placed in the middle of the forehead, lead 2 was 2.8 cm to the left of lead 1, and lead 3 was placed in the temporal region between the lateral canthus and the hairline. Lead 1 of the post-auricular sensors was placed post-auricularly adjacent to the hairline, 2.5 cm medial to the mastoid area, on the same side of the face. The mastoid area was where lead 2 was placed, and the temporal region between the lateral canthus and the hairline was where lead 3 was attached on the same side. The BIS values between 40 and 60 were utilized to sustain the anesthetic depth titration (Fig. We gathered three pieces of data in each case at each of the six-time points: BIS score, signal quality index (SQI) score calculating the signal’s strength and EMG score: before the onset of anesthesia (awake), when the eyelash reflex is lost (LOC), after intubation (intubation), after the first surgical incision (incision), every 30 min during the procedure (maintenance), and at the moment the patient’s eyes open naturally after waking up from anesthesia (emergence).The data analysis removed the BIS values connected with sudden, high electromyography (EMG) ratings because they were considered artifacts.