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응급 간이식이 요구되는 전격성 간부전 환자들에게서 Bispectral Index Monitoring을 이용한 이식 전후 의식상태의 지속적인 평가의 유용성
박정익(Jeong-Ik Park),황신(Shin Hwang),이승규(Sung-Gyu Lee),황규삼(Gyu-Sam Hwang),김기훈(Ki-Hun Kim),안철수(Chul-Soo Ahn),문덕복(Deok-bok Moon),하태용(Tae-Yong Ha),송기원(Gi-Won Song),정동환(Dong-Hwan Jung),유제호(Je-Ho Ryu),이효준(Hyo 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.1
Purpose: Deterioration of consciousness is the most critical problem in patients with fulminant hepatic failure (FHF). Electroencephalography (EEG) is a standard procedure to determine the brain activity in unconscious patients. The bispectral (BIS) index derived from EEG was primarily developed to monitor the depth of unconsciousness. Methods: A prospective study was performed to assess the clinical utility of peritransplant BIS monitoring in 11 fulminant hepatic failure (FHF) patients who were undergoing emergency living donor liver transplantation (LT) with using a right liver graft. All the patients recovered their consciousness after LT. Results: There was a significant correlation between the BIS index values and the derived GCS score (r2=0.634, p <0.001). Timing of eye opening to voice command matched the BIS index value of 64±9.5, which was after 14±9.4 hours passing BIS index of 50. All the patients with endotracheal intubation during the early posttransplant period showed progressive increase of their BIS index, which appeared slightly earlier and more evident than the rise of derived GCS scores. Conclusion: BIS monitoring is a noninvasive, simple and easy-to-interpret method and it also appears to be a useful to assess and predict the recovery of a patient’s consciousness level after LT. Therefore, we concluded that BIS monitoring can be an indispensable component of the peritransplant intensive care for patients with FHF and who require emergency LT.