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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2024.tde-13052024-154450
Document
Author
Full name
Matheus Campello Vieira
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2023
Supervisor
Committee
Garcia, Waynice Neiva de Paula (President)
Azi, Liana Maria Tôrres de Araújo
Abrão, João
Title in Portuguese
A influência da técnica anestésica na diferença entre valores de dois monitores de profundidade anestésica - estudo transversal
Keywords in Portuguese
Anestesia
Eletroencefalografia
Monitores de consciência
Abstract in Portuguese
A monitorização do nível de profundidade anestésica através da análise eletroencefalográfica tem se tornado cada vez mais presente na prática médica atual. Alguns dos benefícios associados à monitorização da profundidade anestésica são redução de delirium e de náuseas e vômitos pós-operatórios, menor tempo para tempo para extubação e alta pós-anestésica e menor utilização de anestésicos. Neste contexto, a tecnologia mais estudada e utilizada globalmente é o Bispectral Index System Monitor (Monitor BIS, Covidien, EUA). Contudo, ainda existem entraves para a adoção extensiva desta modalidade de monitorização, com seu relativo alto custo de implantação figurando entre as principais dificuldades atuais. Assim, recentemente novas alternativas comerciais ao BIS surgiram. Merece destaque o monitor Narcosis INDEX (NINDEX, Controles S.A., Uruguai) devido ao seu baixo custo operacional e fácil portabilidade. Todavia, apesar do uso autorizado e validado pelos órgãos fiscalizadores internacionais, ainda faltam estudos comparativos robustos entre NINDEX e o padrão global BIS nos mais diferentes contextos anestésicos. Sob esta conjuntura, o presente trabalho objetivou avaliar a influência da técnica anestésica na discrepância entre os valores dos índices NINDEX e BIS observados em pacientes submetidos a anestesia geral balanceada com aqueles encontrados em pacientes sob anestesia venosa total (TIVA). A partir de banco de dados prévio, analisou-se os valores simultâneos de BIS e NINDEX em 37 pacientes, sendo 16 submetidos a anestesia balanceada, 17 a TIVA e 4 em que houve transição da TIVA para balanceada. Os resultados indicam que o "número NINDEX" permanece cerca de 10,7 unidades acima do valor do BIS em pacientes sob anestesia venosa total. Todavia, quando sob anestesia balanceada a discrepância é de aproximadamente 8,60 unidades, menor que a originalmente esperada pelo fabricante do monitor NINDEX. Espera-se que os resultados consigam estimular a expansão da monitorização da profundidade anestésica de maneira financeiramente acessível e eficaz.
Title in English
The influence of anesthetic technique on the difference between values of two anesthetic depth monitors - a cross-sectional study
Keywords in English
Anesthesia
Consciousness monitors
Electroencephalography
Abstract in English
The monitoring of anesthetic depth through electroencephalographic analysis has become increasingly prevalent in current medical practice. Some of the associated benefits include a reduction in delirium, postoperative nausea and vomiting, shorter extubation and post-anesthetic recovery times, and a decrease in the overall use of anesthetics. In this context, the most studied and globally utilized technology is the Bispectral Index System Monitor (BIS Monitor, Covidien, USA). However, challenges persist in the widespread adoption of this intraoperative monitoring modality, with its relatively high implementation cost being among the main current difficulties. Recently, new commercial alternatives to BIS have emerged, with noteworthy mention of the Narcosis INDEX monitor (NINDEX, Controles S.A., Uruguay) due to its low operational cost and easy portability. Nevertheless, despite being authorized and validated by international regulatory bodies, there is still a lack of robust comparative studies between NINDEX and the global standard BIS in various anesthetic contexts. In this scenario, the present study aimed to assess the influence of anesthetic technique on the discrepancy between NINDEX and BIS values observed in patients undergoing balanced general anesthesia compared to those under total intravenous anesthesia (TIVA). Utilizing a pre-existing database, simultaneous BIS and NINDEX values were analyzed in 37 patients, with 16 undergoing balanced anesthesia, 17 TIVA, and 4 experiencing a transition from TIVA to balanced anesthesia. The results indicate that the "NINDEX number" remains approximately 10.7 units above the BIS value in patients under total intravenous anesthesia. However, under balanced anesthesia, the discrepancy is around 8.6 units, which is lower than originally expected by the NINDEX monitor manufacturer. These findings are expected to encourage the expansion of financially accessible and effective depth of anesthesia monitoring.
 
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Publishing Date
2024-07-17
 
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