caa a22 4500 445372834 CHVBK 20180317142953.0 cr unu---uuuuu 170323e20110201xx s 000 0 eng 10.1007/s00540-010-1055-6 doi (NATIONALLICENCE)springer-10.1007/s00540-010-1055-6 Use of bispectral index monitoring for a patient with hepatic encephalopathy requiring living donor liver transplantation: a case report [Elektronische Daten] [Hirobumi Okawa, Tomoko Ono, Eiji Hashiba, Toshihito Tsubo, Hironori Ishihara, Kazuyoshi Hirota] We report the use of perioperative bispectral index (BIS) monitoring in a patient who underwent living donor liver transplantation (LDLT). Hepatic encephalopathy featuring extreme excitement developed in a 42-year-old male and was diagnosed as acute hepatitis. Sedation with continuous infusion of midazolam was necessary. BIS value gradually decreased and reached 0 17h after commencement of continuous infusion of midazolam. Midazolam infusion was stopped but BIS value remained 0. Brain CT scan revealed an almost normal image. Multi-lead electroencephalogram was recorded revealing almost no electrical activity. Administration of flumazenil did not improve his consciousness and BIS value. Adequate spontaneous respiration was maintained and the possibility of brain death was excluded. LDLT was performed on the 5th ICU day. BIS value remained 0 throughout surgery. BIS value suddenly increased 2h after surgery and reached 60 11h after surgery. It became possible to communicate with the patient and his trachea was extubated on the 4th postoperative day. We believe that, with BIS, we were able to follow preoperative exacerbation of the "pathological” process of hepatic encephalopathy, and predict postoperative emergence from general anesthesia, suggesting normal graft function. Japanese Society of Anesthesiologists, 2010 Bispectral index nationallicence Hepatic encephalopathy nationallicence Living donor liver transplantation nationallicence Okawa Hirobumi Department of Anesthesia, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, 036-8216, Hirosaki, Japan aut Ono Tomoko Intensive Care Unit, Hirosaki University Hospital, Hirosaki, Japan aut Hashiba Eiji Intensive Care Unit, Hirosaki University Hospital, Hirosaki, Japan aut Tsubo Toshihito Intensive Care Unit, Hirosaki University Hospital, Hirosaki, Japan aut Ishihara Hironori Department of Anesthesia, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, 036-8216, Hirosaki, Japan aut Hirota Kazuyoshi Department of Anesthesia, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, 036-8216, Hirosaki, Japan aut Journal of Anesthesia Springer Japan 25/1(2011-02-01), 117-119 0913-8668 25:1<117 2011 25 540 https://doi.org/10.1007/s00540-010-1055-6 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00540-010-1055-6 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Okawa Hirobumi Department of Anesthesia, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, 036-8216, Hirosaki, Japan aut NATIONALLICENCE 700 1- Ono Tomoko Intensive Care Unit, Hirosaki University Hospital, Hirosaki, Japan aut NATIONALLICENCE 700 1- Hashiba Eiji Intensive Care Unit, Hirosaki University Hospital, Hirosaki, Japan aut NATIONALLICENCE 700 1- Tsubo Toshihito Intensive Care Unit, Hirosaki University Hospital, Hirosaki, Japan aut NATIONALLICENCE 700 1- Ishihara Hironori Department of Anesthesia, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, 036-8216, Hirosaki, Japan aut NATIONALLICENCE 700 1- Hirota Kazuyoshi Department of Anesthesia, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, 036-8216, Hirosaki, Japan aut NATIONALLICENCE 773 0- Journal of Anesthesia Springer Japan 25/1(2011-02-01), 117-119 0913-8668 25:1<117 2011 25 540 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer