Patient State Index versus Bispectral Index in cirrhotic patients and non-cirrhotics undergoing hepatic resection:
A controlled randomized study
Khaled Ahmed Yassen,1 Eman Mohammed Badawy,1 Maha Lotfy EL Sheikh,1 Safa Mohamed Helal,2 Ahmed AbdelRaouf Metwally.2Anaesthesia Departments of Liver Institute1 and Faculty of Medicine,2
Menoufia University, Shebeen Elkom City, Egypt
Introduction: Liver resection is a lengthy operation with greater risk of hemodynamic instability during surgery, to avoid intraoperative awareness; Patient State Index (PSI) and Bispectral Index (BIS) monitor anesthesia depth with different algorithms.
Purpose: Primary goal is to test PSI&BIS agreement in 2 different groups: 
Healthy volunteers undergoing right hepatotomy for living donor liver transplantation.  
liver cirrhotic patients undergoing major liver resection. Secondarily their sevoflurane (Sevo) consumption and tolerance to electrocautery interferences.
Methods: PSI (Masimo, USA) (Target depth: 25-50) or BIS (Aspect, USA) (Target depth: 40-60).  Both forehead sensors were applied simultaneously. Anaethesist when monitoring PSI was blinded to BIS and vice versa.
4 subgroups: Cirrhotic (PSI) (n=15), Cirrhotic (BIS) (n=15), Non-cirrhotic (PSI) (n=15) and Non-cirrhotic (BIS) (n=15). PSI, BIS values, end-tidal (ET) Sevo concentration (%) monitored perioperative. 
Results: 60 patients, the median age was 56 years old among cirrhotics and 30 years old among non-cirrhotic with similar operation times in all studied group.
Conclusion: The agreement between PSI and BIS during surgery is excellent with healthy or cirrhotic livers patients. Both were able to monitor trends of anaesthesia

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