Postoperative surveillance in neurosurgical patients - usefulness of neurological assessment scores and bispectral index.

Background and objectives: We examined the additive effect of the Ramsay scale, Canadian
Neurological Scale (CNS), Nursing Delirium Screening Scale (Nu-DESC), and Bispectral Index
(BIS) to see whether along with the assessment of pupils and Glasgow Coma Scale (GCS) it
improved early detection of postoperative neurological complications.
Methods: We designed a prospective observational study of two elective neurosurgery groups of
patients: craniotomies (CG) and non-craniotomies (NCG). We analyze the concordance and the
odds ratio (OR) of altered neurological scales and BIS in the Post-Anesthesia Care Unit (PACU)
for postoperative neurological complications. We compared the isolated assessment of pupils
and GCS (pupils-GCS) with all the neurologic assessment scales and BIS (scales-BIS).
Results: In the CG (n = 70), 16 patients (22.9%) had neurological complications in PACU. The
scales-BIS registered more alterations than the pupils-GCS (31.4% vs. 20%; p < 0.001), were more
sensitive (94% vs. 50%) and allowed a more precise estimate for neurological complications
in PACU (p = 0.002; OR = 7.15, 95% CI = 2.1---24.7 vs. p = 0.002; OR = 9.5, 95% CI = 2.3---39.4). In
the NCG (n = 46), there were no neurological complications in PACU. The scales-BIS showed
alterations in 18 cases (39.1%) versus 1 (2.2%) with the pupils-GCS (p < 0.001). Altered CNS
on PACU admission increased the risk of neurological complications in the ward (p = 0.048;
OR = 7.28, 95% CI = 1.021---52.006).
Conclusions: Applied together, the assessment of pupils, GCS, Ramsay scale, CNS, Nu-DESC and
BIS improved early detection of postoperative neurological complications in PACU after elective
craniotomies