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JYMS : Journal of Yeungnam Medical Science

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Recovery of the ascending reticular activating system and consciousness following comprehensive management in a patient with traumatic brain injury: a case report
Sung Ho Jang, Young Hyeon Kwon
J Yeungnam Med Sci. 2022;39(4):332-335.   Published online August 12, 2021
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We report on changes in the ascending reticular activating system (ARAS) concurrent with the recovery of impaired consciousness following rehabilitation and cranioplasty in a patient with traumatic brain injury (TBI), which were demonstrated on diffusion tensor tractography (DTT). A 34-year-old male patient was diagnosed with a traumatic intracerebral hemorrhage after falling from a height of approximately 7 m and underwent a right frontoparietotemporal decompressive craniectomy and hematoma removal. At 5 months after onset, when starting rehabilitation, the patient showed impaired consciousness, with a Glasgow Coma Scale (GCS) score of 4. Comprehensive rehabilitative therapy was provided until 14 months after onset, and his GCS score improved to 8. Cranioplasty was performed using auto-bone at 14 months after onset. One month after cranioplasty, his GCS score improved to 12. On the 15-month DTT, the deviated lower dorsal ARAS was restored on both sides, and the right side had become thicker. The right lower ventral ARAS was reconstructed, and increased neural connectivity of the upper ARAS was detected in both the prefrontal cortices. Thus, changes in the ARAS were demonstrated in a patient with TBI during recovery of consciousness following rehabilitation and cranioplasty.
Awareness during general anesthesia despite simultaneous bispectral index and end-tidal anesthetic gas concentration monitoring
Jungwon Lee, Chorong Park, Saeyoung Kim
Yeungnam Univ J Med. 2019;36(1):50-53.   Published online December 14, 2018
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  • 134 Download
  • 3 Crossref
AbstractAbstract PDF
Awareness during general anesthesia occurs in approximately 0.1–0.2% of cases; nevertheless, particular attention is required because it can lead to critical complications including insomnia, depression, anxiety, and post-traumatic stress disorder. To prevent these complications, bispectral index (BIS) and end-tidal anesthetic gas (ETAG) concentration monitoring are commonly used to examine patient consciousness during surgery. In the present case, an 80-year-old man was scheduled for total gastrectomy. Anesthesia was maintained using desflurane 4.0–5.0% vol, oxygen, and nitrous oxide. The authors simultaneously monitored BIS, which was maintained between 37 and 43, and ETAG, which was maintained between 0.9 and 1.2 minimum alveolar concentration (MAC). After the operation, however, the authors were surprised to learn that the patient complained of awareness during anesthesia. Although BIS and ETAG concentration monitoring are useful in preventing awareness during anesthesia, they cannot be completely trusted. Even though BIS was maintained at approximately 40 and ETAG at 0.7–1.3 MAC, awareness during anesthesia occurred.


Citations to this article as recorded by  
  • Depth of anaesthesia monitoring: updated evidence. Comment on Br J Anaesth 2023; 131: 196–9
    Paul S. Myles
    British Journal of Anaesthesia.2023; 131(5): e145.     CrossRef
  • Impact of bispectral index monitoring on critical incidents rate in high-risk patients: a randomised controlled trial
    N. V. Trembach
    Kuban Scientific Medical Bulletin.2022; 29(1): 48.     CrossRef
  • A Crossover Comparison of the Sensitivity and the Specificity between BIS and AEP in Predicting Unconsciousness in General Anesthesia
    Haitao Yang, Guan Wang, Jinxia Gao, Jie Liu, Liang Zhao
    Scientific Programming.2020; 2020: 1.     CrossRef

JYMS : Journal of Yeungnam Medical Science