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Background  The major difficulty in postoperative care in patients after craniotomy is to distinguish the intracranial deficits from the residual effect of general anesthesia. In present study, we used cerebral state index (CSI) monitoring in patients after craniotomy with delayed recovery, and evaluated the prediction probability of CSI for long-term postoperative unconsciousness.    Methods  We enrolled 57 consecutive adult patients admitted to neurosurgical intensive care unit (NICU) after elective craniotomy with delayed recovery. CSI was continuously monitored for 6 hours after admission. Patient's level of consciousness was followed up for 24 hours. According to whether obeyed verbal command, patients were divided into awaken group and non-awaken group. CSI values were compared between the two groups. Prediction probability (P K ) was calculated to determine the probability of CSI in predicting unconsciousness 24 hours after operation.    Results  In awaken group (n = 51), CSI increased significantly after the 2nd NICU admitted hour ( P  < 0.05). At each time point, CSI values in awaken group were significantly higher than those in non-awaken group (n = 6) ( P  < 0.05). The values of P K  (SE) for CSI in the first 6 admitted hours ranged from 0.94 (0.06) to 0.99 (0.02).    Conclusions  In patients after craniotomy with delayed recovery, CSI monitoring in early postoperative hours had high prediction probability for long-term unconsciousness. CSI monitoring may be a reliable objective method to predict level of consciousness after elective craniotomy.

Use of cerebral state index to predict long-term unconsciousness in patients after elective craniotomy with delay recovery