Review

. 2024 Oct 4;3(6):e0063.

doi: 10.1097/EA9.0000000000000063. eCollection 2024 Dec.

Brain health: A concern for anaesthesiologists and intensivists

Vincent Bonhomme¹, Christian Putensen¹, Bernd W Böttiger¹, Markus F Stevens¹, Nandor Marczin¹, Daniel Arnal¹, Evgeni Brotfain¹, Aeyal Raz¹, Aline Defresne¹, Elisa Bogossian¹, Sigal Sviri¹, Paolo Cardone¹, Alexander Mair¹, Chiara Robba¹, Ozlem Korkmaz Dilmen¹, Julien Ly¹, Maria I Crisan¹, Jurgen C De Graaff¹, Nadia Najafi¹, Laszlo Vutskits¹, Anthony Absalom¹, Igor Abramovich¹, Quentin Souberbielle¹, Mona Momeni¹, Douglas Campbell¹, Lisbeth Evered¹, Susana Vacas¹, Sarah Saxena¹, Nicolas Bruder¹, Dilara A Oksuz¹, Francisco A Lobo¹, Michel van Putten¹, Marko Sahinovic¹, Gregory W J Hawryluk¹, Antonia Kustura¹, Fatima Yürek¹, Dana Baron Shahaf¹, Goded Shahaf¹, Finn Radke¹, Celine Khalifa¹

Affiliations

Affiliation

¹ From the Department of Anesthesia and Intensive Care Medicine (VB), Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research, Liege University Hospital, Liege, Belgium (VB, AD), Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn (CP), University of Cologne, Medical Faculty, and Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany (BWB), Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (MFS), Division of Anaesthesia, Pain Medicine and Intensive Care, Imperial College London, Royal Brompton & Harefield Hospitals, Guy's & St. Thomas' NHS, London, United Kingdom (NM), Department of Anaesthesia and Intensive Care, Semmelweis University, Budapest, Hungary (NM), Anaesthesiology Department, Hospital Universitario Fundacion Alcorcon, Alcorcon, Spain (DA), General Intensive Care Unit, Division of Anesthesiology and Intensive Care, Soroka University Medical Center, Ben Gurion University of the Negev, Beer- Sheva, Israel (EB), Department of Anesthesiology, Rambam Healthcare Campus (AR), The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (AR), University Department of Anesthesia and Intensive Care Medicine, CHR Citadelle (AD), Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium (AD), Department of Intensive Care Medicine, Erasme Hospital - University Hospital of Brussels, Université Libre de Bruxelles, Brussels, Belgium (EB), Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel (SS), Coma Science Group, GIGA-Consciousness, Liege University, Belgium, and Centre du Cerveau, Liege University Hospital, Liege, Belgium (PC), Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland (AM), Dipartimento di Scienze Chirurgiche Diagnostiche e Integrate, University of Genoa (CR), IRCCS Policlinico San Martino, Genoa, Italy (CR), Department of Anaesthesiology and Intensive Care, Cerrahpasa Faculty of Medicine, Istanbul University- Cerrahpasa, Istanbul, Turkey (OKD), Department of Neurology, Liege University Hospital, Liege, Belgium (JL), Emergency Department, University Hospital Zurich, Zurich, Switzerland (MIC), Department of Anesthesia, Adrz-Erasmus MC, Goes, the Netherlands (JCDG), Department of Anesthesiology, Weill Cornell Medicine, New York, USA (JCDG, LE), Department of Anesthesiology and Perioperative Medicine, University Hospital of Brussels, Brussels, Belgium (NN), University Hospitals of Geneva, Geneva, Switzerland (LV), Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (AA, MS), Department of Anesthesiology and Intensive Care Medicine | CCM | CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany (IA, FY), Department of Anesthesiology, Cliniques universitaires Saint Luc (QS, MM), Institut de Recherche Expérimentale et Clinique (MM, CK), Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium (MM, CK), Department of Anaesthesiology, Auckland City Hospital, Auckland, New Zealand (DC), Department of Critical Care, School of Medicine, University of Melbourne (LE), Department of Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital Melbourne, Melbourne, Australia (LE), Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, USA (SV), Department of Anaesthesiology-Critical Care, AZ Sint-Jan, Bruges, Belgium (SS), Hospital La Conception and Aix-Marseille University, Marseille, France (NB), Tip Fakültesi, Cerrahi Tip Bilimleri, Anesteziyoloji ve Reanimasyon, Gazi University, Ankara, Turkey (DAO), Anesthesiology Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates (FAL), Department of Clinical Neurophysiology, University of Twente and Medisch Spectrum Twente, Enschede (MvP), Neurological Institute, Cleveland Clinic Akron General Hospital, Fairlawn, Ohio, USA (GWJH), Division of Anesthesiology, Intensive Care and Pain Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia (AK), Department of Anesthesia (DBS), The Applied Neurophysiology Lab, Rambam Healthcare Campus, Haifa, Israel (GS), Department of Anaesthesia and Intensive Care, Nykoebing Hospital, University of Southern Denmark, Denmark (FR) and Department of Anesthesiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium (CK).

PMID: 39917635
PMCID: PMC11798402
DOI: 10.1097/EA9.0000000000000063

Review

Brain health: A concern for anaesthesiologists and intensivists

Vincent Bonhomme et al. Eur J Anaesthesiol Intensive Care. 2024.

. 2024 Oct 4;3(6):e0063.

doi: 10.1097/EA9.0000000000000063. eCollection 2024 Dec.

Authors

Affiliation

¹ From the Department of Anesthesia and Intensive Care Medicine (VB), Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research, Liege University Hospital, Liege, Belgium (VB, AD), Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn (CP), University of Cologne, Medical Faculty, and Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany (BWB), Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (MFS), Division of Anaesthesia, Pain Medicine and Intensive Care, Imperial College London, Royal Brompton & Harefield Hospitals, Guy's & St. Thomas' NHS, London, United Kingdom (NM), Department of Anaesthesia and Intensive Care, Semmelweis University, Budapest, Hungary (NM), Anaesthesiology Department, Hospital Universitario Fundacion Alcorcon, Alcorcon, Spain (DA), General Intensive Care Unit, Division of Anesthesiology and Intensive Care, Soroka University Medical Center, Ben Gurion University of the Negev, Beer- Sheva, Israel (EB), Department of Anesthesiology, Rambam Healthcare Campus (AR), The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (AR), University Department of Anesthesia and Intensive Care Medicine, CHR Citadelle (AD), Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium (AD), Department of Intensive Care Medicine, Erasme Hospital - University Hospital of Brussels, Université Libre de Bruxelles, Brussels, Belgium (EB), Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel (SS), Coma Science Group, GIGA-Consciousness, Liege University, Belgium, and Centre du Cerveau, Liege University Hospital, Liege, Belgium (PC), Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland (AM), Dipartimento di Scienze Chirurgiche Diagnostiche e Integrate, University of Genoa (CR), IRCCS Policlinico San Martino, Genoa, Italy (CR), Department of Anaesthesiology and Intensive Care, Cerrahpasa Faculty of Medicine, Istanbul University- Cerrahpasa, Istanbul, Turkey (OKD), Department of Neurology, Liege University Hospital, Liege, Belgium (JL), Emergency Department, University Hospital Zurich, Zurich, Switzerland (MIC), Department of Anesthesia, Adrz-Erasmus MC, Goes, the Netherlands (JCDG), Department of Anesthesiology, Weill Cornell Medicine, New York, USA (JCDG, LE), Department of Anesthesiology and Perioperative Medicine, University Hospital of Brussels, Brussels, Belgium (NN), University Hospitals of Geneva, Geneva, Switzerland (LV), Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (AA, MS), Department of Anesthesiology and Intensive Care Medicine | CCM | CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany (IA, FY), Department of Anesthesiology, Cliniques universitaires Saint Luc (QS, MM), Institut de Recherche Expérimentale et Clinique (MM, CK), Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium (MM, CK), Department of Anaesthesiology, Auckland City Hospital, Auckland, New Zealand (DC), Department of Critical Care, School of Medicine, University of Melbourne (LE), Department of Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital Melbourne, Melbourne, Australia (LE), Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, USA (SV), Department of Anaesthesiology-Critical Care, AZ Sint-Jan, Bruges, Belgium (SS), Hospital La Conception and Aix-Marseille University, Marseille, France (NB), Tip Fakültesi, Cerrahi Tip Bilimleri, Anesteziyoloji ve Reanimasyon, Gazi University, Ankara, Turkey (DAO), Anesthesiology Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates (FAL), Department of Clinical Neurophysiology, University of Twente and Medisch Spectrum Twente, Enschede (MvP), Neurological Institute, Cleveland Clinic Akron General Hospital, Fairlawn, Ohio, USA (GWJH), Division of Anesthesiology, Intensive Care and Pain Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia (AK), Department of Anesthesia (DBS), The Applied Neurophysiology Lab, Rambam Healthcare Campus, Haifa, Israel (GS), Department of Anaesthesia and Intensive Care, Nykoebing Hospital, University of Southern Denmark, Denmark (FR) and Department of Anesthesiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium (CK).

PMID: 39917635
PMCID: PMC11798402
DOI: 10.1097/EA9.0000000000000063

Abstract

Damage to the brain can have disastrous and long-lasting consequences. The European Society of Anaesthesiology and Intensive Care (ESAIC) is aware of the importance of taking good care of the brain, both of patients and of anaesthesia and intensive care unit (ICU) caregivers, and has organised a complete learning track on brain health to bring this concern to the attention of practitioners. This learning track included an online Focus Meeting on Brain Health (November 25, 2023). We here provide readers with a digest of the information that was delivered during that meeting in an opinion paper driven by the authors' own reading of the literature. It is divided according to the meeting's sessions, including how to improve the health of an injured brain, how to keep a young or old brain healthy, how to keep a healthy adult brain unimpaired, how monitoring can impact brain health in the operating room and in the intensive care unit, and how to keep the anaesthesia and ICU caregivers' brain healthy. Each part is a brief and focused summary. The main delivered messages are that the management of injured brain patients involves an adequate choice of sedation, adequate brain monitoring, and focused attention to specific points depending on the underlying pathology; that several measures can be undertaken to protect the brain of the very young needing anaesthesia; that it is possible to detect older patients at risk of postoperative neurocognitive disorders, and that dedicated perioperative management by a multidisciplinary expert team may improve their outcomes; that apparently healthy adult brains may suffer during anaesthesia; that the electroencephalogram may track peri-operative brain dysfunction, and that female patients should be given special care in this respect; that multimodal brain monitoring helps to detect pathological processes and to maintain brain homeostasis; and that burnout in anaesthesiologists can be effectively fought using personal, organisational, managerial and legal approaches.

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Conflict of interest statement

Conflicts of interest: VB has had or continue to have financial relationships with Medtronic, Edwards Medical, Orion Pharma, Grünenthal and Elsevier. He is Deputy Editor-in-Chief of the Acta Anaesthesiologica Belgica. BWB is treasurer of the European Resuscitation Council (ERC), Founder of the ERC Research NET, Chairman of the German Resuscitation Council (GRC), Member of the Advanced Life Support (ALS) Task Force of the International Liaison Committee on Resuscitation (ILCOR), Former Member of the Executive Committee of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), Founder of the ‘Deutsche Stiftung Wiederbelebung’, Federal Medical Advisor of the German Red Cross (DRK), Member of the Advisory Board of the ‘Deutsche Herzstiftung’, Co-Editor of ‘Resuscitation’, Editor of the Journal ‘Notfall + Rettungsmedizin’, Co-Editor of the Brazilian Journal of Anesthesiology. He received fees for lectures from the following companies: Forum für medizinische Fortbildung (FomF), ZOLL Medical Deutschland GmbH, C.R. Bard GmbH and Becton Dickinson GmbH. CR received fees as speaker from Edwards and BT. JCDG is an Editor for European Journal of Anaesthesiology. FAL is advisor for Masimo, Editor-in-Chief of the Journal of Clinical Monitoring and Computing, and EuroSIVA Chairman. AR has been a consultant for Medtronic and Neuroindex and has given a webinar for MSD.

Figures

**Fig. 1**
How to improve the health of an injured brain.

**Fig. 2**
Considerations on keeping a very young brain healthy (neonates and infants).

**Fig. 3**
How to keep an old brain healthy.

**Fig. 4**
How to keep a healthy adult brain unimpaired.

**Fig. 5**
Does monitoring the brain in the operating room and in the intensive care help keeping it healthy?.

**Fig. 6**
How to keep the anaesthesia and intensive care unit caregivers’ brain healthy.

See this image and copyright information in PMC

References

1. Le Roux P, Menon DK, Citerio G, et al. . Consensus summary statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care: a statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive. Neurocrit Care 2014; 21: (Suppl 2): S1–26. - PMC - PubMed
1. Panchal AR, Bartos JA, Cabañas JG, et al. . Adult Basic and Advanced Life Support Writing Group Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2020; 142:S366–S468. - PubMed
1. Rajagopalan S, Sarwal A. Neuromonitoring in critically ill patients. Crit Care Med 2023; 51:525–542. - PubMed
1. Cattalani A, Grasso VM, Vitali M, et al. . Transcranial color-coded duplex sonography for evaluation of midline-shift after chronic-subdural hematoma evacuation (TEMASE): a prospective study. Clin Neurol Neurosurg 2017; 162:101–107. - PubMed
1. Brunser A, Hoppe A, Cárcamo DA, et al. . Validation of transcranial Doppler in the diagnosis of brain death. Revista medica de Chile 2010; 138:406–412. - PubMed

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Brain health: A concern for anaesthesiologists and intensivists

Affiliation

Brain health: A concern for anaesthesiologists and intensivists

Authors

Affiliation

Abstract

Conflict of interest statement

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Publication types

Grants and funding

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Full Text Sources