Improving Postoperative Outcomes for DoC Patients: The Role of BIS-Monitored Depth Regulation

Improving Postoperative Outcomes for DoC Patients: The Role of BIS-Monitored Depth Regulation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Improving Postoperative Outcomes for DoC Patients: The Role of BIS-Monitored Depth Regulation Xuanling Chen, Xuewei Qin, Yutong Zhuang, Zhengqian Li, Zhenhu Liang, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4026071/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To assess whether maintaining an appropriate depth of anesthesia using the Bispectral Index (BIS) could enhance outcomes following spinal cord stimulation (SCS) device implantation in patients with chronic disorders of consciousness (DoC). Methods : A total of 103 patients with DoC who underwent SCS implantation were reviewed between January 2019 and December 2021, of whom 83 met the inclusion and exclusion criteria. Patients were categorized into the BIS group (n = 45) and the non-BIS group (n = 38) based on whether BIS monitoring was used during the operation. Relevant data, such as disease course, cause, anesthesia, and operation time, were collected. Preoperative Coma Recovery Scale —Revised (CRS-R (preoperative) ) score, postoperative CRS-R (24h), and postoperative CRS-R (3m) changes were recorded. Results: The CRS-R (3m) score was significantly higher in the BIS group than that in the non-BIS group (preoperative) , with a statistically significant difference ( p < 0.05). Furthermore, in the CRS-R (24h) , the BIS group demonstrated a higher score than the non-BIS group, with a statistically significant difference noted (X 2 = 8.787, p = 0.004). When assessing the improvement in consciousness in the multivariate logistic regression analysis model, it was revealed that the thalamus independently influenced the enhancement of consciousness ( p < 0.05). Throughout the follow-up, one patient in the BIS group experienced a decline in consciousness from a minimally consciousness state (MCS) - to-vegetative state, whereas two patients in the non-BIS group passed away during the follow-up. Conclusion: For patients with DoC undergoing SCS implantation under general anesthesia, employing BIS monitoring during surgery to regulate the depth of sedation under general anesthesia can reduce propofol dosage and influence the brain network. Patients can benefit from improved hearing, as observed in the CRS-R (24h) . We recommend using BIS to monitor the depth of anesthesia in patients with DoC to enhance overall patient outcomes. Biological sciences/Neuroscience Health sciences/Diseases Health sciences/Medical research Health sciences/Neurology Chronic disturbance of consciousness Vegetative state Spinal cord stimulation General anesthesia Bispectral Index Propofol Improved coma Recovery scale Figures Figure 1 Figure 2 Introduction With the rapid development of surgical technology, improvements in intensive care rescue capabilities, and the widespread adoption of cardiopulmonary resuscitation technology, the number of patients with craniocerebral injuries surviving after all-out treatment has increased significantly. DoC refers to the various states of loss of consciousness caused by severe brain injury, such as coma, vegetative state (VS), and minimally conscious state (MCS) [1-3] . VS refers to a state in which the basic reflexes of the brain stem and sleep-wake cycle are preserved [4] , with spontaneous eye-opening or stimulated eye-opening, but with unconscious content [3, 5] . In contrast, MCS may involve residual sensory and partial consciousness retention [6-8] , such as pain localization, visual object tracking [6] , and target gaze [9] , but it cannot complete compliance activities. The mutual change between the two states represents a change in consciousness level. Currently, the gold standard for the clinical evaluation of DoC is the Coma Recovery Scale-Revised (CRS-R) [10-12] , which includes six aspects: auditory, visual, motor, oromotor/verbal function, communication, and arousal level. It is currently recommended by the mainstream, particularly in identifying VS and MCS, owing to its reliability [13] . There is no unified standard treatment for DOC wakefulness therapy in clinical practice. Currently, therapeutic approaches such as hyperbaric oxygen therapy [14, 15] , music therapy [15-17] , stem cell therapy [18, 19] , and amantadine [20, 21] have shown limited effect [1, 22] . Common surgical treatments include deep brain simulation (DBS) [23] , spinal cord stimulation (SCS), cortical electrical stimulation [24] , and vagus nerve electrical stimulation [25, 26] . SCS is currently the recommended treatment method [27-29] . Studies have shown that SCS can directly stimulate the reticular structure and the thalamus [30, 31] or enhance cerebral blood flow in the injured area through the brainstem pathway, leading to improved levels of neurotransmitters and neuromodulators, thereby promoting central nervous system neuroplasticity [32] . Currently, the depth of sedation under general anesthesia is assessed using the BIS in clinical practice. Maintaining the BIS within the range of 40–60 during the perioperative period is considered optimal for anesthesia depth [33] . Too deep or too shallow anesthesia increases perioperative mortality and intraoperative awareness [34, 35] . Is BIS monitoring beneficial for patients with DoC undergoing SCS implantation under general anesthesia? Limited research exists on this topic. This study aimed to investigate the effects of perioperative BIS monitoring on the outcomes of resuscitation therapy in patients with DoC. Methods 1.1 General information We collected data from 103 patients with DoC admitted to the Department of Neurosurgery at Peking University International Hospital between January 2019 and December 2021. Patient information was collected from the inpatient and anesthesia information systems (We confirm that the research was performed in accordance with relevant regulations, we performed research in accordance with the Declaration of Helsinki. Exemption from informed consent by Peking University International Hospital's institutional review committee (Approval No. 2022-KY-0023-01); International registration code: ChiCTR2300069756). Inclusion criteria are: (1) Age 18–65 years old; (2) No central sedative drugs were used 24 h before anesthesia; No prior history of a brain tumor or family psychosis; and (3) tracheotomy. Exclusion criteria: (1) single/multiple organ failure; (2) severe coagulation dysfunction; (3) unstable circulatory system; and (4) loss to follow-up. A total of 83 patients were included in the study and categorized into the BIS group (n = 45) and the non-BIS group (n = 38) based on whether BIS was monitored in the perioperative period. Figure 1 and Table 1 display the general data for the two groups. 1.2 Methods and monitoring of anesthesia ECG, pulse oxygen saturation (SPO 2 ), invasive arterial blood pressure, end-tidal carbon dioxide (EtCO 2 ), body temperature, and intermittent blood gas analysis. The anesthesia machine was connected to the patient via a tracheostomy tube. Propofol (1 mg/kg), Sufentanil (0.4 µg/kg), and Rocuronium (0.8 mg/kg) were used for induction under general anesthesia. After induction, the ventilation mode was changed to mechanical ventilation; the respiratory rate was 10–12 times/min, the tidal volume was 8–10 mL/kg, and the EtCO 2 was maintained at 35–45 mmHg. Anesthetic maintenance: Propofol 2–3 mg/kg·h, Remifentanil 0.1–0.2 µg/kg·min. In the BIS group, anesthesia depth was kept within the range of 40–60, while in the non-BIS group, the anesthesiologist adjusted the depth based on their clinical experience. After the operation, the patient was administered 200 mg of sodium sulfate glucose for antagonism. When the patient recovered from spontaneous breathing and inhaled air for > 10 min, the SPO 2 > 90% was transferred to the rehabilitation department for further treatment. 1.3 Surgical methods and CRS-R scale evaluation The same senior neurosurgeon performed SCS implantation surgery. With the patient in the prone position, the T 6 –T 7 space was identified using radiography for the puncture point. The puncture needle was then inserted into the skin at an angle of approximately 30°. Once the needle tip reached the epidural space, the stimulation electrode was delivered to the level of the C 2 vertebral body under X-ray guidance. The electrical impedance of the electrode was assessed, and the electrode lead was secured upon meeting the requirements. Subsequently, the patients underwent postoperative care in our hospital’s rehabilitation department, including awakening treatment and regular follow-ups. The CRS-R scores for all patients were obtained by the same qualified neurosurgeon who performed the assessments. 1.4 Data collection and analysis Data were collected from the inpatient and anesthesia information systems of Peking University International Hospital, which include variables such as sex, age, height, weight, etiology, disease duration, anesthesia, and operation times. CRS-R (preoperative) , CRS-R (24h) , and CRS-R (3m) scores were recorded along with consciousness improvement indicators. The criteria for awareness improvement included: (1) the awareness of patients initially classified as VS improved to MCS − , MCS + , or EMCS; and (2) the awareness of patients initially classified as MCS − improved to MCS + or EMCS. Cases where the clinical diagnosis did not improve were classified as invalid (Table 2 ). Table2. CRS-R rating scale Auditory Visual Motor Oromotor/verbal function Communication Arousal Consistent movement to command 4 Object recognition 5 Functional Object use 6 Intelligible verbalization 3 Functional: Accurate 2 Attention 3 Reproducible movement to command 3 Object localization: Reaching 4 Automatic motor response 5 Vocalization/Oral movement 2 Non-functional: Intentioanl 1 Eye-opening w/o stimulation 2 Localization to sound 2 Pursuit eye movements 3 Object manipulation 4 Oral reflexive movement 1 None 0 Eye-opening with stimulation 1 Auditory startle 1 Fixation 2 Localization to noxious stimulation 3 None 0 None 0 None 0 Visual Startle 1 Flexion withdrawal 2 None 0 Abnormal posturing 1 None 0 VS MCS EMCS 1.5 Statistical processing Data analysis was conducted using SPSS 26.0 (IBM,CHI,USA). Measurement data following a normal distribution were presented as mean ± standard deviation and analyzed using a paired T-test. For dependent variables, we performed multivariate logistic regression analysis using Fisher's and Mann-Whitney U tests to compare differences between groups. Anesthesia duration (Propofol and Remifentanil); CRS-R scores at three-time points (CRS-R (preoperative) , CRS-R (24h) , and CRS-R (3m) ); and disease-related variables, such as cause, disease duration, and affected brain regions (temporal lobe, parietal lobe, frontal lobe, basal ganglia, thalamus, brainstem, occipital lobe, and pontine), were included as independent variables. Statistical significance was set at a p -value of 0.05, Table 1 ). Table 1 Comparison of general data Event BIS Group Non-BIS Group t /X 2 p- value Gender Male 33 (73.3%) 27 (71.1%) 0.053 0.817 female 12 (26.7%) 11 (28.9%) Age (years) 48.04 ± 13.61 50.16 ± 14.89 0.675 0.501 Height (cm) 170.33 ± 7.09 170.60 ± 6.56 0.180 0.858 Weight (kg) 63.50 ± 15.28 57.10 ± 12.19 −0.1035 0.314 Etiology TBI 21 (46.7%) 17 (44.7%) 0.031 0.860 CVA 24 (53.3%) 21 (55.3%) Duration of disease (month) 6 (3,12) 6 (4, 7) −0.648 0.517 Operation time (min) 149.40 ± 75.45 147.05 ± 57.93 −0.157 0.876 Duration of anesthesia (min) 206.69 ± 110.38 181.62 ± 114.79 −0.1005 0.318 *TBI: Traumatic brain injury; CVA: Cerebrovascular accident 2.2 Comparison of consciousness level and CRS-R score at different time points between groups No statistically significant difference was found in the composition ratio of consciousness levels presurgery, 24 h post-surgery, and 3 months post-surgery between the groups ( p > 0.05). However, the CRS-R (3m) scores of the BIS group surpassed those of the non-BIS group, with a statistically significant difference ( p < 0.05). The recorded consciousness levels 3 months post-surgery demonstrated substantial improvement compared to the preoperative period, and the difference was statistically significant ( p < 0.05). Additionally, the CRS-R (3m) score was significantly higher than the CRS-R (preoperative) score, with a statistically significant difference ( p 0.05, Table 3 ). Table 3 Comparison of preoperative diagnosis, outcome, and CRS-R scores between groups Parameters BIS ( n = 45) Non-BIS ( n = 38) p- value Preoperative diagnosis 0.223 VS 23 (51.1%) 26 (68.4%) MCS- 16 (35.6%) 10 (26.3%) MCS+ 6 (13.3%) 2 (5.3%) CRS-R (preoperative) 7.60 ± 2.59 7.55 ± 2.50 0.933 Postoperative diagnosis (24h) VS 23 (51.1%) 26 (68.4%) MCS − 16 (35.6%) 10 (26.3%) MCS + 6 (13.3%) 2 (5.3%) CRS-R (24h) 7.91 ± 4.07 7.55 ± 2.43 0.514 Postoperative diagnosis (3 months) VS 5 (11.1%) 3 (7.9%) 0.872 MCS − 11 (24.4%) 8 (21.1%) MCS + 11 (24.4%) 12 (31.6%) EMCS 18 (40.0%) 15 (39.5%) CRS-R (3m) 11.29 ± 4.15 * 9.13 ± 4.07 * 0.020 *Within groups, p 0.05). However, 24 h post-surgery, the auditory aspect of the CRS-R score of the BIS group surpassed that of the non-BIS group, with a statistically significant difference ( p 0.05). Three months post-surgery, no statistically significant difference was observed in CRS-R scores across the six aspects between the two groups ( p > 0.05). See Fig. 2 (A, B, C). 2.4 Logistic regression analysis of consciousness improvement and multiple factors during operation Events associated with anesthesia (duration of anesthesia, Propofol, and Remifentanil); CRS-R scores at three-time points (CRS-R (preoperative) , CRS-R (24h) , CRS-R (3m) ); and disease-related events, such as cause, disease duration, and affected brain regions (temporal lobe, parietal lobe, frontal lobe, basal ganglia, thalamus, brainstem, occipital lobe, and pontus), were considered independent variables. These were included in the multivariate logistic regression analysis model, with consciousness improvement as the dependent variable. Regression analysis revealed that the thalamus emerged as an independent influencing factor in consciousness improvement, while other independent variables did not pose a high risk for consciousness improvement ( p > 0.05, Table 4 ). Table 4 Multivariate logistic regression analysis of consciousness improvement B sig T OR [95% CI] Anesthesia-related events Duration of anesthesia 0.002 0.994 0.008 1 [1,1.01] Propofol 0.434 0.743 0.328 1.54 [0.12, 20.49] Remifentanil −13.386 0.993 −0.009 0 [0, Inf] CRS-R CRS-R (preoperative) 0.466 0.005 2.781 1.59 [1.15, 2.21] CRS-R (24h) −0.420 0.538 −0.617 0.66 [0.17,2.5] CRS-R (3m) −0.208 0.105 −1.622 0.81 [0.63,1.04] Events of the disease itself Cause −0.641 0.345 −0.943 0.53 [0.14, 2] Course −0.08 0.155 −1.422 0.92 [0.83, 1.03] Affected brain regions Temporal lobe −1.255 0.195 −1.295 0.29 [0.04, 1.9] Parietal lobe 1.935 0.070 1.812 6.92 [0.85, 56.07] Frontal lobe −0.399 0.662 −0.437 0.67 [0.11, 4.02] Basal ganglia −0.066 0.932 −0.086 0.94 [0.21, 4.23] Thalamus −2.855 0.039 −2.066 0.06 [0, 0.86] Brainstem −1.462 0.117 −1.568 0.23 [0.04, 1.44] Occipital lobe 2.1 0.073 2.925 445.78 [3.49, 26548.57] Pontus −2.555 0.173 −1.364 0.08 [0, 3.06] 2.5 Adverse outcomes In a cohort of 83 patients with dissociative disorder (Do), a three-month postoperative follow-up was conducted.One patient in the BIS group experienced a decline in consciousness from the originally diagnosed MCS − to VS. In contrast, two patients in the non-BIS group died: one during SCS stimulation and the other on postoperative day 81 due to pulmonary infection and systemic multiple organ failure. Discussion Current medical technology faces significant challenges in improving the consciousness of patients with DoC. However, studies have indicated that SCS holds promise for improving the consciousness of these patients [21, 22] . SCS is performed with the patient in the prone position and under braking, with general anesthesia serving as the only option. This study investigated whether general anesthesia drugs influence the recovery of consciousness in patients with DoC and whether monitoring anesthesia depth aids in the recovery of consciousness. By measuring the frequency and power of the electroencephalogram and processing the data digitally, a comprehensive monitoring index known as BIS (Bispetral Index) for anesthesia depth was obtained. BIS is a relatively objective indicator for evaluating sedation levels [29] . It evaluates cortical electrical inhibition or excitation [30] and guides anesthetic administration, thereby reducing the incidence of adverse reactions [31] . However, presently, BIS is primarily used for patients with unconscious disorders in clinical practice, with only a few relevant studies exploring its accuracy in monitoring sedation depth in patients with DoC. Xue et al. [32] found that BIS could assess cerebral ischemia and hypoxia in patients with craniocerebral injury, aiding prognosis. Some studies have suggested the potential usefulness of BIS monitoring in general anesthesia for DoC patients [29, 33] . Our study observed no significant difference in the CRS-R (24h) scores compared to preoperative scores, indicating a minimal short-term impact of anesthetic drugs on patients with DoC. The ability of BIS to accurately monitor anesthesia depth, effectively control the anesthetic state, prevent excessive sedation, and reduce its impact on brain function may help facilitate nerve remodeling and functional recovery in patients during rehabilitation. In our study, the BIS group demonstrated a significant increase in CRS-R scores at 3 months postoperatively compared to preoperative scores, aligning with the anticipated role of BIS monitoring. However, the appropriate BIS threshold for DoC patients under general anesthesia and its precise impact on consciousness improvement must be verified using larger samples and extended long-term follow-up studies. Hearing is the primary means of assessing cognitive abilities in patients with DoC, including UWS (unresponsive wakefulness syndrome), MCS (minimally consciousness state), or cognitive-motor dissociation [35] . Several studies have noted enhanced brain response, especially in the auditory system, following significant stimulation in patients with DoC, leading to significantly improved brain sensitivity [36–38] and function [12, 13, 39] . Boly et al. [40, 41] further demonstrated the high sensitivity of the auditory system to changes in consciousness levels. Additionally, Heine et al. [42] compared the activation of the auditory cortex with a patient's conscious state in a clinic, proposing that auditory cortex retention might be an indicator of consciousness retention. These studies indicate a correlation between hearing and consciousness. Propofol, a widely used general anesthetic drug, enhances the inhibitory effect of the neurotransmitter gamma-aminobutyrate (GABA), thereby suppressing the excitability of the central nervous system [34] . Given extreme sedation depth, propofol may excessively inhibit nervous system activity, including the brain’s ability to perceive and process external stimuli, such as those related to the auditory system. We found a higher hearing score on the CRS-R (24 h) rating scale in the BIS group than that in the non-BIS group. Thus, we posit that BIS monitoring can help reduce propofol dosage and its inhibition of the auditory system, offering potential benefits for short-term improvements in hearing and cognitive function among patients with DoC. The thalamus and its neural network are relay stations for delivering cortical nerve commands and transmitting sensory signals upward [43] . They are integral components of the ascending reticular activating systemin the midbrain, making the thalamic network crucial for maintaining arousal levels [44] . In this study, we found that reduced involvement of the thalamus in cranial injuries correlated with better awakening outcomes 3 months post-surgery. This finding indicates the pivotal role of the thalamus in the neural correlation theory of consciousness, both in terms of neuroanatomy and functional neural brain networks [45–47] . Dolce et al. [48] noted the prevalence of thalamic injury in patients with VS/UWS, with neuronal death in the thalamus being the primary pathological outcome [49] . The relative preservation of corticothalamic connections in patients with MCS may contribute significantly to residual consciousness [50] and cognitive function [19] . Even in severe multifocal brain injuries associated with permanent VS, evidence of large-scale neural electrical activity in the thalamic network system has been demonstrated, providing a physiological basis for arousal therapy in these patients [51] . Zhang et al. [52] proposed that the functional connectivity between the thalamus and the entire brain could serve as an imaging marker for evaluating the prognosis of patients with DoC and assessing the potential conscious function of the remaining brain network. Therefore, decreased involvement of the thalamus in craniocerebral injuries may lead to better outcomes following 3 months of awakening therapy. This was a retrospective study, and several confounding factors may have influenced the analysis results, including the study design limitations and variations in surgical treatments that may affect therapeutic outcomes. Additionally, while utilizing BIS monitoring offers many advantages, it also presents limitations, such as data extraction and processing delays. Furthermore, individual variations in BIS readings and their interpretation across different populations may not uniformly reflect the depth of anesthesia.Simultaneously, MRI brain network research in patients with DoC should be increased to identify additional influential factors affecting consciousness improvement. Moreover, enhancing the design of clinical trials and conducting prospective controlled studies with larger sample sizes and extended follow-up times are further warranted to strengthen the credibility of the research findings. In conclusion, perioperative BIS monitoring showed short-term benefits for hearing based on the CRS-R score. Additionally, we observed that a greater distance from the injury site to the thalamus correlated with better consciousness improvement. Declarations Author Contributions Clinical data were collected by XC and XQ. The data were analyzed and interpreted by HZ and XL. XC and XQ drafted the manuscript, while YL, ZL and XG provided critical revisions to ensure the accuracy of the knowledge content. Statistical analysis of the data was performed by XC and HZ. Supervision and validation the manuscript was performed by XG and JH. All authors have reviewed and approved the final manuscript. Funding Funding source: STI2030-Major Projects+2021ZD0204300 Declarations Ethics approval and consent to participate Exemption from informed consent by Peking University International Hospital's institutional review committee (Approval No. 2022-KY-0023-01). Registration International registration code: ChiCTR2300069756. Consent for publication Inapplicable. Competing interests In conducting this study, the authors declare that they have no competing commercial or financial interests . Availability of data and materials Data and materials used or analyzed in the current study are available from the corresponding author on reasonable request. References Eapen BC, Georgekutty J, Subbarao B, Bavishi S, Cifu DX. Disorders of Consciousness. Phys Med Rehabil Clin N Am. 2017,28(2):245–258.doi:10.1016/j.pmr.2016.12.003. Kondziella D, Bender A, Diserens K, et al. European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness. Eur J Neurol.2020,27(5):741–756. doi:10.1111/ene.14151 Monti MM, Laureys S, Owen AM. The vegetative state. BMJ.2010;341:c3765. doi:10.1136/bmj.c3765. Cavanna AE, Shah S, Eddy CM, Williams A, Rickards H. Consciousness: a neurological perspective. Behav Neurol. 2011,24(1):107–116. doi:10.3233/BEN-2011-0322 . Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state (2). N Engl J Med. 1994,330(22):1572–1579. doi:10.1056/NEJM199406023302206 Bruno MA, Vanhaudenhuyse A, Thibaut A, Moonen G, Laureys S. From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness. J Neurol. 2011,258(7):1373–1384. doi:10.1007/s00415-011-6114-x . Laureys S, Perrin F, Faymonville ME, et al. Cerebral processing in the minimally conscious state. Neurology. 2004,63(5):916–918. doi:10.1212/01.wnl.0000137421.30792.9b Laureys S, Owen AM, Schiff ND. Brain function in coma, vegetative state, and related disorders. Lancet Neurol. 2004,3(9):537–546. doi:10.1016/S1474-4422(04)00852-X Prakash J, Ganiger VC. Acute Kidney Injury in Pregnancy-specific Disorders. Indian J Nephrol. 2017,27(4):258–270. doi:10.4103/0971-4065.202406 Rosenbaum AM, Giacino JT. Clinical management of the minimally conscious state. Handb Clin Neurol. 2015,127:395–410. doi:10.1016/B978-0-444-52892-6.00025-8 . Bruno MA, Soddu A, Demertzi A, et al. Disorders of consciousness: Moving from passive to resting state and active paradigms. Cogn Neurosci. 2010,1(3):193–203. doi:10.1080/17588928.2010.485677. Giacino JT, Kalmar K, Whyte J. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil.2004,85(12):2020–2029. doi:10.1016/j.apmr.2004.02.033 Rüegg S, Sutter R. All in the numbers? Computational prediction of optimal anaesthetic weaning in status epilepticus. Brain. 2020,143(4):1048–1050. doi:10.1093/brain/awaa073 Xie K, Wang P. Clinical study on effect of HBO plus electric stimulation on treatment for the vegetative state. Acta Neurochir Suppl. 2003,87:19–21. doi:10.1007/978-3-7091-6081-7_5 O'Kelly J, James L, Palaniappan R, Taborin J, Fachner J, Magee WL. Neurophysiological and behavioral responses to music therapy in vegetative and minimally conscious States. Front Hum Neurosci. 2013,7:884. doi:10.3389/fnhum.2013.00884 Okumura Y, Asano Y, Takenaka S, et al. Brain activation by music in patients in a vegetative or minimally conscious state following diffuse brain injury. Brain Inj. 2014,28(7):944–950. doi:10.3109/02699052.2014.888477 Lancioni GE, Singh NN, O'Reilly MF, Sigafoos J, Desideri L. Music Stimulation for People with Disorders of Consciousness: A Scoping Review. Brain Sci. 2021,11(7):858. doi:10.3390/brainsci11070858 Hazell AS. The Vegetative State and Stem Cells: Therapeutic Considerations. Front Neurol. 2016,7:118. doi:10.3389/fneur.2016.00118 Liem NT, Chinh VD, Phuong DTM, et al. Outcomes of Bone Marrow-Derived Mononuclear Cell Transplantation for Patients in Persistent Vegetative State After Drowning: Report of Five Cases. Front Pediatr. 2020,8:564. doi:10.3389/fped.2020.00564 Gao Y, Zhang Y, Li Z, Ma L, Yang J. Persistent vegetative state after severe cerebral hemorrhage treated with amantadine: A retrospective controlled study. Medicine (Baltimore). 2020,99(33):e21822. doi:10.1097/MD.0000000000021822 Gao Y, Ma L, Liang F, et al. The use of amantadine in patients with unresponsive wakefulness syndrome after severe cerebral hemorrhage. Brain Inj. 2020,34(8):1084–1088. doi:10.1080/02699052.2020.1780315 Giacino JT, Fins JJ, Laureys S, Schiff ND. Disorders of consciousness after acquired brain injury: the state of the science. Nat Rev Neurol. 2014,10(2):99–114. doi:10.1038/nrneurol.2013.279 Mattogno PP, Barbagallo G, Iacopino G, et al. Recovery from Chronic Diseases of Consciousness: State of the Art in Neuromodulation for Persistent Vegetative State and Minimally Conscious State. Acta Neurochir Suppl. 2017,124:19–25. doi:10.1007/978-3-319-39546-3_4 Xie Y, Zhang T. Repetitive transcranial magnetic stimulation improves consciousness disturbance in stroke patients: A quantitative electroencephalography spectral power analysis. Neural Regen Res. 2012,7(31):2465–2472. doi:10.3969/j.issn.1673-5374.2012.31.008 Yifei W, Yi Y, Yu W, et al. Transcutaneous auricular vague nerve stimulation improved brain connection activity on patients of disorders of consciousness: a pilot study. J Tradit Chin Med. 2022,42(3):463–471. doi:10.19852/j.cnki.jtcm.2022.03.012 Morita I, Keith MW, Kanno T. Dorsal column stimulation for persistent vegetative state. Acta Neurochir Suppl. 2007,97(Pt 1):455–459. doi:10.1007/978-3-211-33079-1_59 Wang Y, Bai Y, Xia X, Yang Y, He J, Li X. Spinal cord stimulation modulates complexity of neural activities in patients with disorders of consciousness. Int J Neurosci. 2020,130(7):662–670. doi:10.1080/00207454.2019.1702543 . Yamamoto T, Katayama Y, Obuchi T, Kobayashi K, Oshima H, Fukaya C. Deep brain stimulation and spinal cord stimulation for vegetative state and minimally conscious state. World Neurosurg. 2013,80(3–4):S30.e1-S30.e9. doi:10.1016/j.wneu.2012.04.010 ZHUANG Yu⁃tong, CHEN Kai⁃tian, YANG Yi, et al.Application of neuroelectrophysiological monitoring technology in prolonged disorders of consciousness Chin J Contemp Neurol Neurosurg.2020,20(11):936–943. doi10.3969/j.issn.1672⁃6731.2020.11.002 Yamamoto T, Katayama Y, Obuchi T, Kobayashi K, Oshima H, Fukaya C. Spinal cord stimulation for treatment of patients in the minimally conscious state. Neurol Med Chir (Tokyo). 2012,52(7):475–481. doi:10.2176/nmc.52.475. Visocchi M, Tartaglione T, Romani R, Meglio M. Spinal cord stimulation prevents the effects of combined experimental ischemic and traumatic brain injury. An MR study. Stereotact Funct Neurosurg. 2001,76(3–4):276–281. doi:10.1159/000066731 Lammi MH, Smith VH, Tate RL, Taylor CM. The minimally conscious state and recovery potential: a follow-up study 2 to 5 years after traumatic brain injury. Arch Phys Med Rehabil. 2005,86(4):746–754. doi:10.1016/j.apmr.2004.11.004 Lim HK, Jung WS, Aizenstein HJ. Aberrant topographical organization in gray matter structural network in late life depression: a graph theoretical analysis. Int Psychogeriatr. 2013,25(12):1929–1940. doi:10.1017/S104161021300149X Mahmood S, El-Menyar A, Shabana A, et al. Bispectral index as a predictor of unsalvageable traumatic brain injury. Brain Inj. 2017,31(10):1382–1386. doi:10.1080/02699052.2017.1330966 LI Qian, MA Wei. Correlation between electroencephalogram monitoring of perioperative anesthesia depth and prognosis of patients.Journal of Southwest Medical University .2023,46(02):93–97. doi:10.3969/j.issn.2096-3351.2023.02.001 Schnakers C, Ledoux D, Majerus S, et al. Diagnostic and prognostic use of bispectral index in coma, vegetative state and related disorders. Brain Inj. 2008,22(12):926–931. doi:10.1080/02699050802530565 Avidan MS, Zhang L, Burnside BA, et al. Anesthesia awareness and the bispectral index. N Engl J Med. 2008,358(11):1097–1108. doi:10.1056/NEJMoa0707361. Wang D, Song Z, Zhang C, Chen P. Bispectral index monitoring of the clinical effects of propofol closed-loop target-controlled infusion: Systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2021,100(4):e23930. doi:10.1097/MD.0000000000023930 XUE Xin, LI Ruihao, REN Haijun.Application and progress of bispectral index monitoring technology in neurosugery. Chinese Journal of Neurosurgical Disease Research.2018,17(06):570–572. WANG Xiao-feng, WANG Qi, BAI Xi-min, et al.Research progress of bispectral index in evaluating severity and prognosis of brain injury. J Clin Neurosurg.2021,18(06):714–716 + 720. DOI: 10.3969 /j. issn.1672-7770.2021.06.025 Heine L, Corneyllie A, Gobert F, Luauté J, Lavandier M, Perrin F. Virtually spatialized sounds enhance auditory processing in healthy participants and patients with a disorder of consciousness. Sci Rep. 2021,11(1):13702. doi:10.1038/s41598-021-93151-6 Heine L, Tillmann B, Hauet M, et al. Effects of preference and sensory modality on behavioural reaction in patients with disorders of consciousness. Brain Inj. 2017,31(10):1307–1311. doi:10.1080/02699052.2017.1306108 Cheng L, Cortese D, Monti MM, et al. Do Sensory Stimulation Programs Have an Impact on Consciousness Recovery? Front Neurol. 2018,9:826. doi:10.3389/fneur.2018.00826 Magee WL. Music in the diagnosis, treatment and prognosis of people with prolonged disorders of consciousness. Neuropsychol Rehabil. 2018,28(8):1331–1339. doi:10.1080/09602011.2018.1494003 Carrière M, Larroque SK, Martial C, et al. An Echo of Consciousness: Brain Function During Preferred Music. Brain Connect. 2020,10(7):385–395. doi:10.1089/brain.2020.0744 Boly M, Faymonville ME, Peigneux P, et al. Auditory processing in severely brain injured patients: differences between the minimally conscious state and the persistent vegetative state. Arch Neurol. 2004,61(2):233–238. doi:10.1001/archneur.61.2.233. Boly M. Measuring the fading consciousness in the human brain. Curr Opin Neurol. 2011,24(4):394–400. doi:10.1097/WCO.0b013e328347da94. Heine L, Castro M, Martial C, Tillmann B, Laureys S, Perrin F. Exploration of Functional Connectivity During Preferred Music Stimulation in Patients with Disorders of Consciousness. Front Psychol. 2015,6:1704. doi:10.3389/fpsyg.2015.01704 Lundström S, Twycross R, Mihalyo M, Wilcock A. Propofol. J Pain Symptom Manage. 2010,40(3):466–470.doi:10.1016/j.jpainsymman.2010.07.001 Shine JM, Lewis LD, Garrett DD, Hwang K. The impact of the human thalamus on brain-wide information processing. Nat Rev Neurosci.2023,24(7):416–430. doi:10.1038/s41583-023-00701-0 Van der Werf YD, Witter MP, Groenewegen HJ. The intralaminar and midline nuclei of the thalamus. Anatomical and functional evidence for participation in processes of arousal and awareness. Brain Res Brain Res Rev. 2002,39(2–3):107–140. doi:10.1016/s0165-0173(02)00181-9 Edelman GM. Naturalizing consciousness: a theoretical framework. Proc Natl Acad Sci U S A. 2003;100(9):5520–5524. doi:10.1073/pnas.0931349100. Ward LM. The thalamic dynamic core theory of conscious experience. Conscious Cogn. 2011,20(2):464–486. doi:10.1016/j.concog.2011.01.007 Marino S, Bonanno L, Giorgio A.Functional connectivity in disorders of consciousness: methodological aspects and clinical relevance[J].Brain Imaging and Behavior.2015,10(2):604-8. Dolce G, Quintieri M, Leto E, Milano M, Pileggi A, Lagani V, et al.Dysautonomia and Clinical Outcome in Vegetative State[J].Journal of Neurotrauma.2021,38(10):1441-4. Fernández-Espejo D, Junque C, Bernabeu M, Roig-Rovira T, Vendrell P, Mercader JM. Reductions of thalamic volume and regional shape changes in the vegetative and the minimally conscious states. J Neurotrauma. 2010,27(7):1187–1193. doi:10.1089/neu.2010.1297 Fernández-Espejo D, Bekinschtein T, Monti MM, et al. Diffusion weighted imaging distinguishes the vegetative state from the minimally conscious state. Neuroimage . 2011,54(1):103–112. doi:10.1016/j.neuroimage.2010.08.035 Lin HC, Pan HC, Lin SH, et al. Central Thalamic Deep-Brain Stimulation Alters Striatal-Thalamic Connectivity in Cognitive Neural Behavior. Front Neural Circuits. 2016,9:87. doi:10.3389/fncir.2015.00087 Zhang J, Zhang H, Yan F, et al. Investigating the mechanism and prognosis of patients with disorders of consciousness on the basis of brain networks between the thalamus and whole-brain. Front Neurol. 2022,13:990686. doi:10.3389/fneur.2022.990686 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4026071","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":285766356,"identity":"f8c88a26-07da-4e64-8b4b-a4c35845e860","order_by":0,"name":"Xuanling Chen","email":"","orcid":"","institution":"Peking University International Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xuanling","middleName":"","lastName":"Chen","suffix":""},{"id":285766357,"identity":"71069e4c-2238-4b67-a040-c39e174be840","order_by":1,"name":"Xuewei Qin","email":"","orcid":"","institution":"Peking University International Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xuewei","middleName":"","lastName":"Qin","suffix":""},{"id":285766358,"identity":"746444e2-c6bc-465b-b244-23dfceaf96f3","order_by":2,"name":"Yutong Zhuang","email":"","orcid":"","institution":"Southern Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yutong","middleName":"","lastName":"Zhuang","suffix":""},{"id":285766359,"identity":"8bf1e3c0-2ad5-47fc-afcb-9f7971bef15a","order_by":3,"name":"Zhengqian Li","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zhengqian","middleName":"","lastName":"Li","suffix":""},{"id":285766360,"identity":"960cbcfd-d760-4d8b-a2ad-8926f8c42fed","order_by":4,"name":"Zhenhu Liang","email":"","orcid":"","institution":"Yanshan 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University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoli","middleName":"","lastName":"Li","suffix":""},{"id":285766364,"identity":"393146b6-9426-4af5-a642-9f94367689e2","order_by":8,"name":"Jianghong He","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYBACAwaGhANAOgHEOfCBQYI0LYwHZxCpBQxAWpgP8xDjMHP2hocHfu6ozeOXbr9w2OaPRR5/A/OzB/i0WPYcSDjYe+Z4seScMwWHc9skiiUOsJkb4NNicCMh4QBv27HEDTdyEg7nNkgkNhzgYcPrI4P7DxIO/oVpsfgjkTifoJYbDAmHedtqgFrSDxxmYJNI3EBQy5mEhMOybQcSZ87IYTjY2yaRuPEwmxl+LcfPJH9821aX2C+R/vjDjz91ifOONz8jEDs8CUDiMIgBDSdm/OqBgP0AkKgDMR4QVDsKRsEoGAUjEwAA6BRZChoZY7kAAAAASUVORK5CYII=","orcid":"","institution":"Capital Medical University","correspondingAuthor":true,"prefix":"","firstName":"Jianghong","middleName":"","lastName":"He","suffix":""},{"id":285766365,"identity":"6120fed6-c6ce-4025-a109-5e86aa85a2a6","order_by":9,"name":"Xiangyang Guo","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiangyang","middleName":"","lastName":"Guo","suffix":""}],"badges":[],"createdAt":"2024-03-07 14:34:00","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4026071/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4026071/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53958539,"identity":"92db974d-ee94-4b31-8022-fe74388b7265","added_by":"auto","created_at":"2024-04-02 17:46:13","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":81644,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4026071/v1/1395cf94f2c9e778cb5248de.png"},{"id":53958538,"identity":"8ef1509d-14ce-48a7-84ec-2587a07ac458","added_by":"auto","created_at":"2024-04-02 17:46:13","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":130278,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of auditory scores in CRS-R (\u003cstrong\u003eA\u003c/strong\u003e) before surgery, (\u003cstrong\u003eB\u003c/strong\u003e) 24 h post-surgery, and (\u003cstrong\u003eC\u003c/strong\u003e) 3 months post-surgery. As shown in (A), there was no statistically significant difference between the two groups in the preoperative auditory scores (X\u003csup\u003e2 \u003c/sup\u003e= 0.929, \u003cem\u003ep\u003c/em\u003e = 0.338). In (B), the auditory scores of the two groups 24 h post-surgery were compared. The auditory scores of the BIS group were higher than those of the non-BIS group, and the difference was statistically significant (X\u003csup\u003e2 \u003c/sup\u003e= 8.787,\u003cem\u003e p \u003c/em\u003e= 0.004). The comparison of hearing scores 3 months post-surgery between the two groups showed no statistical significance (X\u003csup\u003e2 \u003c/sup\u003e= 2.078,\u003cem\u003e p\u003c/em\u003e = 0.153).\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4026071/v1/a5918bb670401f5636089e91.jpeg"},{"id":57594218,"identity":"7cd39d29-bc21-4419-b9b2-0b322f89a486","added_by":"auto","created_at":"2024-06-03 06:24:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":902212,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4026071/v1/56374008-5489-4b98-ba1e-45b1a36b78ab.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Improving Postoperative Outcomes for DoC Patients: The Role of BIS-Monitored Depth Regulation","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWith the rapid development of surgical technology, improvements in intensive care rescue capabilities, and the widespread adoption of cardiopulmonary resuscitation technology, the number of\u0026nbsp;patients with craniocerebral injuries\u0026nbsp;surviving after all-out treatment has increased significantly. DoC refers to\u0026nbsp;the various states of loss of consciousness caused by severe brain injury, such as coma, vegetative state (VS), and minimally\u0026nbsp;conscious state (MCS) \u003csup\u003e[1-3]\u003c/sup\u003e. VS refers to a state in which the basic reflexes of the brain stem and sleep-wake cycle are preserved \u003csup\u003e[4]\u003c/sup\u003e, with spontaneous eye-opening or stimulated eye-opening, but with unconscious content \u003csup\u003e[3, 5]\u003c/sup\u003e. In contrast, MCS may involve residual sensory and partial consciousness retention \u003csup\u003e[6-8]\u003c/sup\u003e, such as pain localization, visual object tracking\u003csup\u003e\u0026nbsp;[6]\u003c/sup\u003e, and target gaze \u003csup\u003e[9]\u003c/sup\u003e, but\u0026nbsp;it cannot complete compliance activities. The mutual change between the two states represents a change in consciousness level. Currently, the gold standard for\u0026nbsp;the clinical evaluation of DoC is the Coma Recovery Scale-Revised (CRS-R) \u003csup\u003e[10-12]\u003c/sup\u003e, which includes six aspects: auditory, visual, motor, oromotor/verbal function, communication, and arousal level. It is currently recommended by the mainstream, particularly in identifying VS and MCS, owing to its reliability \u003csup\u003e[13]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThere is no unified standard treatment for DOC wakefulness therapy in clinical practice. Currently, therapeutic approaches\u0026nbsp;such as hyperbaric oxygen therapy \u003csup\u003e[14, 15]\u003c/sup\u003e, music therapy\u003csup\u003e\u0026nbsp;[15-17]\u003c/sup\u003e, stem cell therapy \u003csup\u003e[18, 19]\u003c/sup\u003e,\u0026nbsp;and amantadine \u003csup\u003e[20, 21]\u003c/sup\u003e have shown limited effect \u003csup\u003e[1, 22]\u003c/sup\u003e. Common surgical treatments include deep brain simulation (DBS)\u003csup\u003e[23]\u003c/sup\u003e, spinal cord stimulation (SCS), cortical electrical stimulation \u003csup\u003e[24]\u003c/sup\u003e, and vagus nerve electrical stimulation \u003csup\u003e[25, 26]\u003c/sup\u003e. SCS is currently the recommended treatment method \u003csup\u003e[27-29]\u003c/sup\u003e. Studies have shown that SCS can directly stimulate the reticular structure and the thalamus \u003csup\u003e[30, 31]\u003c/sup\u003e or enhance cerebral blood flow in the injured area through the brainstem pathway, leading to improved levels of neurotransmitters and neuromodulators, thereby promoting central nervous system neuroplasticity \u003csup\u003e[32]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eCurrently, the depth of sedation under general anesthesia is assessed using the BIS in clinical practice. Maintaining\u0026nbsp;the BIS within the range of 40\u0026ndash;60 during the perioperative period is considered optimal for anesthesia depth \u003csup\u003e[33]\u003c/sup\u003e. Too deep or too shallow anesthesia increases perioperative mortality and intraoperative awareness \u003csup\u003e[34, 35]\u003c/sup\u003e. Is BIS monitoring beneficial for patients\u0026nbsp;with DoC undergoing SCS implantation under general anesthesia? Limited research exists on this topic. This study aimed to investigate the effects of perioperative BIS monitoring\u0026nbsp;on the outcomes of resuscitation therapy in patients with DoC.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\"\u003e\n \u003ch2\u003e1.1 General information\u003c/h2\u003e\n \u003cp\u003eWe collected data from 103 patients with DoC admitted to the Department of Neurosurgery at Peking University International Hospital between January 2019 and December 2021. Patient information was collected from the inpatient and anesthesia information systems (We confirm that the research was performed in accordance with relevant regulations, we performed research in accordance with the Declaration of Helsinki. Exemption from informed consent by Peking University International Hospital\u0026apos;s institutional review committee (Approval No. 2022-KY-0023-01); International registration code: ChiCTR2300069756). Inclusion criteria are: (1) Age 18\u0026ndash;65 years old; (2) No central sedative drugs were used 24 h before anesthesia; No prior history of a brain tumor or family psychosis; and (3) tracheotomy. Exclusion criteria: (1) single/multiple organ failure; (2) severe coagulation dysfunction; (3) unstable circulatory system; and (4) loss to follow-up. A total of 83 patients were included in the study and categorized into the BIS group (n\u0026thinsp;=\u0026thinsp;45) and the non-BIS group (n\u0026thinsp;=\u0026thinsp;38) based on whether BIS was monitored in the perioperative period. Figure\u0026nbsp;\u003cspan\u003e1\u003c/span\u003e and Table\u0026nbsp;\u003cspan\u003e1\u003c/span\u003e display the general data for the two groups.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\"\u003e\n \u003ch2\u003e1.2 Methods and monitoring of anesthesia\u003c/h2\u003e\n \u003cp\u003eECG, pulse oxygen saturation (SPO\u003csub\u003e2\u003c/sub\u003e), invasive arterial blood pressure, end-tidal carbon dioxide (EtCO\u003csub\u003e2\u003c/sub\u003e), body temperature, and intermittent blood gas analysis. The anesthesia machine was connected to the patient via a tracheostomy tube. Propofol (1 mg/kg), Sufentanil (0.4 \u0026micro;g/kg), and Rocuronium (0.8 mg/kg) were used for induction under general anesthesia. After induction, the ventilation mode was changed to mechanical ventilation; the respiratory rate was 10\u0026ndash;12 times/min, the tidal volume was 8\u0026ndash;10 mL/kg, and the EtCO\u003csub\u003e2\u003c/sub\u003e was maintained at 35\u0026ndash;45 mmHg. Anesthetic maintenance: Propofol 2\u0026ndash;3 mg/kg\u0026middot;h, Remifentanil 0.1\u0026ndash;0.2 \u0026micro;g/kg\u0026middot;min.\u003c/p\u003e\n \u003cp\u003eIn the BIS group, anesthesia depth was kept within the range of 40\u0026ndash;60, while in the non-BIS group, the anesthesiologist adjusted the depth based on their clinical experience. After the operation, the patient was administered 200 mg of sodium sulfate glucose for antagonism. When the patient recovered from spontaneous breathing and inhaled air for \u0026gt;\u0026thinsp;10 min, the SPO\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;\u0026gt;\u0026thinsp;90% was transferred to the rehabilitation department for further treatment.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\"\u003e\n \u003ch2\u003e1.3 Surgical methods and CRS-R scale evaluation\u003c/h2\u003e\n \u003cp\u003eThe same senior neurosurgeon performed SCS implantation surgery. With the patient in the prone position, the T\u003csub\u003e6\u003c/sub\u003e\u0026ndash;T\u003csub\u003e7\u003c/sub\u003e space was identified using radiography for the puncture point. The puncture needle was then inserted into the skin at an angle of approximately 30\u0026deg;. Once the needle tip reached the epidural space, the stimulation electrode was delivered to the level of the C\u003csub\u003e2\u003c/sub\u003e vertebral body under X-ray guidance. The electrical impedance of the electrode was assessed, and the electrode lead was secured upon meeting the requirements. Subsequently, the patients underwent postoperative care in our hospital\u0026rsquo;s rehabilitation department, including awakening treatment and regular follow-ups. The CRS-R scores for all patients were obtained by the same qualified neurosurgeon who performed the assessments.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\"\u003e\n \u003ch2\u003e1.4 Data collection and analysis\u003c/h2\u003e\n \u003cp\u003eData were collected from the inpatient and anesthesia information systems of Peking University International Hospital, which include variables such as sex, age, height, weight, etiology, disease duration, anesthesia, and operation times. CRS-R\u003csub\u003e(preoperative)\u003c/sub\u003e, CRS-R\u003csub\u003e(24h)\u003c/sub\u003e, and CRS-R\u003csub\u003e(3m)\u003c/sub\u003e scores were recorded along with consciousness improvement indicators. The criteria for awareness improvement included: (1) the awareness of patients initially classified as VS improved to MCS\u003csup\u003e\u0026minus;\u003c/sup\u003e, MCS\u003csup\u003e+\u003c/sup\u003e, or EMCS; and (2) the awareness of patients initially classified as MCS\u003csup\u003e\u0026minus;\u003c/sup\u003e improved to MCS\u003csup\u003e+\u003c/sup\u003e or EMCS. Cases where the clinical diagnosis did not improve were classified as invalid (Table \u003cspan\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eTable2. CRS-R rating scale\u003c/p\u003e\n \u003ctable\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:13.26%;border:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;text-indent:21.0pt;font-size:14px;font-family:DengXian;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eAuditory\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.94%;border:solid windowtext 1.0pt;border-left: none;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:11.06%;border:solid windowtext 1.0pt;border-left: none;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eVisual\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.96%;border:solid windowtext 1.0pt;border-left: none;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:11.72%;border:solid windowtext 1.0pt;border-left: none;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eMotor\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.96%;border:solid windowtext 1.0pt;border-left: none;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:16.94%;border:solid windowtext 1.0pt;border-left: none;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eOromotor/verbal function\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.92%;border:solid windowtext 1.0pt;border-left: none;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:16.06%;border:solid windowtext 1.0pt;border-left: none;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eCommunication\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:3.46%;border:solid windowtext 1.0pt;border-left: none;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:12.02%;border:solid windowtext 1.0pt;border-left: none;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eArousal\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:3.64%;border:solid windowtext 1.0pt;border-left: none;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:justify;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:13.26%;border:solid windowtext 1.0pt;border-top: none;background:#B4C6E7;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;text-indent:21.0pt;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eConsistent movement to command\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.94%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#B4C6E7;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:11.06%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#B4C6E7;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eObject recognition\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.96%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#B4C6E7;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:11.72%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#6373BA;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eFunctional Object use\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.96%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#6373BA;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:16.94%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#B4C6E7;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eIntelligible verbalization\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.92%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#B4C6E7;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:16.06%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#6373BA;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eFunctional: Accurate\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:3.46%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#6373BA;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:12.02%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eAttention\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:3.64%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:justify;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:13.26%;border:solid windowtext 1.0pt;border-top: none;background:#B4C6E7;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eReproducible movement to command\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.94%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#B4C6E7;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:11.06%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#B4C6E7;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eObject localization: Reaching\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.96%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#B4C6E7;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:11.72%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#B4C6E7;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eAutomatic motor response\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.96%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#B4C6E7;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:16.94%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eVocalization/Oral movement\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.92%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:16.06%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#B4C6E7;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eNon-functional: Intentioanl\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:3.46%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#B4C6E7;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:12.02%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eEye-opening w/o stimulation\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:3.64%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:justify;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:13.26%;border:solid windowtext 1.0pt;border-top: none;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eLocalization to sound\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.94%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:white;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:11.06%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#B4C6E7;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003ePursuit eye movements\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.96%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#B4C6E7;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:11.72%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#B4C6E7;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eObject manipulation\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.96%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#B4C6E7;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:16.94%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eOral reflexive movement\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.92%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:16.06%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eNone\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:3.46%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:12.02%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eEye-opening with stimulation\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:3.64%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:justify;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times 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1.0pt;border-right:solid windowtext 1.0pt;background:#B4C6E7;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eFixation\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.96%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#B4C6E7;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:11.72%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#B4C6E7;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eLocalization to noxious stimulation\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.96%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#B4C6E7;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:16.94%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New 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windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:12.02%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eNone\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:3.64%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:justify;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times 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0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eVisual Startle\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.96%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:11.72%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eFlexion 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1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:16.06%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:3.46%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New 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style='font-family:\"Times New Roman\",serif;'\u003eNone\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.96%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:11.72%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eAbnormal posturing\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.96%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:16.94%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.92%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:16.06%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:3.46%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:12.02%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.64%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;height: 46.8pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0cm;text-align:justify;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:13.26%;border:solid windowtext 1.0pt;border-top: none;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.94%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:11.06%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.96%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:11.72%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eNone\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.96%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:16.94%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.92%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:16.06%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:3.46%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:12.02%;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;height:46.8pt;\"\u003e\n \u003cp style=\"margin:0cm;text-align:center;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.64%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0cm 5.4pt;height: 46.8pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0cm;text-align:justify;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003ctable\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35.95pt;border: 1pt solid windowtext;padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0cm;text-align:justify;text-indent:0cm;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eVS\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41pt;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;background: rgb(180, 198, 231);padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0cm;text-align:justify;text-indent:0cm;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eMCS\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44.7pt;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;background: rgb(99, 115, 186);padding: 0cm 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0cm;text-align:justify;text-indent:0cm;font-size:14px;font-family:DengXian;\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eEMCS\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\"\u003e\n \u003ch2\u003e1.5 Statistical processing\u003c/h2\u003e\n \u003cp\u003eData analysis was conducted using SPSS 26.0 (IBM,CHI,USA). Measurement data following a normal distribution were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and analyzed using a paired T-test. For dependent variables, we performed multivariate logistic regression analysis using Fisher\u0026apos;s and Mann-Whitney U tests to compare differences between groups. Anesthesia duration (Propofol and Remifentanil); CRS-R scores at three-time points (CRS-R\u003csub\u003e(preoperative)\u003c/sub\u003e, CRS-R\u003csub\u003e(24h)\u003c/sub\u003e, and CRS-R\u003csub\u003e(3m)\u003c/sub\u003e); and disease-related variables, such as cause, disease duration, and affected brain regions (temporal lobe, parietal lobe, frontal lobe, basal ganglia, thalamus, brainstem, occipital lobe, and pontine), were included as independent variables. Statistical significance was set at a \u003cem\u003ep\u003c/em\u003e-value of \u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003e2.1\u003c/b\u003e General Information\u003c/p\u003e \u003cp\u003eComparison of general data between the BIS and non-BIS groups showed no statistical significant differences (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of general data\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEvent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBIS Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-BIS Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et /X\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (73.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (71.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.817\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (28.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.04\u0026thinsp;\u0026plusmn;\u0026thinsp;13.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.16\u0026thinsp;\u0026plusmn;\u0026thinsp;14.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.675\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.501\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e170.33\u0026thinsp;\u0026plusmn;\u0026thinsp;7.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e170.60\u0026thinsp;\u0026plusmn;\u0026thinsp;6.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.858\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63.50\u0026thinsp;\u0026plusmn;\u0026thinsp;15.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.10\u0026thinsp;\u0026plusmn;\u0026thinsp;12.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.1035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.314\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEtiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTBI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (46.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (44.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.860\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (53.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (55.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of disease (month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (3,12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (4, 7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.648\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.517\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e149.40\u0026thinsp;\u0026plusmn;\u0026thinsp;75.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e147.05\u0026thinsp;\u0026plusmn;\u0026thinsp;57.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.876\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of anesthesia (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e206.69\u0026thinsp;\u0026plusmn;\u0026thinsp;110.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e181.62\u0026thinsp;\u0026plusmn;\u0026thinsp;114.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.1005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.318\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*TBI: Traumatic brain injury; CVA: Cerebrovascular accident\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e2.2\u003c/b\u003e Comparison of consciousness level and CRS-R score at different time points between groups\u003c/p\u003e \u003cp\u003eNo statistically significant difference was found in the composition ratio of consciousness levels presurgery, 24 h post-surgery, and 3 months post-surgery between the groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, the CRS-R\u003csub\u003e(3m)\u003c/sub\u003e scores of the BIS group surpassed those of the non-BIS group, with a statistically significant difference (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The recorded consciousness levels 3 months post-surgery demonstrated substantial improvement compared to the preoperative period, and the difference was statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, the CRS-R\u003csub\u003e(3m)\u003c/sub\u003e score was significantly higher than the CRS-R\u003csub\u003e(preoperative)\u003c/sub\u003e score, with a statistically significant difference (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Conversely, there was no significant difference between the CRS-R\u003csub\u003e(24h)\u003c/sub\u003e and CRS-R\u003csub\u003e(preoperative)\u003c/sub\u003e scores (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of preoperative diagnosis, outcome, and CRS-R scores between groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBIS\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-BIS\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative diagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.223\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23 (51.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26 (68.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMCS-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (35.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (26.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMCS+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRS-R\u003csub\u003e(preoperative)\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.55\u0026thinsp;\u0026plusmn;\u0026thinsp;2.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.933\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative diagnosis\u003csub\u003e(24h)\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23 (51.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26 (68.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMCS\u003csup\u003e\u0026minus;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (35.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (26.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMCS\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRS-R\u003csub\u003e(24h)\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.91\u0026thinsp;\u0026plusmn;\u0026thinsp;4.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.55\u0026thinsp;\u0026plusmn;\u0026thinsp;2.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.514\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative diagnosis (3 months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.872\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMCS\u003csup\u003e\u0026minus;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (24.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (21.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMCS\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (24.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (31.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEMCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (39.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRS-R\u003csub\u003e(3m)\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.29\u0026thinsp;\u0026plusmn;\u0026thinsp;4.15\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.13\u0026thinsp;\u0026plusmn;\u0026thinsp;4.07\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*Within groups, \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e2.3.\u003c/b\u003e Comparison of six aspects of the CRS-R score between groups\u003c/p\u003e \u003cp\u003eBefore surgery, no statistical significance was observed in CRS-R scores across six aspects between the two groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, 24 h post-surgery, the auditory aspect of the CRS-R score of the BIS group surpassed that of the non-BIS group, with a statistically significant difference (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The other aspects showed no statistically significant difference (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Three months post-surgery, no statistically significant difference was observed in CRS-R scores across the six aspects between the two groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). See Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e (A, B, C).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Logistic regression analysis of consciousness improvement and multiple factors during operation\u003c/h2\u003e \u003cp\u003eEvents associated with anesthesia (duration of anesthesia, Propofol, and Remifentanil); CRS-R scores at three-time points (CRS-R\u003csub\u003e(preoperative)\u003c/sub\u003e, CRS-R\u003csub\u003e(24h)\u003c/sub\u003e, CRS-R\u003csub\u003e(3m)\u003c/sub\u003e); and disease-related events, such as cause, disease duration, and affected brain regions (temporal lobe, parietal lobe, frontal lobe, basal ganglia, thalamus, brainstem, occipital lobe, and pontus), were considered independent variables. These were included in the multivariate logistic regression analysis model, with consciousness improvement as the dependent variable. Regression analysis revealed that the thalamus emerged as an independent influencing factor in consciousness improvement, while other independent variables did not pose a high risk for consciousness improvement (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate logistic regression analysis of consciousness improvement\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003esig\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eOR [95% CI]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnesthesia-related events\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDuration of anesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.994\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1 [1,1.01]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePropofol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.434\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.743\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.328\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.54 [0.12, 20.49]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eRemifentanil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;13.386\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.993\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026minus;0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0 [0, Inf]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRS-R\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCRS-R\u003csub\u003e(preoperative)\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e2.781\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.59 [1.15, 2.21]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCRS-R\u003csub\u003e(24h)\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.420\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.538\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026minus;0.617\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.66 [0.17,2.5]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCRS-R\u003csub\u003e(3m)\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026minus;1.622\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.81 [0.63,1.04]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEvents of the disease itself\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCause\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.641\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026minus;0.943\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.53 [0.14, 2]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCourse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026minus;1.422\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.92 [0.83, 1.03]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAffected brain regions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTemporal lobe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;1.255\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026minus;1.295\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.29 [0.04, 1.9]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eParietal lobe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.935\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.812\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6.92 [0.85, 56.07]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFrontal lobe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.399\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.662\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026minus;0.437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.67 [0.11, 4.02]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBasal ganglia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.932\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026minus;0.086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.94 [0.21, 4.23]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eThalamus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;2.855\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026minus;2.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.06 [0, 0.86]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBrainstem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;1.462\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026minus;1.568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.23 [0.04, 1.44]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eOccipital lobe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e2.925\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e445.78 [3.49, 26548.57]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePontus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;2.555\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026minus;1.364\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.08 [0, 3.06]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Adverse outcomes\u003c/h2\u003e \u003cp\u003eIn a cohort of 83 patients with dissociative disorder (Do), a three-month postoperative follow-up was conducted.One patient in the BIS group experienced a decline in consciousness from the originally diagnosed MCS\u003csup\u003e\u0026minus;\u003c/sup\u003e to VS. In contrast, two patients in the non-BIS group died: one during SCS stimulation and the other on postoperative day 81 due to pulmonary infection and systemic multiple organ failure.\u003c/p\u003e \u003c/div\u003e "},{"header":"Discussion","content":" \u003cp\u003eCurrent medical technology faces significant challenges in improving the consciousness of patients with DoC. However, studies have indicated that SCS holds promise for improving the consciousness of these patients \u003csup\u003e[21, 22]\u003c/sup\u003e. SCS is performed with the patient in the prone position and under braking, with general anesthesia serving as the only option. This study investigated whether general anesthesia drugs influence the recovery of consciousness in patients with DoC and whether monitoring anesthesia depth aids in the recovery of consciousness.\u003c/p\u003e \u003cp\u003eBy measuring the frequency and power of the electroencephalogram and processing the data digitally, a comprehensive monitoring index known as BIS (Bispetral Index) for anesthesia depth was obtained. BIS is a relatively objective indicator for evaluating sedation levels \u003csup\u003e[29]\u003c/sup\u003e. It evaluates cortical electrical inhibition or excitation \u003csup\u003e[30]\u003c/sup\u003e and guides anesthetic administration, thereby reducing the incidence of adverse reactions \u003csup\u003e[31]\u003c/sup\u003e. However, presently, BIS is primarily used for patients with unconscious disorders in clinical practice, with only a few relevant studies exploring its accuracy in monitoring sedation depth in patients with DoC. Xue et al. \u003csup\u003e[32]\u003c/sup\u003e found that BIS could assess cerebral ischemia and hypoxia in patients with craniocerebral injury, aiding prognosis. Some studies have suggested the potential usefulness of BIS monitoring in general anesthesia for DoC patients \u003csup\u003e[29, 33]\u003c/sup\u003e. Our study observed no significant difference in the CRS-R\u003csub\u003e(24h)\u003c/sub\u003e scores compared to preoperative scores, indicating a minimal short-term impact of anesthetic drugs on patients with DoC. The ability of BIS to accurately monitor anesthesia depth, effectively control the anesthetic state, prevent excessive sedation, and reduce its impact on brain function may help facilitate nerve remodeling and functional recovery in patients during rehabilitation. In our study, the BIS group demonstrated a significant increase in CRS-R scores at 3 months postoperatively compared to preoperative scores, aligning with the anticipated role of BIS monitoring. However, the appropriate BIS threshold for DoC patients under general anesthesia and its precise impact on consciousness improvement must be verified using larger samples and extended long-term follow-up studies.\u003c/p\u003e \u003cp\u003eHearing is the primary means of assessing cognitive abilities in patients with DoC, including UWS (unresponsive wakefulness syndrome), MCS (minimally consciousness state), or cognitive-motor dissociation \u003csup\u003e[35]\u003c/sup\u003e. Several studies have noted enhanced brain response, especially in the auditory system, following significant stimulation in patients with DoC, leading to significantly improved brain sensitivity \u003csup\u003e[36\u0026ndash;38]\u003c/sup\u003e and function \u003csup\u003e[12, 13, 39]\u003c/sup\u003e. Boly et al. \u003csup\u003e[40, 41]\u003c/sup\u003e further demonstrated the high sensitivity of the auditory system to changes in consciousness levels. Additionally, Heine et al. \u003csup\u003e[42]\u003c/sup\u003e compared the activation of the auditory cortex with a patient's conscious state in a clinic, proposing that auditory cortex retention might be an indicator of consciousness retention. These studies indicate a correlation between hearing and consciousness. Propofol, a widely used general anesthetic drug, enhances the inhibitory effect of the neurotransmitter gamma-aminobutyrate (GABA), thereby suppressing the excitability of the central nervous system \u003csup\u003e[34]\u003c/sup\u003e. Given extreme sedation depth, propofol may excessively inhibit nervous system activity, including the brain\u0026rsquo;s ability to perceive and process external stimuli, such as those related to the auditory system. We found a higher hearing score on the CRS-R\u003csub\u003e(24 h)\u003c/sub\u003e rating scale in the BIS group than that in the non-BIS group. Thus, we posit that BIS monitoring can help reduce propofol dosage and its inhibition of the auditory system, offering potential benefits for short-term improvements in hearing and cognitive function among patients with DoC.\u003c/p\u003e \u003cp\u003eThe thalamus and its neural network are relay stations for delivering cortical nerve commands and transmitting sensory signals upward \u003csup\u003e[43]\u003c/sup\u003e. They are integral components of the ascending reticular activating systemin the midbrain, making the thalamic network crucial for maintaining arousal levels \u003csup\u003e[44]\u003c/sup\u003e. In this study, we found that reduced involvement of the thalamus in cranial injuries correlated with better awakening outcomes 3 months post-surgery. This finding indicates the pivotal role of the thalamus in the neural correlation theory of consciousness, both in terms of neuroanatomy and functional neural brain networks \u003csup\u003e[45\u0026ndash;47]\u003c/sup\u003e. Dolce et al. \u003csup\u003e[48]\u003c/sup\u003e noted the prevalence of thalamic injury in patients with VS/UWS, with neuronal death in the thalamus being the primary pathological outcome \u003csup\u003e[49]\u003c/sup\u003e. The relative preservation of corticothalamic connections in patients with MCS may contribute significantly to residual consciousness \u003csup\u003e[50]\u003c/sup\u003e and cognitive function \u003csup\u003e[19]\u003c/sup\u003e. Even in severe multifocal brain injuries associated with permanent VS, evidence of large-scale neural electrical activity in the thalamic network system has been demonstrated, providing a physiological basis for arousal therapy in these patients \u003csup\u003e[51]\u003c/sup\u003e. Zhang et al. \u003csup\u003e[52]\u003c/sup\u003e proposed that the functional connectivity between the thalamus and the entire brain could serve as an imaging marker for evaluating the prognosis of patients with DoC and assessing the potential conscious function of the remaining brain network. Therefore, decreased involvement of the thalamus in craniocerebral injuries may lead to better outcomes following 3 months of awakening therapy.\u003c/p\u003e \u003cp\u003eThis was a retrospective study, and several confounding factors may have influenced the analysis results, including the study design limitations and variations in surgical treatments that may affect therapeutic outcomes. Additionally, while utilizing BIS monitoring offers many advantages, it also presents limitations, such as data extraction and processing delays. Furthermore, individual variations in BIS readings and their interpretation across different populations may not uniformly reflect the depth of anesthesia.Simultaneously, MRI brain network research in patients with DoC should be increased to identify additional influential factors affecting consciousness improvement. Moreover, enhancing the design of clinical trials and conducting prospective controlled studies with larger sample sizes and extended follow-up times are further warranted to strengthen the credibility of the research findings.\u003c/p\u003e \u003cp\u003eIn conclusion, perioperative BIS monitoring showed short-term benefits for hearing based on the CRS-R score. Additionally, we observed that a greater distance from the injury site to the thalamus correlated with better consciousness improvement.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinical data were collected by XC and XQ. The data were analyzed and interpreted by HZ and XL. XC and XQ drafted the manuscript, while YL, ZL and XG provided critical revisions to ensure the accuracy of the knowledge content. Statistical analysis of the data was performed by XC and HZ. Supervision and validation the manuscript was performed by XG and JH. All\u0026nbsp;authors have reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding source: STI2030-Major Projects+2021ZD0204300\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExemption from informed consent by Peking University International Hospital\u0026apos;s institutional review committee (Approval No. 2022-KY-0023-01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRegistration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInternational registration code: ChiCTR2300069756.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInapplicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn conducting this study, the authors declare that they have no competing commercial or financial interests .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData and materials used or analyzed in the current study are available from the corresponding author on \u0026nbsp;reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEapen BC, Georgekutty J, Subbarao B, Bavishi S, Cifu DX. Disorders of Consciousness. Phys Med Rehabil Clin N Am. 2017,28(2):245\u0026ndash;258.doi:10.1016/j.pmr.2016.12.003.\u003c/li\u003e\n\u003cli\u003eKondziella D, Bender A, Diserens K, et al. European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness. Eur J Neurol.2020,27(5):741\u0026ndash;756. doi:10.1111/ene.14151\u003c/li\u003e\n\u003cli\u003eMonti MM, Laureys S, Owen AM. The vegetative state. BMJ.2010;341:c3765. doi:10.1136/bmj.c3765.\u003c/li\u003e\n\u003cli\u003eCavanna AE, Shah S, Eddy CM, Williams A, Rickards H. Consciousness: a neurological perspective. Behav Neurol. 2011,24(1):107\u0026ndash;116. doi:10.3233/BEN-2011-0322 .\u003c/li\u003e\n\u003cli\u003eMulti-Society Task Force on PVS. Medical aspects of the persistent vegetative state (2). N Engl J Med. 1994,330(22):1572\u0026ndash;1579. doi:10.1056/NEJM199406023302206\u003c/li\u003e\n\u003cli\u003eBruno MA, Vanhaudenhuyse A, Thibaut A, Moonen G, Laureys S. From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness. J Neurol. 2011,258(7):1373\u0026ndash;1384. doi:10.1007/s00415-011-6114-x .\u003c/li\u003e\n\u003cli\u003eLaureys S, Perrin F, Faymonville ME, et al. Cerebral processing in the minimally conscious state. Neurology. 2004,63(5):916\u0026ndash;918. doi:10.1212/01.wnl.0000137421.30792.9b\u003c/li\u003e\n\u003cli\u003eLaureys S, Owen AM, Schiff ND. Brain function in coma, vegetative state, and related disorders. Lancet Neurol. 2004,3(9):537\u0026ndash;546. doi:10.1016/S1474-4422(04)00852-X\u003c/li\u003e\n\u003cli\u003ePrakash J, Ganiger VC. Acute Kidney Injury in Pregnancy-specific Disorders. Indian J Nephrol. 2017,27(4):258\u0026ndash;270. doi:10.4103/0971-4065.202406\u003c/li\u003e\n\u003cli\u003eRosenbaum AM, Giacino JT. Clinical management of the minimally conscious state. Handb Clin Neurol. 2015,127:395\u0026ndash;410. doi:10.1016/B978-0-444-52892-6.00025-8 .\u003c/li\u003e\n\u003cli\u003eBruno MA, Soddu A, Demertzi A, et al. Disorders of consciousness: Moving from passive to resting state and active paradigms. Cogn Neurosci. 2010,1(3):193\u0026ndash;203. doi:10.1080/17588928.2010.485677.\u003c/li\u003e\n\u003cli\u003eGiacino JT, Kalmar K, Whyte J. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil.2004,85(12):2020\u0026ndash;2029. doi:10.1016/j.apmr.2004.02.033\u003c/li\u003e\n\u003cli\u003eR\u0026uuml;egg S, Sutter R. All in the numbers? Computational prediction of optimal anaesthetic weaning in status epilepticus. Brain. 2020,143(4):1048\u0026ndash;1050. doi:10.1093/brain/awaa073\u003c/li\u003e\n\u003cli\u003eXie K, Wang P. Clinical study on effect of HBO plus electric stimulation on treatment for the vegetative state. Acta Neurochir Suppl. 2003,87:19\u0026ndash;21. doi:10.1007/978-3-7091-6081-7_5\u003c/li\u003e\n\u003cli\u003eO'Kelly J, James L, Palaniappan R, Taborin J, Fachner J, Magee WL. Neurophysiological and behavioral responses to music therapy in vegetative and minimally conscious States. Front Hum Neurosci. 2013,7:884. doi:10.3389/fnhum.2013.00884\u003c/li\u003e\n\u003cli\u003eOkumura Y, Asano Y, Takenaka S, et al. Brain activation by music in patients in a vegetative or minimally conscious state following diffuse brain injury. Brain Inj. 2014,28(7):944\u0026ndash;950. doi:10.3109/02699052.2014.888477\u003c/li\u003e\n\u003cli\u003eLancioni GE, Singh NN, O'Reilly MF, Sigafoos J, Desideri L. Music Stimulation for People with Disorders of Consciousness: A Scoping Review. Brain Sci. 2021,11(7):858. doi:10.3390/brainsci11070858\u003c/li\u003e\n\u003cli\u003eHazell AS. The Vegetative State and Stem Cells: Therapeutic Considerations. Front Neurol. 2016,7:118. doi:10.3389/fneur.2016.00118\u003c/li\u003e\n\u003cli\u003eLiem NT, Chinh VD, Phuong DTM, et al. Outcomes of Bone Marrow-Derived Mononuclear Cell Transplantation for Patients in Persistent Vegetative State After Drowning: Report of Five Cases. Front Pediatr. 2020,8:564. doi:10.3389/fped.2020.00564\u003c/li\u003e\n\u003cli\u003eGao Y, Zhang Y, Li Z, Ma L, Yang J. Persistent vegetative state after severe cerebral hemorrhage treated with amantadine: A retrospective controlled study. Medicine (Baltimore). 2020,99(33):e21822. doi:10.1097/MD.0000000000021822\u003c/li\u003e\n\u003cli\u003eGao Y, Ma L, Liang F, et al. The use of amantadine in patients with unresponsive wakefulness syndrome after severe cerebral hemorrhage. Brain Inj. 2020,34(8):1084\u0026ndash;1088. doi:10.1080/02699052.2020.1780315\u003c/li\u003e\n\u003cli\u003eGiacino JT, Fins JJ, Laureys S, Schiff ND. Disorders of consciousness after acquired brain injury: the state of the science. Nat Rev Neurol. 2014,10(2):99\u0026ndash;114. doi:10.1038/nrneurol.2013.279\u003c/li\u003e\n\u003cli\u003eMattogno PP, Barbagallo G, Iacopino G, et al. Recovery from Chronic Diseases of Consciousness: State of the Art in Neuromodulation for Persistent Vegetative State and Minimally Conscious State. Acta Neurochir Suppl. 2017,124:19\u0026ndash;25. doi:10.1007/978-3-319-39546-3_4\u003c/li\u003e\n\u003cli\u003eXie Y, Zhang T. Repetitive transcranial magnetic stimulation improves consciousness disturbance in stroke patients: A quantitative electroencephalography spectral power analysis. Neural Regen Res. 2012,7(31):2465\u0026ndash;2472. doi:10.3969/j.issn.1673-5374.2012.31.008\u003c/li\u003e\n\u003cli\u003eYifei W, Yi Y, Yu W, et al. Transcutaneous auricular vague nerve stimulation improved brain connection activity on patients of disorders of consciousness: a pilot study. J Tradit Chin Med. 2022,42(3):463\u0026ndash;471. doi:10.19852/j.cnki.jtcm.2022.03.012\u003c/li\u003e\n\u003cli\u003eMorita I, Keith MW, Kanno T. Dorsal column stimulation for persistent vegetative state. Acta Neurochir Suppl. 2007,97(Pt 1):455\u0026ndash;459. doi:10.1007/978-3-211-33079-1_59\u003c/li\u003e\n\u003cli\u003eWang Y, Bai Y, Xia X, Yang Y, He J, Li X. Spinal cord stimulation modulates complexity of neural activities in patients with disorders of consciousness. Int J Neurosci. 2020,130(7):662\u0026ndash;670. doi:10.1080/00207454.2019.1702543 .\u003c/li\u003e\n\u003cli\u003eYamamoto T, Katayama Y, Obuchi T, Kobayashi K, Oshima H, Fukaya C. Deep brain stimulation and spinal cord stimulation for vegetative state and minimally conscious state. World Neurosurg. 2013,80(3\u0026ndash;4):S30.e1-S30.e9. doi:10.1016/j.wneu.2012.04.010\u003c/li\u003e\n\u003cli\u003eZHUANG Yu⁃tong, CHEN Kai⁃tian, YANG Yi, et al.Application of neuroelectrophysiological monitoring technology in prolonged disorders of consciousness Chin J Contemp Neurol Neurosurg.2020,20(11):936\u0026ndash;943. doi10.3969/j.issn.1672⁃6731.2020.11.002\u003c/li\u003e\n\u003cli\u003eYamamoto T, Katayama Y, Obuchi T, Kobayashi K, Oshima H, Fukaya C. Spinal cord stimulation for treatment of patients in the minimally conscious state. Neurol Med Chir (Tokyo). 2012,52(7):475\u0026ndash;481. doi:10.2176/nmc.52.475.\u003c/li\u003e\n\u003cli\u003eVisocchi M, Tartaglione T, Romani R, Meglio M. Spinal cord stimulation prevents the effects of combined experimental ischemic and traumatic brain injury. An MR study. Stereotact Funct Neurosurg. 2001,76(3\u0026ndash;4):276\u0026ndash;281. doi:10.1159/000066731\u003c/li\u003e\n\u003cli\u003eLammi MH, Smith VH, Tate RL, Taylor CM. The minimally conscious state and recovery potential: a follow-up study 2 to 5 years after traumatic brain injury. Arch Phys Med Rehabil. 2005,86(4):746\u0026ndash;754. doi:10.1016/j.apmr.2004.11.004\u003c/li\u003e\n\u003cli\u003eLim HK, Jung WS, Aizenstein HJ. Aberrant topographical organization in gray matter structural network in late life depression: a graph theoretical analysis. Int Psychogeriatr. 2013,25(12):1929\u0026ndash;1940. doi:10.1017/S104161021300149X\u003c/li\u003e\n\u003cli\u003eMahmood S, El-Menyar A, Shabana A, et al. Bispectral index as a predictor of unsalvageable traumatic brain injury. Brain Inj. 2017,31(10):1382\u0026ndash;1386. doi:10.1080/02699052.2017.1330966\u003c/li\u003e\n\u003cli\u003eLI Qian, MA Wei. Correlation between electroencephalogram monitoring of perioperative anesthesia depth and prognosis of patients.Journal of Southwest Medical University .2023,46(02):93\u0026ndash;97. doi:10.3969/j.issn.2096-3351.2023.02.001\u003c/li\u003e\n\u003cli\u003eSchnakers C, Ledoux D, Majerus S, et al. Diagnostic and prognostic use of bispectral index in coma, vegetative state and related disorders. Brain Inj. 2008,22(12):926\u0026ndash;931. doi:10.1080/02699050802530565\u003c/li\u003e\n\u003cli\u003eAvidan MS, Zhang L, Burnside BA, et al. Anesthesia awareness and the bispectral index. N Engl J Med. 2008,358(11):1097\u0026ndash;1108. doi:10.1056/NEJMoa0707361.\u003c/li\u003e\n\u003cli\u003eWang D, Song Z, Zhang C, Chen P. Bispectral index monitoring of the clinical effects of propofol closed-loop target-controlled infusion: Systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2021,100(4):e23930. doi:10.1097/MD.0000000000023930\u003c/li\u003e\n\u003cli\u003eXUE Xin, LI Ruihao, REN Haijun.Application and progress of bispectral index monitoring technology in neurosugery. Chinese Journal of Neurosurgical Disease Research.2018,17(06):570\u0026ndash;572.\u003c/li\u003e\n\u003cli\u003eWANG Xiao-feng, WANG Qi, BAI Xi-min, et al.Research progress of bispectral index in evaluating severity and prognosis of brain injury. J Clin Neurosurg.2021,18(06):714\u0026ndash;716\u0026thinsp;+\u0026thinsp;720. DOI: 10.3969 /j. issn.1672-7770.2021.06.025\u003c/li\u003e\n\u003cli\u003eHeine L, Corneyllie A, Gobert F, Luaut\u0026eacute; J, Lavandier M, Perrin F. Virtually spatialized sounds enhance auditory processing in healthy participants and patients with a disorder of consciousness. Sci Rep. 2021,11(1):13702. doi:10.1038/s41598-021-93151-6\u003c/li\u003e\n\u003cli\u003eHeine L, Tillmann B, Hauet M, et al. Effects of preference and sensory modality on behavioural reaction in patients with disorders of consciousness. Brain Inj. 2017,31(10):1307\u0026ndash;1311. doi:10.1080/02699052.2017.1306108\u003c/li\u003e\n\u003cli\u003eCheng L, Cortese D, Monti MM, et al. Do Sensory Stimulation Programs Have an Impact on Consciousness Recovery? Front Neurol. 2018,9:826. doi:10.3389/fneur.2018.00826\u003c/li\u003e\n\u003cli\u003eMagee WL. Music in the diagnosis, treatment and prognosis of people with prolonged disorders of consciousness. Neuropsychol Rehabil. 2018,28(8):1331\u0026ndash;1339. doi:10.1080/09602011.2018.1494003\u003c/li\u003e\n\u003cli\u003eCarri\u0026egrave;re M, Larroque SK, Martial C, et al. An Echo of Consciousness: Brain Function During Preferred Music. Brain Connect. 2020,10(7):385\u0026ndash;395. doi:10.1089/brain.2020.0744\u003c/li\u003e\n\u003cli\u003eBoly M, Faymonville ME, Peigneux P, et al. Auditory processing in severely brain injured patients: differences between the minimally conscious state and the persistent vegetative state. Arch Neurol. 2004,61(2):233\u0026ndash;238. doi:10.1001/archneur.61.2.233.\u003c/li\u003e\n\u003cli\u003eBoly M. Measuring the fading consciousness in the human brain. Curr Opin Neurol. 2011,24(4):394\u0026ndash;400. doi:10.1097/WCO.0b013e328347da94.\u003c/li\u003e\n\u003cli\u003eHeine L, Castro M, Martial C, Tillmann B, Laureys S, Perrin F. Exploration of Functional Connectivity During Preferred Music Stimulation in Patients with Disorders of Consciousness. Front Psychol. 2015,6:1704. doi:10.3389/fpsyg.2015.01704\u003c/li\u003e\n\u003cli\u003eLundstr\u0026ouml;m S, Twycross R, Mihalyo M, Wilcock A. Propofol. J Pain Symptom Manage. 2010,40(3):466\u0026ndash;470.doi:10.1016/j.jpainsymman.2010.07.001\u003c/li\u003e\n\u003cli\u003eShine JM, Lewis LD, Garrett DD, Hwang K. The impact of the human thalamus on brain-wide information processing. Nat Rev Neurosci.2023,24(7):416\u0026ndash;430. doi:10.1038/s41583-023-00701-0\u003c/li\u003e\n\u003cli\u003eVan der Werf YD, Witter MP, Groenewegen HJ. The intralaminar and midline nuclei of the thalamus. Anatomical and functional evidence for participation in processes of arousal and awareness. Brain Res Brain Res Rev. 2002,39(2\u0026ndash;3):107\u0026ndash;140. doi:10.1016/s0165-0173(02)00181-9\u003c/li\u003e\n\u003cli\u003eEdelman GM. Naturalizing consciousness: a theoretical framework. Proc Natl Acad Sci U S A. 2003;100(9):5520\u0026ndash;5524. doi:10.1073/pnas.0931349100.\u003c/li\u003e\n\u003cli\u003eWard LM. The thalamic dynamic core theory of conscious experience. Conscious Cogn. 2011,20(2):464\u0026ndash;486. doi:10.1016/j.concog.2011.01.007\u003c/li\u003e\n\u003cli\u003eMarino S, Bonanno L, Giorgio A.Functional connectivity in disorders of consciousness: methodological aspects and clinical relevance[J].Brain Imaging and Behavior.2015,10(2):604-8.\u003c/li\u003e\n\u003cli\u003eDolce G, Quintieri M, Leto E, Milano M, Pileggi A, Lagani V, et al.Dysautonomia and Clinical Outcome in Vegetative State[J].Journal of Neurotrauma.2021,38(10):1441-4.\u003c/li\u003e\n\u003cli\u003eFern\u0026aacute;ndez-Espejo D, Junque C, Bernabeu M, Roig-Rovira T, Vendrell P, Mercader JM. Reductions of thalamic volume and regional shape changes in the vegetative and the minimally conscious states. J Neurotrauma. 2010,27(7):1187\u0026ndash;1193. doi:10.1089/neu.2010.1297\u003c/li\u003e\n\u003cli\u003eFern\u0026aacute;ndez-Espejo D, Bekinschtein T, Monti MM, et al. Diffusion weighted imaging distinguishes the vegetative state from the minimally conscious state. \u003cem\u003eNeuroimage\u003c/em\u003e. 2011,54(1):103\u0026ndash;112. doi:10.1016/j.neuroimage.2010.08.035\u003c/li\u003e\n\u003cli\u003eLin HC, Pan HC, Lin SH, et al. Central Thalamic Deep-Brain Stimulation Alters Striatal-Thalamic Connectivity in Cognitive Neural Behavior. Front Neural Circuits. 2016,9:87. doi:10.3389/fncir.2015.00087\u003c/li\u003e\n\u003cli\u003eZhang J, Zhang H, Yan F, et al. Investigating the mechanism and prognosis of patients with disorders of consciousness on the basis of brain networks between the thalamus and whole-brain. Front Neurol. 2022,13:990686. doi:10.3389/fneur.2022.990686\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Chronic disturbance of consciousness, Vegetative state, Spinal cord stimulation, General anesthesia, Bispectral Index, Propofol, Improved coma Recovery scale","lastPublishedDoi":"10.21203/rs.3.rs-4026071/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4026071/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To assess whether maintaining an appropriate depth of anesthesia using the Bispectral Index (BIS) could enhance outcomes following spinal cord stimulation (SCS) device implantation in patients with chronic disorders of consciousness (DoC).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A total of 103 patients with DoC who underwent SCS implantation were reviewed between January 2019 and December 2021, of whom 83 met the inclusion and exclusion criteria. Patients were categorized into the BIS group (n = 45) and the non-BIS group (n = 38) based on whether BIS monitoring was used during the operation. Relevant data, such as disease course, cause, anesthesia, and operation time, were collected. Preoperative Coma Recovery\u0026nbsp;\u003cem\u003eScale\u003c/em\u003e—Revised (CRS-R\u003csub\u003e(preoperative)\u003c/sub\u003e) score, postoperative CRS-R\u003csub\u003e(24h), \u003c/sub\u003eand postoperative CRS-R\u003csub\u003e(3m)\u003c/sub\u003e changes were recorded.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe CRS-R\u003csub\u003e(3m)\u003c/sub\u003e score was significantly higher in the BIS group than that in the non-BIS group \u003csub\u003e(preoperative)\u003c/sub\u003e, with a statistically significant difference (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05). Furthermore, in the CRS-R\u003csub\u003e(24h)\u003c/sub\u003e, the BIS group demonstrated a higher score than the non-BIS group, with a statistically significant difference noted (X\u003csup\u003e2 \u003c/sup\u003e= 8.787,\u003cem\u003e p\u003c/em\u003e = 0.004). When assessing the improvement in consciousness in the multivariate logistic regression analysis model, it was revealed that the thalamus independently influenced the enhancement of consciousness (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05). Throughout the follow-up, one patient in the BIS group experienced a decline in consciousness from a \u003cstrong\u003eminimally consciousness state (MCS)\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e- \u003c/strong\u003e\u003c/sup\u003eto-vegetative state, whereas two patients in the non-BIS group passed away during the follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eFor patients with DoC undergoing SCS implantation under general anesthesia, employing BIS monitoring during surgery to regulate the depth of sedation under general anesthesia can reduce propofol dosage and influence the brain network. Patients can benefit from improved hearing, as observed in the CRS-R\u003csub\u003e(24h)\u003c/sub\u003e. We recommend using BIS to monitor the depth of anesthesia in patients with DoC to enhance overall patient outcomes.\u003c/p\u003e","manuscriptTitle":"Improving Postoperative Outcomes for DoC Patients: The Role of BIS-Monitored Depth Regulation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-02 17:46:09","doi":"10.21203/rs.3.rs-4026071/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0287f876-6d80-41b5-b3a9-d73217d82a2b","owner":[],"postedDate":"April 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":30080318,"name":"Biological sciences/Neuroscience"},{"id":30080319,"name":"Health sciences/Diseases"},{"id":30080320,"name":"Health sciences/Medical research"},{"id":30080321,"name":"Health sciences/Neurology"}],"tags":[],"updatedAt":"2024-06-03T06:16:30+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-02 17:46:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4026071","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4026071","identity":"rs-4026071","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}