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Katerenchuk V, Calçada A, Batista AC, Cordeiro L. Unreported Source of Interference with the Bispectral Index During Liposuction: A Case Report. A A Pract 2024; 18:e01797. [PMID: 38828981 DOI: 10.1213/xaa.0000000000001797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Incorrect bispectral index (BIS) values have been reported due to interference with this monitoring system. We report a case of a 46-year-old woman who underwent liposuction and breast lipofilling, where we observed a misinterpretation by the BIS algorithm that has not yet been reported. Concurrently with abdominal and thigh liposuction, an increase in the BIS value was observed. The importance of examining electroencephalogram (EEG) and density spectral array (DSA) readings during liposuction procedures is highlighted in this case report, extending our observations beyond just the numerical BIS value, which is not always reliable.
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Affiliation(s)
- Vasyl Katerenchuk
- From the Department of Anaesthesiology, Unidade Local de Saúde da Arrábida, E.P.E., Hospital São Bernardo, Setúbal, Portugal
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Schmierer T, Li T, Li Y. Harnessing machine learning for EEG signal analysis: Innovations in depth of anaesthesia assessment. Artif Intell Med 2024; 151:102869. [PMID: 38593683 DOI: 10.1016/j.artmed.2024.102869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/31/2024] [Accepted: 04/03/2024] [Indexed: 04/11/2024]
Abstract
Anaesthesia, crucial to surgical practice, is undergoing renewed scrutiny due to the integration of artificial intelligence in its medical use. The precise control over the temporary loss of consciousness is vital to ensure safe, pain-free procedures. Traditional methods of depth of anaesthesia (DoA) assessment, reliant on physical characteristics, have proven inconsistent due to individual variations. In response, electroencephalography (EEG) techniques have emerged, with indices such as the Bispectral Index offering quantifiable assessments. This literature review explores the current scope and frontier of DoA research, emphasising methods utilising EEG signals for effective clinical monitoring. This review offers a critical synthesis of recent advances, specifically focusing on electroencephalography (EEG) techniques and their role in enhancing clinical monitoring. By examining 117 high-impact papers, the review delves into the nuances of feature extraction, model building, and algorithm design in EEG-based DoA analysis. Comparative assessments of these studies highlight their methodological approaches and performance, including clinical correlations with established indices like the Bispectral Index. The review identifies knowledge gaps, particularly the need for improved collaboration for data access, which is essential for developing superior machine learning models and real-time predictive algorithms for patient management. It also calls for refined model evaluation processes to ensure robustness across diverse patient demographics and anaesthetic agents. The review underscores the potential of technological advancements to enhance precision, safety, and patient outcomes in anaesthesia, paving the way for a new standard in anaesthetic care. The findings of this review contribute to the ongoing discourse on the application of EEG in anaesthesia, providing insights into the potential for technological advancement in this critical area of medical practice.
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Affiliation(s)
- Thomas Schmierer
- School of Mathematics, Physics and Computing, University of Southern Queensland, Australia.
| | - Tianning Li
- School of Mathematics, Physics and Computing, University of Southern Queensland, Australia.
| | - Yan Li
- School of Mathematics, Physics and Computing, University of Southern Queensland, Australia.
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Zhang X, Chen XY, Gao RJ, Huang Y, Mao SM, Feng JY. The Effect of Depth of Anesthesia on Postoperative Pain in Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Trial. Obes Surg 2024; 34:1793-1800. [PMID: 38587781 PMCID: PMC11031442 DOI: 10.1007/s11695-024-07207-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/23/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Patients with obesity are more sensitive to pain and more likely to have acute postoperative pain (APP). Studies have shown that the depth of anesthesia may affect the incidence of APP. The purpose of the study was to look into the connection between APP and depth of anesthesia in patients with obesity undergoing laparoscopic sleeve gastrectomy. METHODS This is a prospective, double-blinded randomized clinical trial, 90 patients undergoing laparoscopic sleeve gastrectomy were randomly divided into two groups: the light anesthesia group (Bispectral Index of 50, BIS 50) and the deep anesthesia group (BIS 35). The degree of pain was evaluated by the visual analogue scale (VAS) at 0, 12, 24, 48, and 72 h after surgery. The use of analgesics, grade of postoperative nausea and vomiting (PONV), and the Quality of Recovery-15 (QoR-15) score were recorded. RESULTS The VAS scores at rest or coughing at 0, 12, and 24 h after surgery in the BIS 35 group were lower than those in the BIS 50 group (P < 0.05). Fewer patients in the deep anesthesia group needed analgesia during the recovery period, and patient satisfaction was higher on the 3rd day after surgery (P < 0.015, P < 0.032, respectively). CONCLUSIONS For patients with obesity, maintaining a deeper depth of anesthesia during surgery is beneficial to reduce APP causes less need for additional analgesic drugs, and improves patient satisfaction.
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Affiliation(s)
- Xue Zhang
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, 222002, Jiangsu, China
| | - Xin-Yue Chen
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, 222002, Jiangsu, China
| | - Rui-Jia Gao
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, 222002, Jiangsu, China
| | - Yu Huang
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, 222002, Jiangsu, China
| | - Shi-Meng Mao
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, 222002, Jiangsu, China
| | - Ji-Ying Feng
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, 222002, Jiangsu, China.
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Kinoshita H, Yamamoto M, Adachi Y, Yamaguchi R, Takemura A. Fascia Iliaca Block Reduces Remifentanil Requirement in Conscious Sedation for Transcatheter Aortic Valve Implantation - A Randomized Clinical Trial. Circ J 2024; 88:475-482. [PMID: 36403975 DOI: 10.1253/circj.cj-22-0580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND Whether nerve block improves the quality of conscious sedation (CS) in patients undergoing transcatheter aortic valve implantation (TAVI) is unclear. This study investigated whether fascia iliaca block (FIB) reduced the remifentanil requirement and relieved pain in CS for TAVI.Methods and Results: This prospective study randomized 72 patients scheduled for elective TAVI under CS into 2 groups, with (FIB) and without (control) FIB (n=36 in each group). The sedation targeted a Bispectral Index <90 with a Richmond Agitation-Sedation Scale of -2 to -1. Dexmedetomidine (0.7 µg/kg, i.v.) combined with remifentanil (0.03 µg/kg/min, i.v.) and propofol (0.3 mg/kg/h, i.v.) was used to commence sedation. FIB using 30 mL of 0.185% ropivacaine was implemented 2 min before TAVI. Patient sedation was maintained with dexmedetomidine (0.4 µg/kg/h, i.v.) supplemented with remifentanil (0-0.02 µg/kg/min, i.v.). Remifentanil (20 µg, i.v.) was used as a rescue dose for intraprocedural pain. Compared with the control group, FIB reduced the both the total (median [interquartile range] 83.0 [65.0-98.0] vs. 34.5 [26.0/45.8)] µg; P<0.001) and continuous (25.3 [20.9/31.5] vs. 9.5 [6.8/12.5] ng/kg/min; P<0.001) doses of remifentanil administered. CONCLUSIONS FIB reduced the remifentanil requirement and relieved pain in patients undergoing TAVI with CS. Therefore, FIB improved the quality of CS in TAVI.
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Affiliation(s)
- Hiroyuki Kinoshita
- Department of Dental Anesthesiology, Institute of Biomedical Sciences, Tokushima University Graduate School
- Department of Anesthesiology and Intensive Care, Hamamatsu Medical University
- Department of Anesthesiology, Toyohashi Heart Center
| | | | - Yuya Adachi
- Department of Cardiology, Toyohashi Heart Center
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Isik OG, Chauhan V, Ahmed MT, Chang BA, Cassim TZ, Graves MC, Rajan S, Garcia PS. Alternate Electrode Placements to Facilitate Frontal Electroencephalography Monitoring in Anesthetized and Critically Ill Patients. J Neurosurg Anesthesiol 2024:00008506-990000000-00098. [PMID: 38466565 DOI: 10.1097/ana.0000000000000955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/19/2023] [Indexed: 03/13/2024]
Abstract
BACKGROUND Frontal electroencephalography (EEG) monitoring can be useful in guiding the titration of anesthetics, but it is not always feasible to place electrodes in the standard configuration in some circumstances, including during neurosurgery. This study compares 5 alternate configurations of the Masimo Sedline Sensor. METHODS Ten stably sedated patients in the intensive care unit were recruited. Frontal EEG was monitored in the standard configuration (bifrontal upright) and 5 alternate configurations: bifrontal inverse, infraorbital, lateral upright, lateral inverse, and semilateral. Average power spectral densities (PSDs) with 95% CIs in the alternate configurations were compared to PSDs in the standard configuration. Two-one-sided-testing with Wilcoxon signed-rank tests assessed equivalence in the spectral edge frequency (SEF-95), EEG power, and relative delta (0.5 to 3.5 Hz), alpha (8 to 12 Hz), and beta (20 to 30 Hz) power between each alternate and standard configurations. RESULTS After the removal of unanalyzable tracings, 7 patients were included for analysis in the infraorbital configuration and 9 in all other configurations. In the lateral upright and lateral inverse configurations, PSDs significantly differed from the standard configuration within the 15 to 20 Hz band. The greatest decrease in EEG power was in the lateral inverse configuration (median: -97 dB; IQR: -130, -62 dB). The largest change in frequency distribution of EEG power was in the infraorbital configuration; median SEF-95 change of -1.4 Hz (IQR: -2.8, 0.7 Hz), median relative delta power change of +7.3% (IQR: 1.4%, 7.9%), and median relative alpha power change of -0.6% (IQR: -5.7%, 0.0%). CONCLUSIONS These 5 alternate Sedline electrode configurations are suitable options for monitoring frontal EEG when the standard configuration is not possible.
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Affiliation(s)
- Oliver G Isik
- Department of Anesthesiology, Columbia University Vagelos College of Physicians & Surgeons, New York, NY
| | - Vikas Chauhan
- Department of Anesthesiology, Columbia University Vagelos College of Physicians & Surgeons, New York, NY
| | - Meah T Ahmed
- Medical School, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Brian A Chang
- Department of Anesthesiology, Columbia University Vagelos College of Physicians & Surgeons, New York, NY
| | - Tuan Z Cassim
- Department of Psychology, School of Social and Behavioral Science, University of Utah, Salt Lake City, UT
| | - Morgan C Graves
- Department of Anesthesiology, Columbia University Vagelos College of Physicians & Surgeons, New York, NY
| | - Shobana Rajan
- Department of Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Paul S Garcia
- Department of Anesthesiology, Columbia University Vagelos College of Physicians & Surgeons, New York, NY
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Woodward W, Carrannante J, Dua K. PRESS (Propofol, Remifentanil, Electricity/EEG, Setup and Setting) to Start: Introducing a Total Intravenous Anaesthesia Checklist at a Large Teaching Hospital. Cureus 2024; 16:e56026. [PMID: 38606212 PMCID: PMC11008608 DOI: 10.7759/cureus.56026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
Total intravenous anaesthesia (TIVA) is becoming more widely used, and as of yet there are few safety checks for the use of TIVA when compared to inhaled anaesthesia. This study aims to assess the feasibility and utility of introducing a TIVA checklist at a large teaching hospital. Methods A survey was sent out to all consultant and trainee anaesthetists at our hospital regarding their use of TIVA and errors in practice related to its use. A checklist was created based on common errors reported in the survey, errors described in NAP5 and our hospital's standard operating procedure. The checklist was introduced, and another survey was distributed a month later to assess compliance and utility and to gain feedback. Results In the first survey, there were 39 responses. A total of 64% had seen an error with the use of TIVA. For those using TIVA 70% of the time or more, 31% had seen an error in the last three months. Twelve per cent of those who had seen errors found that the errors led to patient harm. Only 33% used a method to double-check for errors prior to commencing TIVA. In the follow-up survey, 80% of those who used the checklist had found it useful, and 30% had corrected an error while using the checklist. Eighty-seven per cent felt the checklist would prevent errors from being made. Eighty per cent of respondents said they would use the checklist in their future practice. The checklist was found to be more useful for trainees, and for those who use TIVA less often. Discussion The 'PRESS to start TIVA" checklist has been shown to be a useful tool to prevent errors and a majority of anaesthetists at our hospital plan to use it going forward. Our data suggests that anaesthetists who are less experienced with TIVA benefit more from having a checklist. There was a marked increase in the number of anaesthetists who would use a checklist in the future, compared to those who used one in the initial survey. This shows that introducing a checklist is feasible and is likely to reduce errors going forward.
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Affiliation(s)
| | | | - Kanika Dua
- Anaesthesia, St George's Hospital, London, GBR
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Qin X, Chen X, Zhao X, Yao L, Li B, Pan G, Xu J, Jiang R, Zhao Z, Liang Z, Guo X, Huang J, Li X. Evaluation of brain function in adult patent ductus arteriosus surgery: A multimodal monitoring approach. Curr Probl Cardiol 2024; 49:102334. [PMID: 38142948 DOI: 10.1016/j.cpcardiol.2023.102334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/04/2023] [Accepted: 12/12/2023] [Indexed: 12/26/2023]
Abstract
Adult patent ductus arteriosus (PDA) repair surgery often involves hypothermic cardiopulmonary bypass (CPB) and is associated with postoperative neurological complications. Our study evaluates brain function during PDA surgery using regional cerebral oxygen saturation (rSO2) and bispectral index (BIS) monitoring to mitigate these complications. Patients were categorized into moderate (26-31 ℃) and mild (32-35 ℃) hypothermia groups. Findings indicate a positive correlation between PDA diameter and pulmonary artery systolic blood pressure, and a strong correlation between delirium and average rSO2-AUC. The mild hypothermia group had longer extubation and hospitalization times. During CPB, rSO2 levels fluctuated significantly, and EEG analysis revealed changes in brain wave patterns. One case of nerve injury in the mild hypothermia group showed incomplete recovery after a year. Our results advocate for moderate hypothermia during CPB in adult PDA repair, suggesting that combined rSO2 and BIS monitoring can reduce neurological complications post-surgery.
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Affiliation(s)
- Xuewei Qin
- Department of Anesthesiology, Peking University International Hospital, Beijing 102206, China
| | - Xuanling Chen
- Department of Anesthesiology, Peking University International Hospital, Beijing 102206, China
| | - Xin Zhao
- Department of Anesthesiology, Peking University International Hospital, Beijing 102206, China
| | - Lan Yao
- Department of Anesthesiology, Peking University International Hospital, Beijing 102206, China.
| | - Bin Li
- Department of Cardiac Surgery, Peking University International Hospital, Beijing 102206, China
| | - Guangyu Pan
- Department of Cardiac Surgery, Peking University International Hospital, Beijing 102206, China
| | - Jianping Xu
- Department of Cardiac Surgery, Peking University International Hospital, Beijing 102206, China; Department of Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Rui Jiang
- Department of Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | | | | | - Xiangyang Guo
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
| | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY 40202, USA
| | - Xiaoli Li
- The State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China
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Fanning JP, Campbell BCV, Bulbulia R, Gottesman RF, Ko SB, Floyd TF, Messé SR. Perioperative stroke. Nat Rev Dis Primers 2024; 10:3. [PMID: 38238382 DOI: 10.1038/s41572-023-00487-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 01/23/2024]
Abstract
Ischaemic or haemorrhagic perioperative stroke (that is, stroke occurring during or within 30 days following surgery) can be a devastating complication following surgery. Incidence is reported in the 0.1-0.7% range in adults undergoing non-cardiac and non-neurological surgery, in the 1-5% range in patients undergoing cardiac surgery and in the 1-10% range following neurological surgery. However, higher rates have been reported when patients are actively assessed and in high-risk populations. Prognosis is significantly worse than stroke occurring in the community, with double the 30-day mortality, greater disability and diminished quality of life among survivors. Considering the annual volume of surgeries performed worldwide, perioperative stroke represents a substantial burden. Despite notable differences in aetiology, patient populations and clinical settings, existing clinical recommendations for perioperative stroke are extrapolated mainly from stroke in the community. Perioperative in-hospital stroke is unique with respect to the stroke occurring in other settings, and it is essential to apply evidence from other settings with caution and to identify existing knowledge gaps in order to effectively guide patient care and future research.
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Affiliation(s)
- Jonathon P Fanning
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.
- Anaesthesia & Perfusion Services, The Prince Charles Hospital, Brisbane, Queensland, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
- The George Institute for Global Health, Sydney, New South Wales, Australia.
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Bruce C V Campbell
- Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Richard Bulbulia
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Department of Vascular Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | | | - Sang-Bae Ko
- Department of Neurology and Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
| | - Thomas F Floyd
- Department of Anaesthesiology & Pain Management, Department of Cardiovascular and Thoracic Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Steven R Messé
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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McFadden J. Carving Nature at Its Joints: A Comparison of CEMI Field Theory with Integrated Information Theory and Global Workspace Theory. ENTROPY (BASEL, SWITZERLAND) 2023; 25:1635. [PMID: 38136515 PMCID: PMC10743215 DOI: 10.3390/e25121635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/29/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
The quest to comprehend the nature of consciousness has spurred the development of many theories that seek to explain its underlying mechanisms and account for its neural correlates. In this paper, I compare my own conscious electromagnetic information field (cemi field) theory with integrated information theory (IIT) and global workspace theory (GWT) for their ability to 'carve nature at its joints' in the sense of predicting the entities, structures, states and dynamics that are conventionally recognized as being conscious or nonconscious. I go on to argue that, though the cemi field theory shares features of both integrated information theory and global workspace theory, it is more successful at carving nature at its conventionally accepted joints between conscious and nonconscious systems, and is thereby a more successful theory of consciousness.
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Affiliation(s)
- Johnjoe McFadden
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
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10
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Huang WK, Lian WY, Zhuo XY, Kang SY, Luo WC, Xie YS, Xi GY, Liu KX, Liu WF. Association between cumulative duration of deep anesthesia and postoperative acute kidney injury after noncardiac surgeries: a retrospective observational study. Ren Fail 2023; 45:2287130. [PMID: 38031451 PMCID: PMC11001356 DOI: 10.1080/0886022x.2023.2287130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Bispectral index (BIS) is a processed electroencephalography monitoring tool and is widely used in anesthetic depth monitoring. Deep anesthesia exposure may be associated with multiple adverse outcomes. However, the relationship between anesthetic depth and postoperative acute kidney injury (AKI) remains unclear. We sought to determine the effect of BIS-based deep anesthesia duration on postoperative AKI following noncardiac surgery. METHODS This retrospective study used data from the Vital Signs DataBase, including patients undergoing noncardiac surgeries with BIS monitoring. The BIS values were collected every second during anesthesia. Restricted cubic splines and logistic regression were used to assess the association between the cumulative duration of deep anesthesia and postoperative AKI. RESULTS 4774 patients were eligible, and 129 (2.7%) experienced postoperative AKI. Restricted cubic splines showed that a cumulative duration of BIS < 45 was nonlinearly associated with postoperative AKI (P-overall = 0.033 and P-non-linear = 0.023). Using the group with the duration of BIS < 45 less than 15 min as the reference, ORs of postoperative AKI were 2.59 (95% confidence interval [CI]:0.60 to 11.09, p = 0.200) in the 15-100 min group, and 4.04 (95%CI:0.92 to 17.76, p = 0.064) in the ≥ 100 min group after adjusting for preoperative and intraoperative covariates in multivariable logistic regression. CONCLUSIONS The cumulative duration of BIS < 45 was independently and nonlinearly associated with the risk of postoperative AKI in patients undergoing noncardiac surgery.
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Affiliation(s)
- Wen-Kao Huang
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wan-Yi Lian
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiao-Yu Zhuo
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Song-Yun Kang
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wen-Chi Luo
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yi-Shan Xie
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Gui-Yang Xi
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ke-Xuan Liu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wei-Feng Liu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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11
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Favre E, Bernini A, Miroz JP, Abed-Maillard S, Ramelet AS, Oddo M. Early processed electroencephalography for the monitoring of deeply sedated mechanically ventilated critically ill patients. Nurs Crit Care 2023. [PMID: 37997530 DOI: 10.1111/nicc.13009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/22/2023] [Accepted: 11/01/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Deep sedation may be indicated in the intensive care unit (ICU) for the management of acute organ failure, but leads to sedative-induced delirium. Whether processed electroencephalography (p-EEG) is useful in this setting is unclear. METHODS We conducted a single-centre observational study of non-neurological ICU patients sedated according to a standardized guideline of deep sedation (Richmond Agitation Sedation Scale [RASS] between -5 and -4) during the acute phase of respiratory and/or cardio-circulatory failure. The SedLine (Masimo Incorporated, Irvine, California) was used to monitor the Patient State Index (PSI) (ranging from 0 to 100, <25 = very deep sedation and >50 = light sedation to full awareness) during the first 72 h of care. Delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). RESULTS The median duration of PSI monitoring was 43 h. Patients spent 49% in median of the total PSI monitoring duration with a PSI <25. Patients with delirium (n = 41/97, 42%) spent a higher percentage of total monitored time with PSI <25 (median 67% [19-91] vs. 47% [12.2-78.9]) in non-delirious patients (p .047). After adjusting for the cumulative dose of analgesia and sedation, increased time spent with PSI <25 was associated with higher delirium (odds ratio 1.014; 95% CI 1.001-1.027, p = .036). CONCLUSIONS A clinical protocol of deep sedation targeted to RASS at the acute ICU phase may be associated with prolonged EEG suppression and increased delirium. Whether PSI-targeted sedation may help reducing sedative dose and delirium deserves further clinical investigation. RELEVANCE TO CLINICAL PRACTICE Patients requiring deep sedation are at high risk of being over-sedated and developing delirium despite the application of an evidence-based sedation guideline. Development of early objective measures are essential to improve sedation management in these critically ill patients.
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Affiliation(s)
- Eva Favre
- Department of Intensive Care, Centre Hospitalier Universitaire Vaudois (CHUV)-Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of Higher Education and Research in Healthcare, CHUV-Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Adriano Bernini
- Department of Intensive Care, Centre Hospitalier Universitaire Vaudois (CHUV)-Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - John-Paul Miroz
- Department of Intensive Care, Centre Hospitalier Universitaire Vaudois (CHUV)-Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Samia Abed-Maillard
- Department of Intensive Care, Centre Hospitalier Universitaire Vaudois (CHUV)-Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anne-Sylvie Ramelet
- Institute of Higher Education and Research in Healthcare, CHUV-Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mauro Oddo
- Medical Directorate for Research, Education and Innovation, CHUV-Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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12
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Luca E, Schipa C, Cambise C, Sollazzi L, Aceto P. Implication of age-related changes on anesthesia management. Saudi J Anaesth 2023; 17:474-481. [PMID: 37779561 PMCID: PMC10540993 DOI: 10.4103/sja.sja_579_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 10/03/2023] Open
Abstract
Elderly patients have a high risk of perioperative morbidity and mortality. Pluri-morbidities, polypharmacy, and functional dependence may have a great impact on intraoperative management and request specific cautions. In addition to surgical stress, several perioperative noxious stimuli such as fasting, blood loss, postoperative pain, nausea and vomiting, drug adverse reactions, and immobility may trigger a derangement leading to perioperative complications. Older patients have a high risk of major hemodynamic derangement due to aging of the cardiovascular system and associated comorbidities. The hemodynamic monitoring as well as fluid therapy should be the most accurate as possible. Aging is accompanied by decreased renal function, which is related to a reduction in renal blood flow, renal mass, and the number and size of functioning nephrons. Drugs eliminated predominantly by the renal route need dosage adjustments based on residual renal function. Liver mass, hepatic blood flow, and intrinsic metabolic activity are decreased in the elderly, and all drugs metabolized by the liver have a variable half-life, thus requiring dose reduction. Decreased neural plasticity contributes to a high risk for postoperative delirium. Monitoring of anesthesia depth should be mandatory to avoid overdosage of hypnotic drugs. Prevention of postoperative pulmonary complications requires both protective ventilation strategies and adequate recovery of neuromuscular function at the end of surgery. Avoidance of hypothermia cannot be missed. The aim of this review is to describe comprehensive strategies for intraoperative management plans tailored to meet the unique needs of elderly surgical patients, thus improving outcomes in this vulnerable population.
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Affiliation(s)
- Ersilia Luca
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Chiara Schipa
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Chiara Cambise
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Liliana Sollazzi
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paola Aceto
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
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Ding YY, Xu F, Wang YF, Han LL, Huang SQ, Zhao S, Ma LL, Zhang TH, Zhao WJ, Chen XD. Electroacupuncture alleviates postoperative pain through inhibiting neuroinflammation via stimulator of interferon genes/type-1 interferon pathway. JOURNAL OF INTEGRATIVE MEDICINE 2023; 21:496-508. [PMID: 37517892 DOI: 10.1016/j.joim.2023.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 06/28/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE This work explores the impact of electroacupuncture (EA) on acute postoperative pain (APP) and the role of stimulator of interferon genes/type-1 interferon (STING/IFN-1) signaling pathway modulation in the analgesic effect of EA in APP rats. METHODS The APP rat model was initiated through abdominal surgery and the animals received two 30 min sessions of EA at bilateral ST36 (Zusanli) and SP6 (Sanyinjiao) acupoints. Mechanical, thermal and cold sensitivity tests were performed to measure the pain threshold, and electroencephalograms were recorded in the primary somatosensory cortex to identify the effects of EA treatment on APP. Western blotting and immunofluorescence were used to examine the expression and distribution of proteins in the STING/IFN-1 pathway as well as neuroinflammation. A STING inhibitor (C-176) was administered intrathecally to verify its role in EA. RESULTS APP rats displayed mechanical and thermal hypersensitivities compared to the control group (P < 0.05). APP significantly reduced the amplitude of θ, α and γ oscillations compared to their baseline values (P < 0.05). Interestingly, expression levels of proteins in the STING/IFN-1 pathway were downregulated after inducing APP (P < 0.05). Further, APP increased pro-inflammatory factors, including interleukin-6, tumor necrosis factor-α and inducible nitric oxide synthase, and downregulated anti-inflammatory factors, including interleukin-10 and arginase-1 (P < 0.05). EA effectively attenuated APP-induced painful hypersensitivities (P < 0.05) and restored the θ, α and γ power in APP rats (P < 0.05). Meanwhile, EA distinctly activated the STING/IFN-1 pathway and mitigated the neuroinflammatory response (P < 0.05). Furthermore, STING/IFN-1 was predominantly expressed in isolectin-B4- or calcitonin-gene-related-peptide-labeled dorsal root ganglion neurons and superficial laminae of the spinal dorsal horn. Inhibition of the STING/IFN-1 pathway by intrathecal injection of C-176 weakened the analgesic and anti-inflammatory effects of EA on APP (P < 0.05). CONCLUSION EA can generate robust analgesic and anti-inflammatory effects on APP, and these effects may be linked to activating the STING/IFN-1 pathway, suggesting that STING/IFN-1 may be a target for relieving APP. Please cite this article as: Ding YY, Xu F, Wang YF, Han LL, Huang SQ, Zhao S, Ma LL, Zhang TH, Zhao WJ, Chen XD. Electroacupuncture alleviates postoperative pain through inhibiting neuroinflammation via stimulator of interferon genes/type-1 interferon pathway. J Integr Med. 2023; 21(5): 496-508.
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Affiliation(s)
- Yuan-Yuan Ding
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Feng Xu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Ya-Feng Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Lin-Lin Han
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Shi-Qian Huang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Shuai Zhao
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Lu-Lin Ma
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Tian-Hao Zhang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Wen-Jing Zhao
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Xiang-Dong Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China.
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Fehrlin ES, Hight D, Kaiser HA, Luedi MM, Huber M, Zubler F, Lersch F. A Pilot Investigation Evaluating Relative Changes in Fronto-Occipital Alpha and Beta Spectral Power as Measurement of Anesthesia Hypnotic Depth. Anesth Analg 2023; 137:656-664. [PMID: 36961823 PMCID: PMC10408731 DOI: 10.1213/ane.0000000000006398] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 03/25/2023]
Abstract
BACKGROUND Other than clinical observation of a patient's vegetative response to nociception, monitoring the hypnotic component of general anesthesia (GA) and unconsciousness relies on electroencephalography (EEG)-based indices. These indices exclusively based on frontal EEG activity neglect an important observation. One of the main hallmarks of transitions from wakefulness to GA is a shift in alpha oscillations (7.5-12.5 Hz activity) from occipital brain regions toward anterior brain regions ("alpha anteriorization"). Monitoring the degree of this alpha anteriorization may help to guide induction and maintenance of hypnotic depth and prevent intraoperative awareness. However, the occipital region of the brain is completely disregarded and occipital alpha as characteristic of wakefulness and its posterior-to-anterior shift during induction are missed. Here, we propose an application of Narcotrend's reduced power alpha beta (RPAB) index, originally developed to monitor differences in hemispheric perfusion, for determining the ratio of alpha and beta activity in the anterior-posterior axis. METHODS Perioperative EEG data of 32 patients undergoing GA in the ophthalmic surgery department of Bern University Hospital were retrospectively analyzed. EEG was recorded with the Narcotrend® monitor using a frontal (Fp1-Fp2) and a posterior (T9-Oz) bipolar derivation with reference electrode over A2. The RPAB index was computed between both bipolar signals, defining the fronto-occipital RPAB (FO-RPAB). FO-RPAB was analyzed during wakefulness, GA maintenance, and emergence, as well as before and after the intraoperative administration of a ketamine bolus. FO-RPAB was compared with a classical quantitative EEG measure-the spectral edge frequency 95% (SEF-95). RESULTS A significant shift of the FO-RPAB was observed during both induction of and emergence from GA ( P < .001). Interestingly, the additional administration of ketamine during GA did not lead to a significant change in FO-RPAB ( P = 0.81). In contrast, a significant increase in the SEF-95 in the frontal channel was observed during the 10-minute period after ketamine administration ( P < .001). CONCLUSIONS FO-RPAB appears to qualify as a marker of unconsciousness, reflecting physiological fronto-occipital activity differences during GA. In contrast to frontal SEF-95, it is not disturbed by additional administration of ketamine for analgesia.
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Affiliation(s)
- Eloy S. Fehrlin
- From the Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Darren Hight
- From the Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Heiko A. Kaiser
- From the Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Sleep-Wake-Epilepsy-Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus M. Luedi
- From the Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus Huber
- From the Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Frédéric Zubler
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Friedrich Lersch
- From the Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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15
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Belletti A, Lee DK, Yanase F, Naorungroj T, Eastwood GM, Bellomo R, Weinberg L. Changes in SedLine-derived processed electroencephalographic parameters during hypothermia in patients undergoing cardiac surgery with cardiopulmonary bypass. Front Cardiovasc Med 2023; 10:1084426. [PMID: 37469479 PMCID: PMC10352607 DOI: 10.3389/fcvm.2023.1084426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 06/19/2023] [Indexed: 07/21/2023] Open
Abstract
Objective Processed electroencephalography (pEEG) is used to monitor depth-of-anesthesia during cardiopulmonary bypass (CPB). The SedLine device has been recently introduced for pEEG monitoring. However, the effect of hypothermia on its parameters during CPB is unknown. Accordingly, we aimed to investigate temperature-induced changes in SedLine-derived pEEG parameters during CPB. Design Prospective observational study. Setting Cardiac surgery operating theatre. Participants 28 patients undergoing elective cardiac surgery with CPB. Interventions We continuously measured patient state index (PSI), suppression ratio (SR), bilateral spectral edge frequency (SEF) and temperature. We used linear mixed modelling with fixed and random effects to study the interactions between pEEG parameters and core temperature. Measurements and main results During CPB maintenance, the median temperature was 32.1°C [interquartile range (IQR): 29.8-33.6] at the end of cooling and 32.8°C (IQR: 30.1-34.0) at rewarming initiation. For each degree Celsius change in temperature during cooling and rewarming the PSI either decreased by 0.8 points [95% confidence interval (CI): 0.7-1.0; p < 0.001] or increased by 0.7 points (95% CI: 0.6-0.8; p < 0.001). The SR increased by 2.9 (95% CI: 2.3-3.4); p < 0.001) during cooling and decreased by 2.2 (95% CI: 1.7-2.7; p < 0.001) during rewarming. Changes in the SEF were not related to changes in temperature. Conclusions During hypothermic CPB, temperature changes led to concordant changes in the PSI. The SR increased during cooling and decreased during rewarming. Clinicians using SedLine for depth-of-anesthesia monitoring should be aware of these effects when interpreting the PSI and SR values.
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Affiliation(s)
- Alessandro Belletti
- Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Dong-Kyu Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Fumitaka Yanase
- Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Thummaporn Naorungroj
- Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia
- Department of Intensive Care, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Glenn M. Eastwood
- Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
- Data Analytics Research and Evaluation Centre, The University of Melbourne and The Austin Hospital, Melbourne, VIC, Australia
| | - Laurence Weinberg
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
- Department of Anaesthesia, Austin Hospital, Heidelberg, VIC, Australia
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16
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Obata Y, Yamada T, Akiyama K, Sawa T. Time-trend analysis of the center frequency of the intrinsic mode function from the Hilbert-Huang transform of electroencephalography during general anesthesia: a retrospective observational study. BMC Anesthesiol 2023; 23:125. [PMID: 37059989 PMCID: PMC10105429 DOI: 10.1186/s12871-023-02082-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/06/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Anesthesiologists are required to maintain an optimal depth of anesthesia during general anesthesia, and several electroencephalogram (EEG) processing methods have been developed and approved for clinical use to evaluate anesthesia depth. Recently, the Hilbert-Huang transform (HHT) was introduced to analyze nonlinear and nonstationary data. In this study, we assessed whether the changes in EEG characteristics during general anesthesia that are analyzed by the HHT are useful for monitoring the depth of anesthesia. METHODS This retrospective observational study enrolled patients who underwent propofol anesthesia. Raw EEG signals were obtained from a monitor through a previously developed software application. We developed an HHT analyzer to decompose the EEG signal into six intrinsic mode functions (IMFs) and estimated the instantaneous frequencies (HHT_IF) for each IMF. Changes over time in the raw EEG waves and parameters such as HHT_IF, BIS, spectral edge frequency 95 (SEF95), and electromyogram parameter (EMGlow) were assessed, and a Gaussian process regression model was created to assess the association between BIS and HHT_IF. RESULTS We analyzed EEG signals from 30 patients. The beta oscillation frequency range (13-25 Hz) was detected in IMF1 and IMF2 during the awake state, then after loss of consciousness, the frequency decreased and alpha oscillation (8-12 Hz) was detected in IMF2. At the emergence phase, the frequency increased and beta oscillations were detected in IMF1, IMF2, and IMF3. BIS and EMGlow changed significantly during the induction and emergence phases, whereas SEF95 showed a wide variability and no significant changes during the induction phase. The root mean square error between the observed BIS values and the values predicted by a Gaussian process regression model ranged from 4.69 to 9.68. CONCLUSIONS We applied the HHT to EEG analyses during propofol anesthesia. The instantaneous frequency in IMF1 and IMF2 identified changes in EEG characteristics during induction and emergence from general anesthesia. Moreover, the HHT_IF in IMF2 showed strong associations with BIS and was suitable for depicting the alpha oscillation. Our study suggests that the HHT is useful for monitoring the depth of anesthesia.
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Affiliation(s)
- Yurie Obata
- Department of Anesthesiology, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawaku, 533-0024, Osaka, Japan.
| | - Tomomi Yamada
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koichi Akiyama
- Department of Anesthesiology, Kindai University, Osaka, Japan
| | - Teiji Sawa
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Introna M, Gemma M, Carozzi C. Improving the benefit of processed EEG monitors: it's not about the car but the driver. J Clin Monit Comput 2023; 37:723-725. [PMID: 37036625 PMCID: PMC10175406 DOI: 10.1007/s10877-023-01004-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 03/27/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Michele Introna
- Neurointensive Care Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy.
| | - Marco Gemma
- Neurointensive Care Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Carla Carozzi
- Neurointensive Care Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
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18
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Roman A, Tufegdzic B, Lamperti M, Pinto V, Roser F. Before the Knife: A Detailed Step-by-Step Description of an Optimized Semi-Sitting Position in Posterior Fossa Surgery. World Neurosurg 2023; 172:e241-e249. [PMID: 36608791 DOI: 10.1016/j.wneu.2022.12.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 12/31/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND In an ample armamentarium in neurosurgery, the semi-sitting position has produced debate regarding its benefits and risks. Although the position is apparently intuitive, many have abandoned its use since its initial inception, because of reported complexity and potential complications, leading to impracticality. However, through standardization, it has been shown not only to be safe but to carry with it many advantages, including less risk of secondary neurovascular injuries and better visualization of the surgical field. As with any surgical technical nuance, the semi-sitting position has advantages and disadvantages that must be weighed before the decision is made to adopt it or not, not only in a case-by-case scenario but also from a departmental standpoint. As we attempt to show, the advantages from a standardized approach for the semi-sitting position in experienced institutions may be more than sufficient to significantly outweigh the disadvantages, making it the preferable option for most, although not all, posterior fossa surgical interventions. METHODS In the present study, we aim to elaborate a straightforward narrative of the steps before incision, in an attempt to simplify the complexity of the position, alleviating its disadvantages and exponentially concentrating on its benefits. In nearly 100 steps, we carefully describe the points that culminate with the skin incision, initiating the intraoperative part of the procedure. Each step, therefore, is detailed in full, not in an effort to create a strict manual of the semi-sitting position but rather to facilitate understanding and put the technique into effect in a real-life scenario, thus simplifying what some depict as complex and time consuming. CONCLUSIONS Although several of the steps described are also relevant and integral parts of other surgical positioning, we intend to create a protocol, in a stepwise fashion, to allow facilitated following, to be easily implemented in departments with different levels of experience. The steps comprise nursing care through to electrophysiologic and anesthesiologic approaches, along with neurosurgical cooperation, making it a team approach, not only to avoid position-related complications but also to optimize preoperative standardization, constructing a safe, efficient, and patient-centered scenario, to set the best possible stage for the next step: the intraoperative part of the intervention.
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Affiliation(s)
- Alex Roman
- Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Boris Tufegdzic
- Anesthesiology Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Massimo Lamperti
- Anesthesiology Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Vania Pinto
- Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Florian Roser
- Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.
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19
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Corner H, Barley M, Metodiev Y. The use of processed electroencephalography (pEEG) in obstetric anaesthesia: a narrative review. Int J Obstet Anesth 2023; 54:103650. [PMID: 36934515 DOI: 10.1016/j.ijoa.2023.103650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/16/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023]
Abstract
Accidental awareness under general anaesthesia (AAGA) remains a major complication of anaesthesia. The incidence of AAGA during obstetric anaesthesia is high relative to other specialities. The use of processed electroencephalography (pEEG) in the form of "depth of anaesthesia" monitoring has been shown to reduce the incidence of AAGA in the non-obstetric population. The evidence for using pEEG to prevent AAGA in the obstetric population is poor and requires further exploration. Furthermore, pregnancy and disease states affecting the central nervous system, such as pre-eclampsia, may alter the interpretation of pEEG waveforms although this has not been fully characterised. National guidelines exist for pEEG monitoring with total intravenous anaesthesia and for "high-risk" cases regardless of technique, including the obstetric population. However, none of the currently available guidelines relates specifically to obstetric anaesthesia. Using pEEG monitoring for obstetric anaesthesia may also provide additional benefits beyond a reduction in risk of AAGA. These potential benefits include reduced postoperative nausea and vomiting, reduced anaesthetic agent use, a shorter post-anaesthetic recovery stay. In addition, pEEG acts as a surrogate marker of cerebral perfusion, and thus as an additional monitor for impending cardiovascular collapse, as seen in amniotic fluid embolism. The subtle physiological and pathological changes in EEG activity that may occur during pregnancy are an unexplored research area in the context of anaesthetic pEEG monitors. We believe that the direction of clinical practice is moving towards greater use of pEEG monitoring and individualisation of anaesthesia.
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Affiliation(s)
- H Corner
- Department of Anaesthesia, Leicester Royal Infirmary, Leicester, UK.
| | - M Barley
- Department of Anaesthesia, Queens Medical Centre, Nottingham, UK
| | - Y Metodiev
- Department of Anaesthesia, University Hospital of Wales, Cardiff, UK
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20
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Processed EEG monitoring in critical care: a black swan or a shining star? J Clin Monit Comput 2023; 37:3-5. [PMID: 35917045 DOI: 10.1007/s10877-022-00905-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 01/24/2023]
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21
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Sumner M, Deng C, Evered L, Frampton C, Leslie K, Short T, Campbell D. Processed electroencephalography-guided general anaesthesia to reduce postoperative delirium: a systematic review and meta-analysis. Br J Anaesth 2023; 130:e243-e253. [PMID: 35183345 DOI: 10.1016/j.bja.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/13/2021] [Accepted: 01/04/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Postoperative delirium (POD) is the most common serious postoperative complication in older adults. It has uncertain aetiology, limited preventative strategies, and poor long-term outcomes. This updated systematic review and meta-analysis aimed to estimate the effect of processed electroencephalography (pEEG)-guided general anaesthesia during surgery on POD incidence. METHODS We performed a systematic review and meta-analysis by searching OVID MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) electronic databases. Studies of adult patients having general anaesthesia for any surgery where pEEG was used and POD was an outcome measure were included. Full-text reports of RCTs published from database inception until August 28, 2021, were included. Trials were excluded if sedation rather than general anaesthesia was administered, or the setting was intensive care. The primary outcome was POD assessed by validated tools. The study was prospectively registered with PROSPERO. RESULTS Nine studies, which included 4648 eligible subjects, were identified. The incidence of POD in the pEEG-guided general anaesthesia or lighter pEEG target group was 19.0% (440/2310) compared with 23.3% (545/2338) in the usual care or deeper pEEG target group (pooled odds ratio=0.78; 95% confidence interval, 0.60-1.00; P=0.054). Significant heterogeneity was detected (I2=53%). CONCLUSIONS Our primary analysis demonstrated a highly sensitive result with a pooled analysis of trials in which the intervention group adhered to manufacturer's recommended guidelines, showing reduced incidence of POD with pEEG guidance. High clinical heterogeneity limits inferences from this and any future meta-analyses. CLINICAL TRIAL REGISTRATION CRD42020199404 (PROSPERO).
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Affiliation(s)
| | | | - Lis Evered
- St. Vincent's Hospital, Melbourne, Australia; Weill Cornell Medicine, New York, NY, USA; University of Melbourne, Melbourne, Australia
| | | | - Kate Leslie
- University of Melbourne, Melbourne, Australia; Royal Melbourne Hospital, Melbourne, Australia; Monash University, Melbourne, Australia
| | - Timothy Short
- Auckland City Hospital, Auckland, New Zealand; University of Auckland, Auckland, New Zealand
| | - Doug Campbell
- Auckland City Hospital, Auckland, New Zealand; University of Auckland, Auckland, New Zealand.
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22
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McFadden J. Consciousness: Matter or EMF? Front Hum Neurosci 2023; 16:1024934. [PMID: 36741784 PMCID: PMC9889563 DOI: 10.3389/fnhum.2022.1024934] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
Conventional theories of consciousness (ToCs) that assume that the substrate of consciousness is the brain's neuronal matter fail to account for fundamental features of consciousness, such as the binding problem. Field ToC's propose that the substrate of consciousness is the brain's best accounted by some kind of field in the brain. Electromagnetic (EM) ToCs propose that the conscious field is the brain's well-known EM field. EM-ToCs were first proposed only around 20 years ago primarily to account for the experimental discovery that synchronous neuronal firing was the strongest neural correlate of consciousness (NCC). Although EM-ToCs are gaining increasing support, they remain controversial and are often ignored by neurobiologists and philosophers and passed over in most published reviews of consciousness. In this review I examine EM-ToCs against established criteria for distinguishing between ToCs and demonstrate that they outperform all conventional ToCs and provide novel insights into the nature of consciousness as well as a feasible route toward building artificial consciousnesses.
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Shi M, Huang Z, Xiao G, Xu B, Ren Q, Zhao H. Estimating the Depth of Anesthesia from EEG Signals Based on a Deep Residual Shrinkage Network. SENSORS (BASEL, SWITZERLAND) 2023; 23:1008. [PMID: 36679805 PMCID: PMC9865536 DOI: 10.3390/s23021008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
The reliable monitoring of the depth of anesthesia (DoA) is essential to control the anesthesia procedure. Electroencephalography (EEG) has been widely used to estimate DoA since EEG could reflect the effect of anesthetic drugs on the central nervous system (CNS). In this study, we propose that a deep learning model consisting mainly of a deep residual shrinkage network (DRSN) and a 1 × 1 convolution network could estimate DoA in terms of patient state index (PSI) values. First, we preprocessed the four raw channels of EEG signals to remove electrical noise and other physiological signals. The proposed model then takes the preprocessed EEG signals as inputs to predict PSI values. Then we extracted 14 features from the preprocessed EEG signals and implemented three conventional feature-based models as comparisons. A dataset of 18 patients was used to evaluate the models' performances. The results of the five-fold cross-validation show that there is a relatively high similarity between the ground-truth PSI values and the predicted PSI values of our proposed model, which outperforms the conventional models, and further, that the Spearman's rank correlation coefficient is 0.9344. In addition, an ablation experiment was conducted to demonstrate the effectiveness of the soft-thresholding module for EEG-signal processing, and a cross-subject validation was implemented to illustrate the robustness of the proposed method. In summary, the procedure is not merely feasible for estimating DoA by mimicking PSI values but also inspired us to develop a precise DoA-estimation system with more convincing assessments of anesthetization levels.
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Affiliation(s)
- Meng Shi
- School of Electronics, Peking University, Beijing 100084, China
| | - Ziyu Huang
- Department of Anesthesiology, Peking University People’s Hospital, Beijing 100044, China
| | - Guowen Xiao
- School of Electronics, Peking University, Beijing 100084, China
| | - Bowen Xu
- School of Electronics, Peking University, Beijing 100084, China
| | - Quansheng Ren
- School of Electronics, Peking University, Beijing 100084, China
| | - Hong Zhao
- Department of Anesthesiology, Peking University People’s Hospital, Beijing 100044, China
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24
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Tagliabue S, Lindner C, da Prat IC, Sanchez-Guerrero A, Serra I, Kacprzak M, Maruccia F, Silva OM, Weigel UM, de Nadal M, Poca MA, Durduran T. Comparison of cerebral metabolic rate of oxygen, blood flow, and bispectral index under general anesthesia. NEUROPHOTONICS 2023; 10:015006. [PMID: 36911206 PMCID: PMC9993084 DOI: 10.1117/1.nph.10.1.015006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
SIGNIFICANCE The optical measurement of cerebral oxygen metabolism was evaluated. AIM Compare optically derived cerebral signals to the electroencephalographic bispectral index (BIS) sensors to monitor propofol-induced anesthesia during surgery. APPROACH Relative cerebral metabolic rate of oxygen ( rCMRO 2 ) and blood flow (rCBF) were measured by time-resolved and diffuse correlation spectroscopies. Changes were tested against the relative BIS (rBIS) ones. The synchronism in the changes was also assessed by the R-Pearson correlation. RESULTS In 23 measurements, optically derived signals showed significant changes in agreement with rBIS: during propofol induction, rBIS decreased by 67% [interquartile ranges (IQR) 62% to 71%], rCMRO 2 by 33% (IQR 18% to 46%), and rCBF by 28% (IQR 10% to 37%). During recovery, a significant increase was observed for rBIS (48%, IQR 38% to 55%), rCMRO 2 (29%, IQR 17% to 39%), and rCBF (30%, IQR 10% to 44%). The significance and direction of the changes subject-by-subject were tested: the coupling between the rBIS, rCMRO 2 , and rCBF was witnessed in the majority of the cases (14/18 and 12/18 for rCBF and 19/21 and 13/18 for rCMRO 2 in the initial and final part, respectively). These changes were also correlated in time ( R > 0.69 to R = 1 , p - values < 0.05 ). CONCLUSIONS Optics can reliably monitor rCMRO 2 in such conditions.
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Affiliation(s)
- Susanna Tagliabue
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Claus Lindner
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | | | - Angela Sanchez-Guerrero
- Vall d’Hebron University Hospital Research Institute, Neurotraumatology and Neurosurgery Research Unit, Barcelona, Spain
| | - Isabel Serra
- Centre de Recerca Matemàtica, Bellaterra, Spain
- Barcelona Supercomputing Center—Centre Nacional de Supercomputació, Spain
| | - Michał Kacprzak
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
- Nalecz Institute of Biocybernetics and Biomedical Engineering PAS, Warsaw, Poland
| | - Federica Maruccia
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
- Vall d’Hebron University Hospital Research Institute, Neurotraumatology and Neurosurgery Research Unit, Barcelona, Spain
| | - Olga Martinez Silva
- Vall d’Hebron University Hospital, Department of Anesthesiology, Barcelona, Spain
| | - Udo M. Weigel
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
- HemoPhotonics S.L., Mediterranean Technology Park, Barcelona, Spain
| | - Miriam de Nadal
- Vall d’Hebron University Hospital, Department of Anesthesiology, Barcelona, Spain
- Universidad Autònoma de Barcelona, Plaça Cívica, Barcelona, Spain
| | - Maria A. Poca
- Vall d’Hebron University Hospital Research Institute, Neurotraumatology and Neurosurgery Research Unit, Barcelona, Spain
- Universidad Autònoma de Barcelona, Plaça Cívica, Barcelona, Spain
- Vall d’Hebron University Hospital, Department of Neurosurgery, Barcelona, Spain
| | - Turgut Durduran
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
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25
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Dubey JK, Goel N, Chawla R, Gupta M, Bhardwaj M. Supralabial Site: An Alternative Site for Bispectral Index Monitoring: A Cross-sectional Study. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2022. [DOI: 10.1055/s-0042-1756430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Background Bi-spectral index (BIS) has been traditionally used to monitor the depth of anesthesia, with the forehead being the usual site for electrode placement. When the manufacturer-recommended site is itself an operative field or the placement interferes with the surgery, the search for an alternative position of electrode placement is warranted. In our endeavor to do so, we conducted this study to compare BIS scores derived from frontal and supralabial electrode placement.
Methods A cross-sectional study was conducted on a group of 50 patients using two BIS Quatro sensors attached to the frontal and supralabial regions of each patient and connected to two different sets of monitors. BIS values, electromyography (EMG) values, and signal quality index (SQI) were noted from both sites every 15 min during the maintenance phase of anesthesia. Collected data were analyzed using the Bland–Altman analysis.
Results Data analysis of BIS values showed negative bias at most time points with a minimum negative bias of 0.2 with a limit of agreement of −3.67/3.27 and a maximum negative bias of 1.14 with a limit of agreement of −7.61/5.33. The overall 95% limit of agreement for pooled BIS data ranged from −6.63 to 6.1.
Conclusion BIS sensor placement at the supralabial site can be used as an alternative to the frontal placement in scenarios where the frontal position is the surgical site or is inaccessible during the maintenance of general anesthesia as in neurosurgery with particular emphasis on skin preparation and proper positioning of BIS electrodes to improve the signal quality.
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Affiliation(s)
- Jitendra K. Dubey
- Department of Anaesthesiology and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Nitesh Goel
- Department of Anaesthesiology and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Rajiv Chawla
- Department of Anaesthesiology and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Manish Gupta
- Department of Anaesthesiology and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Manoj Bhardwaj
- Department of Anaesthesiology and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Analgosedation in Critically Ill Adults Receiving Extracorporeal Membrane Oxygenation Support. ASAIO J 2022; 68:1419-1427. [PMID: 35593878 PMCID: PMC9675878 DOI: 10.1097/mat.0000000000001758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is an increasingly utilized intervention for cardiopulmonary failure. Analgosedation during ECMO support is essential to ensure adequate pain and agitation control and ventilator synchrony, optimize ECMO support, facilitate patient assessment, and minimize adverse events. Although the principles of analgosedation are likely similar for all critically ill patients, ECMO circuitry alters medication pharmacodynamics and pharmacokinetics. The lack of clinical guidelines for analgosedation during ECMO, especially at times of medication shortage, can affect patient management. Here, we review pharmacological considerations, protocols, and special considerations for analgosedation in critically ill adults receiving ECMO support.
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Lan JY, Shieh JS, Yeh JR, Fan SZ. Fractal Properties of Heart Rate Dynamics: A New Biomarker for Anesthesia-Biphasic Changes in General Anesthesia and Decrease in Spinal Anesthesia. SENSORS (BASEL, SWITZERLAND) 2022; 22:9258. [PMID: 36501959 PMCID: PMC9740393 DOI: 10.3390/s22239258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/10/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
Processed electroencephalogram (EEG) has been considered a useful tool for measuring the depth of anesthesia (DOA). However, because of its inability to detect the activities of the brain stem and spinal cord responsible for most of the vital signs, a new biomarker for measuring the multidimensional activities of the central nervous system under anesthesia is required. Detrended fluctuation analysis (DFA) is a new technique for detecting the scaling properties of nonstationary heart rate (HR) behavior. This study investigated the changes in fractal properties of heart rate variability (HRV), a nonlinear analysis, under intravenous propofol, inhalational desflurane, and spinal anesthesia. We compared the DFA method with traditional spectral analysis to evaluate its potential as an alternative biomarker under different levels of anesthesia. Eighty patients receiving elective procedures were randomly allocated different anesthesia. HRV was measured with spectral analysis and DFA short-term (4-11 beats) scaling exponent (DFAα1). An increase in DFAα1 followed by a decrease at higher concentrations during propofol or desflurane anesthesia is observed. Spinal anesthesia decreased the DFAα1 and low-/high-frequency ratio (LF/HF ratio). DFAα1 of HRV is a sensitive and specific method for distinguishing changes from baseline to anesthesia state. The DFAα1 provides a potential real-time biomarker to measure HRV as one of the multiple dimensions of the DOA.
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Affiliation(s)
- Jheng-Yan Lan
- Department of Anesthesiology, Taipei Veterans General Hospital, Yuli Branch, Hualian 98142, Taiwan
| | - Jiann-Shing Shieh
- Department of Mechanical Engineering, Yuan Ze University, Taoyuan 320, Taiwan
| | - Jia-Rong Yeh
- Department of Anesthesiology, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Shou-Zen Fan
- Department of Anesthesiology, National Taiwan University Hospital, Taipei 10002, Taiwan
- Department of Anesthesiology, En Chu Kong Hospital, New Taipei City 237, Taiwan
- College of Medicine, National Taiwan University, Taipei 10002, Taiwan
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28
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Tobar E, Farías JI, Rojas V, Penna A, Egaña JI, Ponce D, Bravo D, Maldonado F, Gajardo A, Gutiérrez R. Electroencephalography spectral edge frequency and suppression rate-guided sedation in patients with COVID-19: A randomized controlled trial. Front Med (Lausanne) 2022; 9:1013430. [DOI: 10.3389/fmed.2022.1013430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
BackgroundSedation in coronavirus disease 2019 (COVID-19) patients has been identified as a major challenge. We aimed to investigate whether the use of a multiparameter electroencephalogram (EEG) protocol to guide sedation in COVID-19 patients would increase the 30-day mechanical ventilation-free days (VFD).MethodsWe conducted a double-blind randomized clinical trial. We included patients with severe pneumonia due to COVID-19 who required mechanical ventilation (MV) and deep sedation. We randomized to the control (n = 25) or multiparameter group (n = 25). Sedation in the intervention group was administered following the standard institutional protocols together with a flow chart designed to reduce the propofol administration dose if the EEG suppression rate was over 2% or the spectral edge frequency 95 (SEF95) was below 10 Hz. We performed an intention-to-treat analysis to evaluate our primary outcome (30-day VFD).ResultsThere was no difference in VFD at day 30 (median: 11 [IQR 0–20] days in the control group vs. 0 [IQR 0–21] days in the BIS multiparameter group, p = 0.87). Among secondary outcomes, we documented a 17% reduction in the total adjusted propofol administered during the first 5 days of the protocol [median: 2.3 (IQR 1.9–2.8) mg/k/h in the control group vs. 1.9(IQR 1.5–2.2) mg/k/h in the MP group, p = 0.005]. This was accompanied by a higher average BIS value in the intervention group throughout the treatment period.ConclusionA sedation protocol guided by multivariate EEG-derived parameters did not increase the 30-day VFD. However, the intervention led to a reduction in total propofol administration.
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Alkhachroum A, Appavu B, Egawa S, Foreman B, Gaspard N, Gilmore EJ, Hirsch LJ, Kurtz P, Lambrecq V, Kromm J, Vespa P, Zafar SF, Rohaut B, Claassen J. Electroencephalogram in the intensive care unit: a focused look at acute brain injury. Intensive Care Med 2022; 48:1443-1462. [PMID: 35997792 PMCID: PMC10008537 DOI: 10.1007/s00134-022-06854-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/31/2022] [Indexed: 02/04/2023]
Abstract
Over the past decades, electroencephalography (EEG) has become a widely applied and highly sophisticated brain monitoring tool in a variety of intensive care unit (ICU) settings. The most common indication for EEG monitoring currently is the management of refractory status epilepticus. In addition, a number of studies have associated frequent seizures, including nonconvulsive status epilepticus (NCSE), with worsening secondary brain injury and with worse outcomes. With the widespread utilization of EEG (spot and continuous EEG), rhythmic and periodic patterns that do not fulfill strict seizure criteria have been identified, epidemiologically quantified, and linked to pathophysiological events across a wide spectrum of critical and acute illnesses, including acute brain injury. Increasingly, EEG is not just qualitatively described, but also quantitatively analyzed together with other modalities to generate innovative measurements with possible clinical relevance. In this review, we discuss the current knowledge and emerging applications of EEG in the ICU, including seizure detection, ischemia monitoring, detection of cortical spreading depolarizations, assessment of consciousness and prognostication. We also review some technical aspects and challenges of using EEG in the ICU including the logistics of setting up ICU EEG monitoring in resource-limited settings.
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Affiliation(s)
- Ayham Alkhachroum
- Department of Neurology, University of Miami, Miami, FL, USA
- Department of Neurology, Jackson Memorial Hospital, Miami, FL, USA
| | - Brian Appavu
- Department of Child Health and Neurology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
- Department of Neurosciences, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Satoshi Egawa
- Neurointensive Care Unit, Department of Neurosurgery, and Stroke and Epilepsy Center, TMG Asaka Medical Center, Saitama, Japan
| | - Brandon Foreman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, USA
| | - Nicolas Gaspard
- Department of Neurology, Erasme Hospital, Free University of Brussels, Brussels, Belgium
| | - Emily J Gilmore
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
- Neurocritical Care and Emergency Neurology, Department of Neurology, Ale University School of Medicine, New Haven, CT, USA
| | - Lawrence J Hirsch
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Pedro Kurtz
- Department of Intensive Care Medicine, D'or Institute for Research and Education, Rio de Janeiro, Brazil
- Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
| | - Virginie Lambrecq
- Department of Clinical Neurophysiology and Epilepsy Unit, AP-HP, Pitié Salpêtrière Hospital, Reference Center for Rare Epilepsies, 75013, Paris, France
| | - Julie Kromm
- Departments of Critical Care Medicine and Clinical Neurosciences, Cumming School of Medicine, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, AB, Canada
| | - Paul Vespa
- Brain Injury Research Center, Department of Neurosurgery, University of California, Los Angeles, USA
| | - Sahar F Zafar
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Benjamin Rohaut
- Department of Neurology, Sorbonne Université, Pitié-Salpêtrière-AP-HP and Paris Brain Institute, ICM, Inserm, CNRS, Paris, France
| | - Jan Claassen
- Department of Neurology, Neurological Institute, Columbia University, New York Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
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30
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Zhang J, Cheng Z, Tian Y, Weng L, Zhang Y, Yang X, Schäfer MKE, Guo Q, Huang C. Cerebral Tissue Oxygen Saturation Correlates with Emergence from Propofol-Remifentanil Anesthesia: An Observational Cohort Study. J Clin Med 2022; 11:jcm11164878. [PMID: 36013112 PMCID: PMC9410034 DOI: 10.3390/jcm11164878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/01/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Anesthesia emergence is accompanied by changes in cerebral circulation. It is unknown whether cerebral tissue oxygen saturation (SctO2) could be an indicator of emergence. Changes in SctO2, bispectral index (BIS), mean arterial pressure (MAP), and heart rate (HR) were evaluated during the emergence from propofol-remifentanil anesthesia. At the time of cessation of anesthetic delivery, SctO2, BIS, MAP, and HR values were recorded as baseline. The changes of these parameters from the baseline were recorded as Δ SctO2, Δ BIS, Δ MAP, and Δ HR. The behavioral signs (body movement, coughing, or eye opening) and response to commands (indicating regaining of consciousness) were used to define emergence states. Prediction probability (Pk) was used to examine the accuracy of SctO2, BIS, MAP, and HR as indicators of emergence. SctO2 showed an abrupt and distinctive increase when appearing behavioral signs. BIS, MAP, and HR, also increased but with a large inter-individual variability. Pk value of Δ SctO2 was 0.97 to predict the appearance behavioral signs from 2 min before that, which was much higher than the Pk values of Δ BIS (0.81), Δ MAP (0.71) and Δ HR (0.87). The regaining of consciousness was associated with a further increase in the SctO2 value.
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Affiliation(s)
- Jianxi Zhang
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
| | - Zhigang Cheng
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha 410008, China
| | - Ying Tian
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
| | - Lili Weng
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
| | - Yiying Zhang
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
| | - Xin Yang
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
| | - Michael K. E. Schäfer
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University Mainz, 55122 Mainz, Germany
- Focus Program Translational Neurosciences (FTN), Research Center of Immunotherapy, Johannes Gutenberg-University Mainz, 55122 Mainz, Germany
| | - Qulian Guo
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha 410008, China
| | - Changsheng Huang
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha 410008, China
- Correspondence: ; Tel./Fax: +86-731-84327413
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31
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Rasulo FA, Hopkins P, Lobo FA, Pandin P, Matta B, Carozzi C, Romagnoli S, Absalom A, Badenes R, Bleck T, Caricato A, Claassen J, Denault A, Honorato C, Motta S, Meyfroidt G, Radtke FM, Ricci Z, Robba C, Taccone FS, Vespa P, Nardiello I, Lamperti M. Processed Electroencephalogram-Based Monitoring to Guide Sedation in Critically Ill Adult Patients: Recommendations from an International Expert Panel-Based Consensus. Neurocrit Care 2022; 38:296-311. [PMID: 35896766 PMCID: PMC10090014 DOI: 10.1007/s12028-022-01565-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/20/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND The use of processed electroencephalography (pEEG) for depth of sedation (DOS) monitoring is increasing in anesthesia; however, how to use of this type of monitoring for critical care adult patients within the intensive care unit (ICU) remains unclear. METHODS A multidisciplinary panel of international experts consisting of 21 clinicians involved in monitoring DOS in ICU patients was carefully selected on the basis of their expertise in neurocritical care and neuroanesthesiology. Panelists were assigned four domains (techniques for electroencephalography [EEG] monitoring, patient selection, use of the EEG monitors, competency, and training the principles of pEEG monitoring) from which a list of questions and statements was created to be addressed. A Delphi method based on iterative approach was used to produce the final statements. Statements were classified as highly appropriate or highly inappropriate (median rating ≥ 8), appropriate (median rating ≥ 7 but < 8), or uncertain (median rating < 7) and with a strong disagreement index (DI) (DI < 0.5) or weak DI (DI ≥ 0.5 but < 1) consensus. RESULTS According to the statements evaluated by the panel, frontal pEEG (which includes a continuous colored density spectrogram) has been considered adequate to monitor the level of sedation (strong consensus), and it is recommended by the panel that all sedated patients (paralyzed or nonparalyzed) unfit for clinical evaluation would benefit from DOS monitoring (strong consensus) after a specific training program has been performed by the ICU staff. To cover the gap between knowledge/rational and routine application, some barriers must be broken, including lack of knowledge, validation for prolonged sedation, standardization between monitors based on different EEG analysis algorithms, and economic issues. CONCLUSIONS Evidence on using DOS monitors in ICU is still scarce, and further research is required to better define the benefits of using pEEG. This consensus highlights that some critically ill patients may benefit from this type of neuromonitoring.
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Affiliation(s)
- Frank A Rasulo
- Department of Anesthesiology and Intensive Care, Spedali Civili Hospital, Brescia, Italy. .,Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
| | - Philip Hopkins
- Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Francisco A Lobo
- Institute of Anesthesiology, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Pierre Pandin
- Department of Anesthesia and Intensive Care, Erasme Hospital, Universitè Libre de Bruxelles, Brussels, Belgium
| | - Basil Matta
- Department of Anaesthesia and Intensive Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Carla Carozzi
- Department of Anesthesia and Intensive Care, Istituto Neurologico C. Besta, Milan, Italy
| | - Stefano Romagnoli
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy
| | - Anthony Absalom
- Department of Anesthesiology, University Medical Center Groningen, Groningen, Netherlands
| | - Rafael Badenes
- Department of Anesthesia and Intensive Care, University of Valencia, Valencia, Spain
| | - Thomas Bleck
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Evanston, IL, USA
| | - Anselmo Caricato
- Department of Anesthesia and Intensive Care, Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jan Claassen
- Department of Neurocritical Care, Columbia University Irving Medical Center, New York, NY, USA
| | - André Denault
- Critical Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Cristina Honorato
- Department of Anesthesiology and Critical Care, Universidad de Navarra, Pamplona, Spain
| | - Saba Motta
- Scientific Library, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Geert Meyfroidt
- Department of Intensive Care, University Hospitals Leuven and Laboratory of Intensive Care Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Finn Michael Radtke
- Department of Anesthesiology IRS, Nykøbing F. Hospital, Nykøbing Falster, Denmark
| | - Zaccaria Ricci
- Department of Pediatric Anesthesia, Meyer University Hospital of Florence, University of Florence, Florence, Italy
| | - Chiara Robba
- Department of Anesthesia and Intensive Care, Policlinico San Martino and University of Genoa, Genoa, Italy
| | - Fabio S Taccone
- Department of Anesthesia and Intensive Care, Erasme Hospital, Universitè Libre de Bruxelles, Brussels, Belgium
| | - Paul Vespa
- Department of Neurosurgery and Neurocritical Care, Los Angeles Medical Center, Ronald Reagan University of California, Los Angeles, CA, USA
| | - Ida Nardiello
- Department of Anesthesiology and Intensive Care, Spedali Civili Hospital, Brescia, Italy
| | - Massimo Lamperti
- Institute of Anesthesiology, Cleveland Clinic, Abu Dhabi, United Arab Emirates
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Krooupa AM, Stone P, McKeever S, Seddon K, Davis S, Sampson EL, Tookman A, Martin J, Nambisan V, Vivat B. Do palliative care patients and relatives think it would be acceptable to use Bispectral index (BIS) technology to monitor palliative care patients' levels of consciousness? A qualitative exploration with interviews and focus groups for the I-CAN-CARE research programme. BMC Palliat Care 2022; 21:86. [PMID: 35610644 PMCID: PMC9131519 DOI: 10.1186/s12904-022-00949-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/14/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Bispectral index (BIS) monitoring uses electroencephalographic data as an indicator of patients' consciousness level. This technology might be a useful adjunct to clinical observation when titrating sedative medications for palliative care patients. However, the use of BIS in palliative care generally, and in the UK in particular, is under-researched. A key area is this technology's acceptability for palliative care service users. Ahead of trialling BIS in practice, and in order to ascertain whether such a trial would be reasonable, we conducted a study to explore UK palliative care patients' and relatives' perceptions of the technology, including whether they thought its use in palliative care practice would be acceptable. METHODS A qualitative exploration was undertaken. Participants were recruited through a UK hospice. Focus groups and semi-structured interviews were conducted with separate groups of palliative care patients, relatives of current patients, and bereaved relatives. We explored their views on acceptability of using BIS with palliative care patients, and analysed their responses following the five key stages of the Framework method. RESULTS We recruited 25 participants. There were ten current hospice patients in three focus groups, four relatives of current patients in one focus group and one individual interview, and eleven bereaved relatives in three focus groups and two individual interviews. Our study participants considered BIS acceptable for monitoring palliative care patients' consciousness levels, and that it might be of use in end-of-life care, provided that it was additional to (rather than a replacement of) usual care, and patients and/or family members were involved in decisions about its use. Participants also noted that BIS, while possibly obtrusive, is not invasive, with some seeing it as equivalent to wearable technological devices such as activity watches. CONCLUSIONS Participants considered BIS technology might be of benefit to palliative care as a non-intrusive means of assisting clinical assessment and decision-making at the end of life, and concluded that it would therefore be acceptable to trial the technology with patients.
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Affiliation(s)
- Anna-Maria Krooupa
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK.
| | - Patrick Stone
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Stephen McKeever
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK ,grid.1008.90000 0001 2179 088XDepartment of Nursing, The University of Melbourne, Melbourne, Australia
| | - Kathy Seddon
- grid.419428.20000 0000 9768 8171Marie Curie Palliative Care Research Voices, London, UK
| | - Sarah Davis
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Elizabeth L. Sampson
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, UK
| | - Adrian Tookman
- grid.419428.20000 0000 9768 8171Marie Curie Hospice Hampstead, London, UK ,Field Editor Cochrane; Palliative and Supportive Care, Oxford, UK
| | - Jonathan Martin
- grid.450578.b0000 0001 1550 1922Central & North West London NHS Foundation Trust, London, UK ,grid.52996.310000 0000 8937 2257National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Bella Vivat
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
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Baron Shahaf D, Weissman A, Priven L, Shahaf G. Identifying Recall Under Sedation by a Novel EEG Based Index of Attention—A Pilot Study. Front Med (Lausanne) 2022; 9:880384. [PMID: 35492350 PMCID: PMC9047181 DOI: 10.3389/fmed.2022.880384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/24/2022] [Indexed: 11/15/2022] Open
Abstract
Overview Recall is an accepted consequence of sedation. But due to the very low prevalence of the more devastating awareness under anesthesia (AUA), it might be of value to assess first the efficacy of new markers for AUA by their efficacy in discovering the more prevalent recall under sedation (RUS). In this pilot study we assessed whether a novel index for attentional effort, the cognitive effort index (CEI), derived in real-time from one forehead EEG channel, could differentiate between patients with or without RUS. Methods EEG was sampled from 2 groups: (1) Patients who underwent deep sedation (n = 25) (using drugs according to the anesthesiologist preference, but generally combining either Midazolam or Propofol together with either Fentanyl or Remifentanil). (2) Patients who underwent general anesthesia (GA, n = 13, a negative control for recall). In recovery, recall was assessed using the BRICE questionnaire. Results Of the 25 sedated patients, 11 experienced recall. The CEI marker was high during significantly longer periods in patients with recall, compared to sedated patients, or patients under GA, without recall. Moreover, the increase in CEI was evident mainly toward the end of the procedure. Conclusion RUS seems to associate with higher level of attention, which is identified in real-time by the easy-to-extract CEI marker.
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Affiliation(s)
- Dana Baron Shahaf
- Department of Anesthesia, Rambam Health Care Campus, Haifa, Israel
- *Correspondence: Dana Baron Shahaf
| | - Avi Weissman
- Department of Anesthesia, Rambam Health Care Campus, Haifa, Israel
| | - Leonid Priven
- Department of Anesthesia, Rambam Health Care Campus, Haifa, Israel
| | - Goded Shahaf
- The Applied Neurophysiology Lab, Rambam Health Care Campus, Haifa, Israel
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Density spectral array as an additional sedative indicator. J Anesth 2022; 36:444. [DOI: 10.1007/s00540-022-03064-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 11/27/2022]
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Campbell J. Interference between processed electroencephalograph and neuromuscular blockade monitoring. Anaesthesia 2022; 77:940-941. [PMID: 35388474 DOI: 10.1111/anae.15734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 12/01/2022]
Affiliation(s)
- J Campbell
- Southern HSC Trust, Northern Ireland, UK
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Hight D, Schanderhazi C, Huber M, Stüber F, Kaiser HA. Age, minimum alveolar concentration and choice of depth of sedation monitor: examining the paradox of age when using the Narcotrend monitor: A secondary analysis of an observational study. Eur J Anaesthesiol 2022; 39:305-314. [PMID: 34313611 DOI: 10.1097/eja.0000000000001576] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND With an ageing global population, it is important to individualise titration of anaesthetics according to age and by measuring their effect on the brain. A recent study reported that during general surgery, the given concentration of volatile anaesthetics, expressed as a fraction of the minimum alveolar concentration (MAC fraction), decreases by around only 3% per age-decade, which is less than the 6% expected from age-adjusted MAC. Paradoxically, despite the excessive dosing, Bispectral index (BIS) values also increased. OBJECTIVE We planned to investigate the paradox of age when using the Narcotrend depth of anaesthesia monitor. DESIGN Secondary analyses of a prospective observational study. SETTING Tertiary hospital in Switzerland, recordings took place during 2016 and 2017. PATIENTS One thousand and seventy-two patients undergoing cardiac surgery entered the study, and 909 with noise-free recordings and isoflurane anaesthesia were included in this analysis. INTERVENTION We calculated mean end-tidal MAC fraction and mean index value of the Narcotrend depth of sedation monitor used in the study during the prebypass period. Statistical associations were modelled using linear regression, local weighted regression (LOESS) and a generalised additive model (GAM). MAIN OUTCOME MEASURES Primary endpoints in this study were the change in end-tidal MAC fraction and mean Narcotrend index values, both measured per age-decade. RESULTS We observed a linear decrease in end-tidal MAC fraction of 3.2% per age-decade [95% confidence interval (CI) -3.97% to -2.38%, P < 0.001], consistent with previous findings. In contrast to the BIS, mean Narcotrend index values decreased with age at 3.0 index points per age-decade (95% CI, -3.55 points to -2.36 points, P < 0.001), a direction of change commensurate with the increasing age-adjusted MAC fraction with patient age. These relationships were consistent regardless of whether age-adjusted MAC was displayed on the anaesthetic machine. CONCLUSIONS We caution that the 'paradox of age' may in part depend on the choice of depth of sedation monitor. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02976584.
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Affiliation(s)
- Darren Hight
- From the Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern (DH, CS, MH, FS, HAK) and Department of General Internal Medicine, Canton Hospital Frauenfeld, Frauenfeld, Switzerland (CS)
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Metodiev Y, Lucas D. The role of total intravenous anaesthesia for caesarean delivery. Int J Obstet Anesth 2022; 51:103548. [DOI: 10.1016/j.ijoa.2022.103548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/23/2022] [Accepted: 04/04/2022] [Indexed: 11/27/2022]
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Efstathiou G, Batistaki C, Soulioti E, Roungeris L, Matsota P. Opioid-Free Anesthesia and Postoperative Cognitive Dysfunction After Minor Urological Surgery: A Case Series Study. Anesth Pain Med 2022; 12:e122094. [PMID: 35433375 PMCID: PMC8995876 DOI: 10.5812/aapm.122094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 12/03/2022] Open
Abstract
Background Postoperative cognitive dysfunction (POCD) is a complication that mainly occurs in adult patients and refers to a new-onset decline in cognitive function after anesthesia and surgery. The literature lacks evidence regarding opioid-free anesthesia and its impact on mental function postoperatively. Objectives The effect of opioid-free anesthesia on POCD following urological surgery has not been previously reported. Accordingly, we present a case series of 15 adult patients undergoing transurethral urological surgery under general anesthesia using an opioid-free protocol with dexmedetomidine, ketamine, and lidocaine. Methods Patients that underwent simple transurethral elective urological procedures under general opioid-free anesthesia were included. This case series is part of a prospective clinical study regarding opioid-free anesthesia and served as a pilot sample. The mini-mental state examination (MMSE) test, performed preoperatively and 12 hours postoperatively, was applied to assess POCD. Results Fifteen patients with a mean age of 68 years old were included in the study. The opioid-free protocol was associated with non-statistically significant changes of the MMSE test after minor urological procedures. Conclusions In our study, an opioid-free protocol of general anesthesia, using a mixture of dexmedetomidine, ketamine, and lidocaine, did not seem to have a negative impact on postoperative cognitive function in patients undergoing transurethral urological surgery. Further studies specifically designed to identify this effect are certainly required to further prove such an effect.
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Affiliation(s)
- Georgia Efstathiou
- 2nd Department of Anesthesiology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, 1 Rimini str, Athens, 12462, Greece
- Corresponding Author: 2nd Department of Anesthesiology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, 1 Rimini str, Athens, 12462, Greece. Tel: +30-2105831961,
| | - Chrysanthi Batistaki
- 2nd Department of Anesthesiology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, 1 Rimini str, Athens, 12462, Greece
| | - Eleftheria Soulioti
- 2nd Department of Anesthesiology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, 1 Rimini str, Athens, 12462, Greece
| | - Loizos Roungeris
- 2nd Department of Anesthesiology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, 1 Rimini str, Athens, 12462, Greece
| | - Paraskevi Matsota
- 2nd Department of Anesthesiology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, 1 Rimini str, Athens, 12462, Greece
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Optimal BIS reference functions for closed-loop induction of anesthesia with propofol. Comput Biol Med 2022; 144:105289. [DOI: 10.1016/j.compbiomed.2022.105289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/10/2022] [Accepted: 01/24/2022] [Indexed: 11/18/2022]
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Davey Z, Gupta PB, Li DR, Nayak RU, Govindarajan P. Rapid Response EEG: Current State and Future Directions. Curr Neurol Neurosci Rep 2022; 22:839-846. [PMID: 36434488 PMCID: PMC9702853 DOI: 10.1007/s11910-022-01243-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To critically appraise the literature on the application, methods, and advances in emergency electroencephalography (EEG). RECENT FINDINGS The development of rapid EEG (rEEG) technologies and other reduced montage approaches, along with advances in machine learning over the past decade, has increased the rate and access to EEG acquisition. These achievements have made EEG in the emergency setting a practical diagnostic technique for detecting seizures, suspected nonconvulsive status epilepticus (NCSE), altered mental status, stroke, and in the setting of sedation. Growing evidence supports using EEG to expedite medical decision-making in the setting of suspected acute neurological injury. This review covers approaches to acquiring EEG in the emergency setting in the adult and pediatric populations. We also cover the clinical impact of this data, the time associated with emergency EEG, and the costs of acquiring EEG in these settings. Finally, we discuss the advances in artificial intelligence for rapid electrophysiological interpretation.
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Affiliation(s)
- Zachary Davey
- grid.414467.40000 0001 0560 6544Department of Neurology, Walter Reed National Military Medical Center, Bethesda, MD USA
| | - Pranjal Bodh Gupta
- grid.240952.80000000087342732Department of Emergency Medicine, Stanford Medicine, Palo Alto, CA USA
| | - David R. Li
- grid.240952.80000000087342732Department of Emergency Medicine, Stanford Medicine, Palo Alto, CA USA
| | - Rahul Uday Nayak
- grid.240952.80000000087342732Department of Emergency Medicine, Stanford Medicine, Palo Alto, CA USA
| | - Prasanthi Govindarajan
- grid.240952.80000000087342732Department of Emergency Medicine, Stanford Medicine, Palo Alto, CA USA
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Zhan J, Yi TT, Wu ZX, Long ZH, Bao XH, Xiao XD, Du ZY, Wang MJ, Li H. A survey of current practices, attitudes and demands of anaesthesiologists regarding the depth of anaesthesia monitoring in China. BMC Anesthesiol 2021; 21:294. [PMID: 34814841 PMCID: PMC8609812 DOI: 10.1186/s12871-021-01510-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 11/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background In this study, we aimed to analyse survey data to explore two different hypotheses; and for this purpose, we distributed an online survey to Chinese anaesthesiologists. The hypothetical questions in this survey include: (1) Chinese anaesthesiologists mainly use the depth of anaesthesia (DoA) monitors to prevent intraoperative awareness and (2) the accuracy of these monitors is the most crucial performance factor during the clinical daily practice of Chinese anaesthesiologists. Methods We collected and statistically analysed the response of a total of 12,750 anesthesiologists who were invited to participate in an anonymous online survey. The Chinese Society of Anaesthesiologists (CSA) trial group provided the email address of each anaesthesiologist, and the selection of respondents was random from the computerized system. Results The overall response rate was 32.0% (4037 respondents). Only 9.1% (95% confidence interval, 8.2-10.0%) of the respondents routinely used DoA monitors. Academic respondents (91.5, 90.3-92.7%) most frequently used DoA monitoring to prevent awareness, whereas nonacademic respondents (88.8, 87.4-90.2%) most frequently used DoA monitoring to guide the delivery of anaesthetic agents. In total, the number of respondents who did not use a DoA monitor and whose patients experienced awareness (61.7, 57.8-65.6%) was significantly greater than those who used one or several DoA monitors (51.5, 49.8-53.2%). Overall, the crucial performance factor during DoA monitoring was considered by 61.9% (60.4-63.4%) of the respondents to be accuracy. However, most respondents (95.7, 95.1-96.3%) demanded improvements in the accuracy of the monitors for DoA monitoring. In addition, broad application in patients of all ages (86.3, 85.2-87.4%), analgesia monitoring (80.4, 79.2-81.6%), and all types of anaesthetic agents (75.6, 74.3-76.9%) was reported. In total, 65.0% (63.6-66.5%) of the respondents believed that DoA monitors should be combined with EEG and vital sign monitoring, and 53.7% (52.1-55.2%) believed that advanced DoA monitors should include artificial intelligence. Conclusions Academic anaesthesiologists primarily use DoA monitoring to prevent awareness, whereas nonacademic anaesthesiologists use DoA monitoring to guide the delivery of anaesthetics. Anaesthesiologists demand high-accuracy DoA monitors incorporating EEG signals, multiple vital signs, and antinociceptive indicators. DoA monitors with artificial intelligence may represent a new direction for future research on DoA monitoring. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01510-7.
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Affiliation(s)
- Jian Zhan
- Department of Anaesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China.,Department of Anaesthesiology, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Ting-Ting Yi
- Department of Anaesthesiology, Yongchuan Hospital, Chongqing Medical University, Chongqing, 402160, China
| | - Zhuo-Xi Wu
- Department of Anaesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China
| | - Zong-Hong Long
- Department of Anaesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China
| | - Xiao-Hang Bao
- Department of Anaesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China
| | - Xu-Dong Xiao
- Department of Anaesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China
| | - Zhi-Yong Du
- Department of Anaesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China
| | - Ming-Jun Wang
- Department of Anaesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
| | - Hong Li
- Department of Anaesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China.
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The impact of bolus versus continuous infusion of intravenous ketamine on bispectral index variations and desflurane administration during major surgery: The KETABIS study. Eur J Anaesthesiol 2021; 38:1168-1179. [PMID: 34474441 DOI: 10.1097/eja.0000000000001588] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although ketamine, a NMDA-receptor antagonist, tends to increase the bispectral index (BIS), it remains a widely used analgesic whenever administered in low doses during major surgery. OBJECTIVE The objective of this study was to compare the impact of intravenous ketamine (given either as a continuous infusion or as a bolus) on BIS and to compare desflurane administration and postoperative outcomes between the groups. DESIGN Prospective, randomised, parallel-group, open-label study. SETTING University hospital, operating room. PARTICIPANTS Fifty patients, scheduled for major abdominal surgery. INTERVENTIONS AND MAIN OUTCOMES MEASURES Patients were randomised into two groups: ketamine by intravenous continuous infusion - group (KI) and ketamine by i.v. bolus - group (KB). In the KI group, ketamine at a rate of 0.25 mg kg-1 h-1 was commenced at skin incision (T0) and maintained at this rate for the duration of surgery. In group KB, a ketamine bolus of 0.25 mg kg-1was administered at T0 and repeated every hour. The difference in BIS between the groups was compared from T0 onwards. The amount of desflurane administered to keep BIS within the usual recommended range (40-60) was compared, as were the doses of phenylephrine and remifentanil. Postoperative pain and recovery outcomes were also assessed. RESULTS After T0, the BIS increased significantly from baseline in group KB compared with group KI: the rise in BIS was 20 ± 8 vs. 11 ± 6, respectively (P = 0.0001). The between-group mean difference (95% confidence interval (CI), was 9 (5 to 13). In group KB, desflurane administration significantly increased for the first 15 min after T0: 6.3 ± 1.8 vs. 3.8 ± 1.3 ml (P < 0.0001) with a mean intergroup group difference (95% CI) of 2.4 (1.5 to 3.4) ml. There was no difference in desflurane administration when considering the full hour from T0 to T60 min: 16 ± 9 vs. 15 ± 5 ml (P = 0.63) with a mean intergroup difference (95% CI) of 1 (-3 to 5) ml. After surgery, pain scores, opioid consumption, incidence of nausea and vomiting and recovery scores were similar between groups. CONCLUSION Compared with a continuous ketamine infusion, a ketamine bolus significantly increased the BIS after T0. In order to keep the BIS below 60, significantly more desflurane was administered from T0 to T15 min in group KB. To prevent such higher desflurane administration and its related atmospheric pollution, our results suggest administering intra-operative intravenous ketamine as an infusion rather than a bolus. TRIAL REGISTRATION Clinicaltrials.gov registration identifier: NCT03781635.
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Zheng M, Yang B. A deep neural network with subdomain adaptation for motor imagery brain-computer interface. Med Eng Phys 2021; 96:29-40. [PMID: 34565550 DOI: 10.1016/j.medengphy.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The nonstationarity problem of EEG is very serious, especially for spontaneous signals, which leads to the poor effect of machine learning related to spontaneous signals, especially in related tasks across time, which correspondingly limits the practical use of brain-computer interface (BCI). OBJECTIVE In this paper, we proposed a new transfer learning algorithm, which can utilize the labeled motor imagery (MI) EEG data at the previous time to achieve better classification accuracies for a small number of labeled EEG signals at the current time. METHODS We introduced an adaptive layer into the full connection layer of a deep convolution neural network. The objective function of the adaptive layer was designed to minimize the Local Maximum Mean Discrepancy (LMMD) and the prediction error while minimizing the distance within each class (DWC) and maximizing the distance between classes within each domain (DBCWD). We verified the effectiveness of the proposed algorithm on two public datasets. RESULTS The classification accuracy of the proposed algorithm was higher than other comparison algorithms, and the paired t-test results also showed that the performance of the proposed algorithm was significantly different from that of other algorithms. The results of the confusion matrix and feature visualization showed the effectiveness of the proposed algorithm. CONCLUSION Experimental results showed that the proposed algorithm can achieve higher classification accuracy than other algorithms when there was only a small amount of labeled MI EEG data at the current time. It can be promising to be applied to the field of BCI.
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Affiliation(s)
- Minmin Zheng
- School of Mechatronic Engineering and Automation, Research Center of Brain Computer Engineering, Shanghai University, Shanghai, China; School of Mechanical and Electrical Engineering, Putian University, Fujian, China
| | - Banghua Yang
- School of Mechatronic Engineering and Automation, Research Center of Brain Computer Engineering, Shanghai University, Shanghai, China.
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Wang Y, Liu D, Liu J, Kong C, Zhang Z, Duan W, Dornbos D, Liu L. Quantitative EEG provides early prediction of poor outcome in acute ischemic stroke after endovascular treatment: a preliminary study. Neurol Res 2021; 43:831-837. [PMID: 34514961 DOI: 10.1080/01616412.2021.1939237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background and Purpose: Quantitative electroencephalogram (QEEG) parameters have been previously utilized in prognosis following acute ischemic stroke (AIS). However, the use and interpretation of QEEG parameters remain scarce following endovascular treatment (EVT) of AIS.Methods: AIS patients were prospectively enrolled following EVT, and 24-hour EEG monitoring was conducted. Global delta/alpha ratio (DAR), (delta + theta)/(alpha + beta) ratio (DTABR), and relative band power were analyzed. Primary outcome was a poor outcome (modified Rankin Scale ≥4 at 90-day follow-up). Multivariate logistic regression and diagnostic analyses were performed.Results: Poor outcome was seen in 35.5% (11/31) of enrolled patients. Multivariable logistic regression identified that higher DAR (OR 1.10, 95% CI 1.02-1.18, p = 0.02) and higher DTABR (OR 1.13, 95% CI 1.01-1.27, p = 0.02) were associated with poor outcome. DAR ≥14.3 demonstrated high sensitivity (90.9%), specificity (90.0%) and accuracy (90.3%) for poor outcome.Conclusions: Early evidence of elevated DAR and DTABR on quantitative EEG was associated with poor outcome at 90 days following EVT for AIS.
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Affiliation(s)
- Yunfeng Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Dacheng Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jingyi Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Chaohong Kong
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhe Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wanying Duan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - David Dornbos
- Department of Neurosurgery, Semmes-Murphey Clinic, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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Tufegdzic B, Lamperti M, Siyam A, Roser F. Air-embolism in the semi-sitting position for craniotomy: A narrative review with emphasis on a single centers experience. Clin Neurol Neurosurg 2021; 209:106904. [PMID: 34482115 DOI: 10.1016/j.clineuro.2021.106904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 01/05/2023]
Abstract
Albeit the semi-sitting position in neurosurgery has been in use for several decades, its application remains controversial in the neurosurgical and neuro-anaesthesia communities. The imminent and most feared risk of the sitting position is air entry into the vascular system due to the negative intravascular pressure leading to potentially life-threatening air embolism with its consequences. Recent advents in neurosurgical (improvement of the operating microscope, employment of intra-operative neurophysiological monitoring) and neuro-anaesthesia care (new anaesthetics, advanced monitoring modalities) have significantly impacted the approach to these surgeries. Vigilant intra-operative observation by an experienced team and peri-operative patient management guided by institutional protocols improves the safety profile of these surgeries. This review outlines the workflow and protocols used in our institution for all cases of semi-sitting position for skull base neurosurgery.
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Affiliation(s)
- Boris Tufegdzic
- Anaesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.
| | - Massimo Lamperti
- Anaesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Amira Siyam
- Anaesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Florian Roser
- Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
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Artificial Intelligence Analysis of EEG Amplitude in Intensive Heart Care. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6284035. [PMID: 34306595 PMCID: PMC8272660 DOI: 10.1155/2021/6284035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/08/2021] [Accepted: 06/22/2021] [Indexed: 02/05/2023]
Abstract
This article first studied the morphological characteristics of the EEG for intensive cardiac care; that is, based on the analysis of the mechanism of disease diagnosis and treatment, a signal processing and machine learning model was constructed. Then, the methods of signal preprocessing, signal feature extraction, new neural network model structure, training mechanism, optimization algorithm, and efficiency are studied, and experimental verification is carried out for public data sets and clinical big data. Then, the principle of intensive cardiac monitoring, the mechanism of disease diagnosis, the types of arrhythmia, and the characteristics of the typical signal are studied, and the rhythm performance, individual variability, and neurophysiological basis of electrical signals in intensive cardiac monitoring are researched. Finally, the automatic signal recognition technology is studied. In order to improve the training speed and generalization ability, a multiclassification model based on Least Squares Twin Support Vector Machine (LS-TWIN-SVM) is proposed. The computational complexity of the classification model algorithm is compared, and intelligence is adopted. The optimization algorithm selects the parameters of the classifier and uses the EEG signal to simulate the model. Support Vector Machines and their improved algorithms have achieved the ultimum in shallow neural networks and have achieved good results in the classification and recognition of bioelectric signals. The LS-TWIN-SVM algorithm proposed in this paper has achieved good results in the classification and recognition of bioelectric signals. It can perform bioinformatics processing on intensive cardiac care EEG signals, systematically biometric information, diagnose diseases, the real-time detection, auxiliary diagnosis, and rehabilitation of patients.
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Obara S, Oishi R, Nakano Y, Noji Y, Ebana H, Isosu T, Kurosawa S, Murakawa M. Update on the SedLine® algorithm for calculating the Patient State Index of older individuals during general anesthesia: a randomized controlled trial. Minerva Anestesiol 2021; 87:774-785. [PMID: 33938673 DOI: 10.23736/s0375-9393.21.14929-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The SedLine® sensor processes (Masimo Corporation; Irvine, CA, USA) raw electroencephalogram (EEG) signals and displays the depth of sedation as a Patient State Index (PSi). Reliance on standard processed EEG data and failure to recognize age-related effects can lead to an erroneous interpretation that low-amplitude EEG findings in an older patient signify an insufficient depth of anesthesia presented as abnormally high PSi values (AHPSi). We hypothesized that the incidence of AHPSi would decrease with the use of the recently-updated version of the SedLine® sensor, in which the Bispectral Index (BIS) values were used to titrate anesthesia. METHODS Thirty-three patients undergoing sevoflurane-remifentanil anesthesia were randomized into two groups. SedLine® sensors designed based on an old (v.1203) or updated (v.2000) algorithms were used. The BIS (v.4.1) and absolute index of total EEG power (TP) were simultaneously recorded. The attending anesthesiologists titrated the anesthetics, and BIS was maintained at 40-60. The incidence of AHPSi (PSi>50 with BIS 40-60) was calculated during the first 30 min after the start of surgery. RESULTS Compared to the old algorithm group, the incidence of AHPSi was significantly lower in the updated algorithm group (26.7% vs. 4.2%, P<0.001). Lower TP values and the use of the old algorithm have significant effect on increased PSi values (P<0.001). CONCLUSIONS The incidence of AHPSi decreased with the use of the updated version of the SedLine® algorithm.
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Affiliation(s)
- Shinju Obara
- Department of Surgical Operation, Fukushima Medical University Hospital, Hikarigaoka, Japan -
| | - Rieko Oishi
- Department of Anesthesiology, Fukushima Medical University School of Medicine, Hikarigaoka, Japan
| | - Yuko Nakano
- Department of Anesthesiology, Fukushima Medical University School of Medicine, Hikarigaoka, Japan
| | - Yoshie Noji
- Department of Anesthesiology, Fukushima Medical University School of Medicine, Hikarigaoka, Japan
| | - Hideaki Ebana
- Department of Anesthesiology, Fukushima Medical University School of Medicine, Hikarigaoka, Japan
| | - Tsuyoshi Isosu
- Department of Intensive Care, Fukushima Medical University Hospital, Hikarigaoka, Japan
| | - Shin Kurosawa
- Department of Anesthesiology, Fukushima Medical University School of Medicine, Hikarigaoka, Japan
| | - Masahiro Murakawa
- Department of Anesthesiology, Fukushima Medical University School of Medicine, Hikarigaoka, Japan
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Na HS, Lim DJ, Koo BW, Oh AY, Lee PB. The influence of moderate or deep neuromuscular block status on anesthetic depth monitoring system during total intravenous anesthesia using propofol and remifentanil: A randomized trial. Sci Prog 2021; 104:368504211010629. [PMID: 33877942 PMCID: PMC10454749 DOI: 10.1177/00368504211010629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The neuromuscular block state may affect the electroencephalogram-derived index representing the anesthetic depth. We applied an Anesthetic Depth Monitoring for Sedation (ADMS) to patients undergoing laparoscopic cholecystectomy under total intravenous anesthesia, and evaluated the requirement of propofol according to the different neuromuscular block state. Adult patients scheduled to undergo laparoscopic cholecystectomy were enrolled and randomly assigned to either the moderate (MB) or deep neuromuscular block (DB) group. The UniCon sensor of ADMS was applied to monitor anesthetic depth and the unicon value was maintained between 40 and 50 during the operation. According to the group assignment, intraoperative rocuronium was administered to maintain proper neuromuscular block state, moderate or deep block state. The unicon value, electromyography (EMG) index, and total dose of propofol and rocuronium were analyzed. At similar anesthetic depth, less propofol was used in the DB group compared to the MB group (6.19 ± 1.36 in the MB mg/kg/h group vs 4.93 ± 3.02 mg/kg/h in the DM group, p = 0.042). As expected, more rocuronium were used in the DB group than in the MB group (0.8 ± 0.2 mg/kg in the MB group vs 1.2 ± 0.2 mg/kg in the DB group, p = 0.023) and the EMG indices were lower in the DB group than in the MB group, at several time points as follows: at starting operation (p < 0.001); at 15 (p = 0.019), 45 (p = 0.011), and 60 min (p < 0.001) after the initiation of the operation; at the end of operation (p = 0.003); and at 5 min after the administration of sugammadex (p < 0.001). At similar anesthetic depth, patients under the deep neuromuscular block state required less propofol with lower intraoperative EMG indices compared to those under the moderate neuromuscular block state during general anesthesia.
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Affiliation(s)
- Hyo-Seok Na
- Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea
| | - Dae-Jin Lim
- Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea
| | - Bon-Wook Koo
- Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea
| | - Ah-Young Oh
- Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea
- Anesthesiology and Pain Medicine, Seoul National University, Seoul, South Korea
| | - Pyung-Bok Lee
- Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea
- Anesthesiology and Pain Medicine, Seoul National University, Seoul, South Korea
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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:e23930. [PMID: 33530193 PMCID: PMC7850716 DOI: 10.1097/md.0000000000023930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/07/2020] [Accepted: 11/27/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To investigate whether closed-loop systems under bispectral index anesthesia depth monitoring can reduce the intraoperative propofol dosage. METHODS All randomized controlled trials (RCTs) on reducing propofol dosage under closed-loop systems were collected, and the literature was screened out, the abstracts and full texts were carefully read, and the references were tracked, data extraction and quality evaluation were conducted on the included research, and the RevMan5.3 software was used for meta-analysis. The main results were propofol and the incidence of adverse reactions such as hypertensive hypotension and postoperative cognitive dysfunction. A total of 879 cases were included in 8 articles, including 450 occurrences in the closed-loop system group and 429 cases in the open-loop system group. RESULTS Compared with manual control, closed-loop systems under bispectral index anesthesia depth monitoring reduced the dose of propofol (MD: -0.62, 95% CI: -1.08--0.16, P = .008), with heterogeneity (I2 = 80%). Closed-loop systems significantly reduced the incidence of abnormal blood pressure (MD: -0.02, 95%CI: -0.05-0.01, P = .15, I2 = 74%) and postoperative cognitive dysfunction (MD: -0.08, 95% CI: -0.14 -0.01, P = .02, I2 = 94%). CONCLUSION Bispectral index monitoring of propofol closed-loop target-controlled infusion system can reduce the amount of propofol, reduce the incidence of adverse reactions such as hypertensive or hypotension and postoperative cognitive dysfunction.
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50
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Norton J. IONM protocols. J Clin Monit Comput 2021; 35:957-958. [PMID: 33459946 DOI: 10.1007/s10877-021-00650-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Jonathan Norton
- Division of Neurosurgery, Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada.
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