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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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Casey CP, Tanabe S, Farahbakhsh ZZ, Parker M, Bo A, White M, Ballweg T, Mcintosh A, Filbey W, Banks MI, Saalmann YB, Pearce RA, Sanders RD. Evaluation of putative signatures of consciousness using specific definitions of responsiveness, connectedness, and consciousness. Br J Anaesth 2024; 132:300-311. [PMID: 37914581 PMCID: PMC10808836 DOI: 10.1016/j.bja.2023.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/15/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Understanding the neural correlates of consciousness has important ramifications for the theoretical understanding of consciousness and for clinical anaesthesia. A major limitation of prior studies is the use of responsiveness as an index of consciousness. We identified a collection of measures derived from unresponsive subjects and more specifically their association with consciousness (any subjective experience) or connectedness (specific experience of environmental stimuli). METHODS Using published data generated through the UNderstanding Consciousness Connectedness and Intra-Operative Unresponsiveness Study (NCT03284307), we evaluated 10 previously published resting-state EEG-based measures that were derived using unresponsiveness as a proxy for unconsciousness. Measures were tested across dexmedetomidine and propofol sedation and natural sleep. These markers represent the complexity, connectivity, cross-frequency coupling, graph theory, and power spectrum measures. RESULTS Although many of the proposed markers were associated with consciousness per se (reported subjective experience), none were specific to consciousness alone; rather, each was also associated with connectedness (i.e. awareness of the environment). In addition, multiple markers showed no association with consciousness and were associated only with connectedness. Of the markers tested, loss of normalised-symbolic transfer entropy (front to back) was associated with connectedness across all three experimental conditions, whereas the transition from disconnected consciousness to unconsciousness was associated with significant decreases in permutation entropy and spectral exponent (P<0.05 for all conditions). CONCLUSIONS None of the proposed EEG-based neural correlates of unresponsiveness corresponded solely to consciousness, highlighting the need for a more conservative use of the term (un)consciousness when assessing unresponsive participants. CLINICAL TRIAL REGISTRATION NCT03284307.
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Affiliation(s)
- Cameron P Casey
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA.
| | - Sean Tanabe
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Zahra Z Farahbakhsh
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Margaret Parker
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Amber Bo
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Marissa White
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Tyler Ballweg
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Andrew Mcintosh
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - William Filbey
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Matthew I Banks
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Yuri B Saalmann
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, USA
| | - Robert A Pearce
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Robert D Sanders
- Specialty of Anaesthetics & NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
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Demir ET, Erbaş M. Investigation of proarrhythmic effect of high sugammadex doses: an experimental animal study. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE (ONLINE) 2022; 2:53. [PMID: 37386607 DOI: 10.1186/s44158-022-00077-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/17/2022] [Indexed: 07/01/2023]
Abstract
BACKGROUND Studies on higher doses of sugammadex effect on QT interval and leading arrhythmia have been limited. In this study, we aimed to investigate possible proarrhythmic effect of higher doses of sugammadex in conditions that required urgent reversal of neuromuscular blockade during general anesthesia in an experimental animal model. METHODS It was experimental animal study. Total of 15 male New Zealand rabbits were randomly divided into three groups for low (4 mg/kg, n = 5), moderate (16 mg/kg, n = 5), and high dose of sugammadex (32 mg/kg, n = 5). All rabbits were premedicated by intramuscular ketamine 10 mg/kg, and general anesthesia was inducted by intravenous injection of 2 mg/kg of a propofol, 1 mcg/kg fentanyl, and 0.6 mg/kg rocuronium injection. Airway was provided by V-gel rabbit and connected to anesthetic device and ventilated at about 40 cycle/min and 10 ml/kg; oxygen 50% plus air 50% mixture was used with 1 MAC isoflurane to maintain anesthesia. Electrocardiographic monitorization and arterial cannulation were provided to follow-up mean arterial pressure and for arterial blood gas analyses. Intravenous sugammadex in three different doses were injected at 25th min of induction. After observing adequate respiration of all rabbits, V-gel rabbit was removed. Parameters and ECG recordings were taken basal value before induction and at the 5th, 10th, 20th, 25th, 30th, and 40th min to measure corrected QT intervals and were stored on digital media. QT interval was calculated as the time from the beginning of the Q wave to the end of the T wave. Corrected QT interval was calculated according to the Bazett's formula. Possible adverse effects were observed and recorded. RESULTS In all three groups, there was no significant statistical difference in mean arterial blood gases parameters, arterial pressures, heart rates, and Bazett QTc values, and no serious arrhythmia was recorded. CONCLUSION We found in animal study that low, moderate, and high doses of sugammadex did not significantly altered corrected QT intervals and did not cause any significant arrhythmia.
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Affiliation(s)
- Emin Tunç Demir
- Department of Anesthesiology and Reanimation, Intensive Care Science, Aydin State Hospital, Aydin, Turkey.
| | - Mesut Erbaş
- Department of Anesthesiology and Reanimation, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Turkey
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Jiang J, Zhao Y, Liu J, Yang Y, Liang P, Huang H, Wu Y, Kang Y, Zhu T, Zhou C. Signatures of Thalamocortical Alpha Oscillations and Synchronization With Increased Anesthetic Depths Under Isoflurane. Front Pharmacol 2022; 13:887981. [PMID: 35721144 PMCID: PMC9204038 DOI: 10.3389/fphar.2022.887981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Electroencephalography (EEG) recordings under propofol exhibit an increase in slow and alpha oscillation power and dose-dependent phase–amplitude coupling (PAC), which underlie GABAA potentiation and the central role of thalamocortical entrainment. However, the exact EEG signatures elicited by volatile anesthetics and the possible neurophysiological mechanisms remain unclear.Methods: Cortical EEG signals and thalamic local field potential (LFP) were recorded in a mouse model to detect EEG signatures induced by 0.9%, 1.5%, and 2.0% isoflurane. Then, the power of the EEG spectrum, thalamocortical coherence, and slow–alpha phase–amplitude coupling were analyzed. A computational model based on the thalamic network was used to determine the primary neurophysiological mechanisms of alpha spiking of thalamocortical neurons under isoflurane anesthesia.Results: Isoflurane at 0.9% (light anesthesia) increased the power of slow and delta oscillations both in cortical EEG and in thalamic LFP. Isoflurane at 1.5% (surgery anesthesia) increased the power of alpha oscillations both in cortical EEG and in thalamic LFP. Isoflurane at 2% (deep anesthesia) further increased the power of cortical alpha oscillations, while thalamic alpha oscillations were unchanged. Thalamocortical coherence of alpha oscillation only exhibited a significant increase under 1.5% isoflurane. Isoflurane-induced PAC modulation remained unchanged throughout under various concentrations of isoflurane. By adjusting the parameters in the computational model, isoflurane-induced alpha spiking in thalamocortical neurons was simulated, which revealed the potential molecular targets and the thalamic network involved in isoflurane-induced alpha spiking in thalamocortical neurons.Conclusion: The EEG changes in the cortical alpha oscillation, thalamocortical coherence, and slow–alpha PAC may provide neurophysiological signatures for monitoring isoflurane anesthesia at various depths.
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Affiliation(s)
- Jingyao Jiang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yi Zhao
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Jin Liu
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yaoxin Yang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Peng Liang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Han Huang
- Department of Anesthesiology, West China Second Hospital of Sichuan University, Chengdu, China
| | - Yongkang Wu
- Intelligent Manufacturing Institute, Chengdu Jincheng College, Chengdu, China
| | - Yi Kang
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
- *Correspondence: Tao Zhu, ; Cheng Zhou,
| | - Cheng Zhou
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
- *Correspondence: Tao Zhu, ; Cheng Zhou,
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Casey CP, Tanabe S, Farahbakhsh Z, Parker M, Bo A, White M, Ballweg T, Mcintosh A, Filbey W, Saalmann Y, Pearce RA, Sanders RD. Distinct EEG signatures differentiate unconsciousness and disconnection during anaesthesia and sleep. Br J Anaesth 2022; 128:1006-1018. [PMID: 35148892 DOI: 10.1016/j.bja.2022.01.010] [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: 10/07/2021] [Revised: 12/10/2021] [Accepted: 01/05/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND How conscious experience becomes disconnected from the environment, or disappears, across arousal states is unknown. We sought to identify the neural correlates of sensory disconnection and unconsciousness using a novel serial awakening paradigm. METHODS Volunteers were recruited for sedation with dexmedetomidine i.v., propofol i.v., or natural sleep with high-density EEG monitoring and serial awakenings to establish whether subjects were in states of disconnected consciousness or unconsciousness in the preceding 20 s. The primary outcome was classification of conscious states by occipital delta power (0.5-4 Hz). Secondary analyses included derivation (dexmedetomidine) and validation (sleep/propofol) studies of EEG signatures of conscious states. RESULTS Occipital delta power differentiated disconnected and unconscious states for dexmedetomidine (area under the curve [AUC] for receiver operating characteristic 0.605 [95% confidence interval {CI}: 0.516; 0.694]) but not for sleep/propofol (AUC 0.512 [95% CI: 0.380; 0.645]). Distinct source localised signatures of sensory disconnection (AUC 0.999 [95% CI: 0.9954; 1.0000]) and unconsciousness (AUC 0.972 [95% CI: 0.9507; 0.9879]) were identified using support vector machine classification of dexmedetomidine data. These findings generalised to sleep/propofol (validation data set: sensory disconnection [AUC 0.743 {95% CI: 0.6784; 0.8050}]) and unconsciousness (AUC 0.622 [95% CI: 0.5176; 0.7238]). We identified that sensory disconnection was associated with broad spatial and spectral changes. In contrast, unconsciousness was associated with focal decreases in activity in anterior and posterior cingulate cortices. CONCLUSIONS These findings may enable novel monitors of the anaesthetic state that can distinguish sensory disconnection and unconsciousness, and these may provide novel insights into the biology of arousal. CLINICAL TRIAL REGISTRATION NCT03284307.
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Affiliation(s)
- Cameron P Casey
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Sean Tanabe
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Zahra Farahbakhsh
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Margaret Parker
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Amber Bo
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Marissa White
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Tyler Ballweg
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Andrew Mcintosh
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - William Filbey
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Yuri Saalmann
- Department of Psychology, University of Wisconsin, Madison, WI, USA
| | - Robert A Pearce
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Robert D Sanders
- Specialty of Anaesthetics, University of Sydney, Camperdown, Sydney, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia.
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Bellini V, Cascella M, Cutugno F, Russo M, Lanza R, Compagnone C, Bignami E. Understanding basic principles of Artificial Intelligence: a practical guide for intensivists. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022297. [PMID: 36300214 PMCID: PMC9686179 DOI: 10.23750/abm.v93i5.13626] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIM Artificial intelligence was born to allow computers to learn and control their environment, trying to imitate the human brain structure by simulating its biological evolution. Artificial intelligence makes it possible to analyze large amounts of data (big data) in real-time, providing forecasts that can support the clinician's decisions. This scenario can include diagnosis, prognosis, and treatment in anesthesiology, intensive care medicine, and pain medicine. Machine Learning is a subcategory of AI. It is based on algorithms trained for decisions making that automatically learn and recognize patterns from data. This article aims to offer an overview of the potential application of AI in anesthesiology and analyzes the operating principles of machine learning Every Machine Learning pathway starts from task definition and ends in model application. CONCLUSIONS High-performance characteristics and strict quality controls are needed during its progress. During this process, different measures can be identified (pre-processing, exploratory data analysis, model selection, model processing and evaluation). For inexperienced operators, the process can be facilitated by ad hoc tools for data engineering, machine learning, and analytics.
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Affiliation(s)
- Valentina Bellini
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy, contributed equally to this paper
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, Napoli, Italy, Department of Electrical Engineering and Information Technologies, University of Napoli “Federico II”, Napoli, Italy, contributed equally to this paper
| | - Franco Cutugno
- Department of Electrical Engineering and Information Technologies, University of Napoli “Federico II”, Napoli, Italy
| | - Michele Russo
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Roberto Lanza
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Christian Compagnone
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Routman J, Boggs SD. Patient monitoring in the nonoperating room anesthesia (NORA) setting: current advances in technology. Curr Opin Anaesthesiol 2021; 34:430-436. [PMID: 34010175 DOI: 10.1097/aco.0000000000001012] [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: 11/27/2022]
Abstract
PURPOSE OF REVIEW Nonoperating room anesthesia (NORA) procedures continue to increase in type and complexity as procedural medicine makes technical advances. Patients presenting for NORA procedures are also older and sicker than ever. Commensurate with the requirements of procedural medicine, anesthetic monitoring must meet the American Society of Anesthesiologists standards for basic monitoring. RECENT FINDINGS There have been improvements in the required monitors that are used for intraoperative patient care. Some of these changes have been with new technologies and others have occurred with software refinements. In addition, specialized monitoring devises have also been introduced into NORA locations (depth of hypnosis, respiratory monitoring, point-of care ultrasound). These additions to the monitoring tools available to the anesthesiologist working in the NORA-environment push the boundaries of procedures which may be accomplished in this setting. SUMMARY NORA procedures constitute a growing percentage of total administered anesthetics. There is no difference in the monitoring standard between that of an anesthetic administered in an operating room and a NORA location. Anesthesiologists in the NORA setting must have the same compendium of monitors available as do their colleagues working in the operating suite.
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Affiliation(s)
- Justin Routman
- Department of Anesthesiology and Perioperative Medicine, The University of Alabama at Birmingham, Alabama, USA
| | - Steven Dale Boggs
- Department of Anesthesiology, College of Medicine, The University of Tennessee Health Science Center, Tennessee, USA
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Jones JH, Nittur VR, Fleming N, Applegate RL. Simultaneous comparison of depth of sedation performance between SedLine and BIS during general anesthesia using custom passive interface hardware: study protocol for a prospective, non-blinded, non-randomized trial. BMC Anesthesiol 2021; 21:105. [PMID: 33823811 PMCID: PMC8022390 DOI: 10.1186/s12871-021-01326-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background Intraoperative brain function monitoring with processed electroencephalogram (EEG) indices, such as the bispectral index (BIS) and patient state index (PSI), may improve characterization of the depth of sedation or anesthesia when compared to conventional physiologic monitors, such as heart rate and blood pressure. However, the clinical assessment of anesthetic depth may not always agree with available processed EEG indices. To concurrently compare the performance of BIS and SedLine monitors, we present a data collection system using shared individual generic sensors connected to a custom-built passive interface box. Methods This prospective, non-blinded, non-randomized study will enroll 100 adult American Society of Anesthesiologists (ASA) class I-III patients presenting for elective procedures requiring general anesthesia. BIS and SedLine electrodes will be placed preoperatively according to manufacturer recommendations and their respective indices tracked throughout anesthesia induction, maintenance and emergence. The concordance between processed EEG indices and clinical assessments of anesthesia depth will be analyzed with chi-square and kappa statistic. Discussion Prior studies comparing brain function monitoring devices have applied both sensors on the forehead of study subjects simultaneously. With limited space and common sensor locations between devices, it is not possible to place both commercial sensor arrays according to the manufacturer’s recommendations, thus compromising the validity of these comparisons. This trial utilizes a custom interface allowing signals from sensors to be shared between BIS and SedLine monitors to provide an accurate comparison. Our results will also characterize the degree of agreement between processed EEG indices and clinical assessments of anesthetic depth as determined by the anesthesiologists’ interpretations of acute changes in blood pressure and heart rate as well as the administration, or change to the continuous delivery, of medications at these timepoints. Patient factors (such as burst suppression state or low power EEG conditions from aging brain), surgical conditions (such as use of electrocautery), artifacts (such as electromyography), and anesthesia medications and doses (such as end-tidal concentration of volatile anesthetic or hypnotic infusion dose) that lead to lack of agreement will be explored as well. Trial registration Clinical Trials (ClinicalTrials.gov), NCT03865316. Registered on 4 February 2019 – retrospectively registered. Sponsor: Masimo Corporation.
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Affiliation(s)
- James Harvey Jones
- Department of Anesthesiology and Pain Medicine, University of California Davis Medical Center, 4150 V Street, PSSB Suite 1200, Sacramento, CA, 95817, USA.
| | - Vinay Ravikumar Nittur
- Department of Anesthesiology and Pain Medicine, University of California Davis Medical Center, 4150 V Street, PSSB Suite 1200, Sacramento, CA, 95817, USA.,School of Medicine, University of California Davis, Sacramento, CA, USA
| | - Neal Fleming
- Department of Anesthesiology and Pain Medicine, University of California Davis Medical Center, 4150 V Street, PSSB Suite 1200, Sacramento, CA, 95817, USA
| | - Richard L Applegate
- Department of Anesthesiology and Pain Medicine, University of California Davis Medical Center, 4150 V Street, PSSB Suite 1200, Sacramento, CA, 95817, USA
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Do epoch lengths of hypnotic depth indicators affect estimated of blood-brain equilibration rate constants of propofol? J Pharmacokinet Pharmacodyn 2021; 48:305-317. [PMID: 33415524 DOI: 10.1007/s10928-020-09733-w] [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: 08/03/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
This study aimed to investigate the effect of epoch length of hypnotic depth indicators on the blood-brain equilibration rate constant (ke0) estimates of propofol. Propofol was administered by zero-order infusion (1.5, 3.0, 6, and 12 mg·kg-1·h-1) for one hour in 63 healthy volunteers. The ke0 of propofol was estimated using an effect-compartment model linking pharmacokinetics and pharmacodynamics, in which response variables were electroencephalographic approximate entropy (ApEn) or bispectral index (BIS) (n = 32 each for propofol infusion rates of 6 and 12 mg·kg-1·h-1). Epoch lengths of ApEn were 2, 10, 30, and 60 seconds (s). The correlations between plasma propofol concentrations (Cp) and BIS and ApEn 2, 10, 30, and 60 s were determined, as was the Ce associated with 50% probability of unconsciousness (Ce50,LOC). The pharmacokinetics of propofol were well described by a three-compartment model. The correlation coefficient between Cp and ApEn 2, 10, 30, and 60 s were -0.64, -0.54, -0.39, and -0.26, respectively, whereas correlation coefficient between Cp and BIS was -0.74. The blood-brain equilibration half-life based on the ke0 estimates for ApEn at 2, 10, 30, 60 s and BIS were 4.31, 3.96, 5.78. 6.54, 5.09 min, respectively, whereas the Ce50,LOC for ApEn at 2, 10, 30, 60 s and BIS were 1.55, 1.47, 1.28, 1.04, and 1.55 μg·ml-1, respectively. Since ke0, which determines the onset of drug action, varies according to the epoch length, it is necessary to consider the epoch length together when estimating ke0.
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Gaviria García V, Loaiza López D, Serna Rojas C, Ríos Arismendy S, Montoya Guevara E, Mora Lesmes JD, Gómez Oquendo FJ, Ochoa Gómez JF. Assessment of changes in the electrical activity of the brain during general anesthesia using portable electroencephalography. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2020. [DOI: 10.5554/22562087.e956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: The analysis of the electrical activity of the brain using scalp electrodes with electroencephalography (EEG) could reveal the depth of anesthesia of a patient during surgery. However, conventional EEG equipment, due to its price and size, are not a practical option for the operating room and the commercial units used in surgery do not provide access to the electrical activity. The availability of low-cost portable technologies could provide for further research on the brain activity under general anesthesia and facilitate our quest for new markers of depth of anesthesia.
Objective: To assess the capabilities of a portable EEG technology to capture brain rhythms associated with the state of consciousness and the general anesthesia status of surgical patients anesthetized with propofol.
Methods: Observational, cross-sectional trial that reviewed 10 EEG recordings captured using OpenBCI portable low-cost technology, in female patients undergoing general anesthesia with propofol. The signal from the frontal electrodes was analyzed with spectral analysis and the results were compared against the reports in the literature.
Results: The signal captured with frontal electrodes, particularly α rhythm, enabled the distinction between resting with eyes closed and with eyes opened in a conscious state, and sustained anesthesia during surgery.
Conclusions: It is possible to differentiate a resting state from sustained anesthesia, replicating previous findings with conventional technologies. These results pave the way to the use of portable technologies such as the OpenBCI tool, to explore the brain dynamics during anesthesia.
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Bonatti G, Iannuzzi F, Amodio S, Mandelli M, Nogas S, Sottano M, Brunetti I, Battaglini D, Pelosi P, Robba C. Neuromonitoring during general anesthesia in non-neurologic surgery. Best Pract Res Clin Anaesthesiol 2020; 35:255-266. [PMID: 34030809 DOI: 10.1016/j.bpa.2020.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/15/2020] [Indexed: 11/30/2022]
Abstract
Cerebral complications are common in perioperative settings even in non-neurosurgical procedures. These include postoperative cognitive dysfunction or delirium as well as cerebrovascular accidents. During surgery, it is essential to ensure an adequate degree of sedation and analgesia, and at the same time, to provide hemodynamic and respiratory stability in order to minimize neurological complications. In this context, the role of neuromonitoring in the operating room is gaining interest, even in the non-neurolosurgical population. The use of multimodal neuromonitoring can potentially reduce the occurrence of adverse effects during and after surgery, and optimize the administration of anesthetic drugs. In addition to the traditional focus on monitoring hemodynamic and respiratory systems during general anesthesia, the ability to constantly monitor the activity and maintenance of brain homeostasis, creating evidence-based protocols, should also become part of the standard of care: in this challenge, neuromonitoring comes to our aid. In this review, we aim to describe the role of the main types of noninvasive neuromonitoring such as those based on electroencephalography (EEG) waves (EEG, Entropy module, Bispectral Index, Narcotrend Monitor), near-infrared spectroscopy (NIRS) based on noninvasive measurement of cerebral regional oxygenation, and Transcranial Doppler used in the perioperative settings in non-neurosurgical intervention. We also describe the advantages, disadvantage, and limitation of each monitoring technique.
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Affiliation(s)
- Giulia Bonatti
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
| | - Francesca Iannuzzi
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy.
| | - Sara Amodio
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy.
| | - Maura Mandelli
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy.
| | - Stefano Nogas
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy.
| | - Marco Sottano
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy.
| | - Iole Brunetti
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
| | - Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy.
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
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12
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Aldana E, Álvarez López-Herrero N, Benito H, Colomina MJ, Fernández-Candil J, García-Orellana M, Guzmán B, Ingelmo I, Iturri F, Martín Huerta B, León A, Pérez-Lorensu PJ, Valencia L, Valverde JL. Consensus document for multimodal intraoperatory neurophisiological monitoring in neurosurgical procedures. Basic fundamentals. ACTA ACUST UNITED AC 2020; 68:82-98. [PMID: 32624233 DOI: 10.1016/j.redar.2020.02.010] [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: 01/24/2020] [Revised: 02/04/2020] [Accepted: 02/18/2020] [Indexed: 01/27/2023]
Abstract
The present work aims to establish a guide to action, agreed by anaesthesiologists and neurophysiologists alike, to perform effective intraoperative neurophysiological monitoring for procedures presenting a risk of functional neurological injury, and neurosurgical procedures. The first section discusses the main techniques currently used for intraoperative neurophysiological monitoring. The second exposes the anaesthetic and non-anaesthetic factors that are likely to affect the electrical records of the nervous system structures. This section is followed by an analysis detailing the adverse effects associated with the most common techniques and their use. Finally, the last section describes a series of guidelines to be followed upon the various intraoperative clinical events.
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Affiliation(s)
- E Aldana
- Anestesiología y Reanimación, Hospital Vithas Xanit Internacional, Benalmádena, Málaga, España
| | - N Álvarez López-Herrero
- Neurofisiología, Servicio de Neurocirugía, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - H Benito
- Anestesiología y Reanimación, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - M J Colomina
- Anestesiología y Reanimación, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Universitat de Barcelona, Barcelona, España
| | | | - M García-Orellana
- Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
| | - B Guzmán
- Neurofisiología clínica, Hospital Clínico Universitario Lozano de Blesa, Zaragoza, España
| | - I Ingelmo
- Anestesiología y Reanimación, Hospital Universitario Ramón y Cajal, Madrid, España
| | - F Iturri
- Anestesiología y Reanimación, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
| | - B Martín Huerta
- Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - A León
- Neurofisiología, Servicio de Neurología, Parc de Salut Mar, Barcelona, España
| | - P J Pérez-Lorensu
- Neurofisiología Clínica, Unidad de Monitorización Neurofisiológica Intraoperatoria, Hospital Universitario de Canarias, Tenerife, España
| | - L Valencia
- Anestesiología y Reanimación, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España
| | - J L Valverde
- Anestesiología y Reanimación, Hospital Vithas Xanit Internacional, Benalmádena, Málaga, España
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13
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Ghanty I, Schraag S. The quantification and monitoring of intraoperative nociception levels in thoracic surgery: a review. J Thorac Dis 2019; 11:4059-4071. [PMID: 31656682 DOI: 10.21037/jtd.2019.08.62] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Nociception is the unconscious perception of a stimulus applied by trauma or surgery and expressed through a response of the autonomous nervous system. Local anaesthetics (LAs), opioids and other modulating agents such as ketamine are usually utilised to blunt nociception as a component during general anaesthesia (GA) and surgery. The effectiveness of these measures, however, are still difficult to quantify and monitoring of anti-nociception has been confined to assess variation of heart rate (HR) or blood pressure (BP). Recently, various monitoring concepts have been introduced to quantify nociception more systematically and on the other hand guide anti-nociceptive interventions more appropriately. This review describes the various technologies, their performance in clinical studies and provides a critical appraisal with particular application to thoracic anaesthesia and surgery and their relevance in the context of chronic pain after surgery.
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Affiliation(s)
- Ismael Ghanty
- Department of Perioperative Medicine, Golden Jubilee National Hospital, Clydebank, UK
| | - Stefan Schraag
- Department of Perioperative Medicine, Golden Jubilee National Hospital, Clydebank, UK
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A Comparison of Bispectral Index and Entropy During Sevoflurane Anesthesia Induction in Children with and without Diplegic Cerebral Palsy. ENTROPY 2019; 21:e21050498. [PMID: 33267212 PMCID: PMC7514986 DOI: 10.3390/e21050498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 11/17/2022]
Abstract
Background: This study compared the correlation of bispectral index (BIS) or entropy with different sevoflurane concentrations between children with and without cerebral palsy (CP) during induction. Methods: For eighty-two children (40 CP and 42 non-CP children), anesthesia was induced with sevoflurane. BIS and entropy (response entropy and state entropy (RE and SE)) were recorded before and after the induction of anesthesia at end-tidal sevoflurane concentrations of 1–3 vol%. The sedation status was assessed using an Observer’s Assessment of Alertness/Sedation scale. The ability to predict awareness was estimated using the area under the receiver-operator characteristic curve (AUC) analysis. Results: RE, SE and BIS values decreased continuously over the observed concentration range of sevoflurane in both groups. The SE values while awake and the RE, SE, BIS values at 3 vol% sevoflurane were lower in children with CP than in those without CP. The AUC of the BIS was significantly better than RE or SE in children without CP. The AUC of the BIS was not significantly higher than that of the RE or SE in children with CP. Conclusion: BIS seems better correlated than entropy with the clinical state of loss of response in children without CP, but not in those with CP.
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15
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Shander A, Lobel GP, Mathews DM. Brain Monitoring and the Depth of Anesthesia: Another Goldilocks Dilemma. Anesth Analg 2018; 126:705-709. [PMID: 28787338 DOI: 10.1213/ane.0000000000002383] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Aryeh Shander
- From the Englewood Hospital and Medical Center, TeamHealth Research Institute, Englewood, New Jersey
| | - Gregg P Lobel
- From the Englewood Hospital and Medical Center, TeamHealth Research Institute, Englewood, New Jersey
| | - Donald M Mathews
- Department of Anesthesiology, University of Vermont College of Medicine, Burlington, Vermont
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Cascella M, Bimonte S, Muzio MR. Towards a better understanding of anesthesia emergence mechanisms: Research and clinical implications. World J Methodol 2018; 8:9-16. [PMID: 30345225 PMCID: PMC6189114 DOI: 10.5662/wjm.v8.i2.9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/09/2018] [Accepted: 08/26/2018] [Indexed: 02/06/2023] Open
Abstract
Emergence from anesthesia (AE) is the ending stage of anesthesia featuring the transition from unconsciousness to complete wakefulness and recovery of consciousness (RoC). A wide range of undesirable complications, including coughing, respiratory/cardiovascular events, and mental status changes such as emergence delirium, and delayed RoC, may occur during this critical phase. In general anesthesia processes, induction and AE represent a neurobiological example of “hysteresis”. Indeed, AE mechanisms should not be simply considered as reverse events of those occurring in the induction phase. Anesthesia-induced loss of consciousness (LoC) and AE until RoC are quite distinct phenomena with, in part, a distinct neurobiology. Althoughanaesthetics produce LoC mostly by affecting cortical connectivity, arousal processes at the end of anesthesia are triggered by structures deep in the brain, rather than being induced within the neocortex. This work aimed to provide an overview on AE processes research, in terms of mechanisms, and EEG findings. Because most of the research in this field concerns preclinical investigations, translational suggestions and research perspectives are proposed. However, little is known about the relationship between AE neurobiology, and potential complications occurring during the emergence, and after the RoC. Thus, another scope of this review is to underline why a better understanding of AE mechanisms could have significant clinical implications, such as improving the patients’ quality of recovery, and avoiding early and late postoperative complications.
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Affiliation(s)
- Marco Cascella
- Division of Anesthesia and Pain Management, Department of Supportive Care, Istituto Nazionale Tumori “Fondazione G. Pascale” - IRCSS, Naples 80131, Italy
| | - Sabrina Bimonte
- Division of Anesthesia and Pain Management, Department of Supportive Care, Istituto Nazionale Tumori “Fondazione G. Pascale” - IRCSS, Naples 80131, Italy
| | - Maria Rosaria Muzio
- Division of Infantile Neuropsychiatry, UOMI-Maternal and Infant Health, ASL NA3 SUD Torre del Greco, Naples 80059, Italy
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17
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Gao WW, He YH, Liu L, Yuan Q, Wang YF, Zhao B. BIS Monitoring on Intraoperative Awareness: A Meta-analysis. Curr Med Sci 2018; 38:349-353. [PMID: 30074196 DOI: 10.1007/s11596-018-1886-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 10/30/2017] [Indexed: 11/24/2022]
Abstract
Intraoperative awareness is a very serious complication of general anesthesia. Several studies have evaluated the potential association between bispectral index (BIS) and intraoperative awareness, however, the results obtained were controversial. Therefore, we performed a meta-analysis to further assess the association between the BIS monitoring and the incidence of intraoperative awareness. A comprehensive search was conducted to identify all eligible studies from the online literature databases published prior to Feb. 2017. A total of five studies with 17 432 cases and 16 749 controls were included. An odds ratio (OR) and a 95% confidence interval (CI) were calculated to examine the strength of the association. The results showed that in the overall analysis, the association between the BIS monitoring and the incidence of intraoperative awareness was not significant (OR=0.58, 95% CI= 0.22-1.58, P=0.29). A stratified analysis by comparing different anesthesia methods revealed that BIS monitoring group showed a lower incidence of intraoperative awareness in patients with intravenous anesthesia when compared with non-BIS monitoring group (OR=0.20, 95% CI=0.08-0.49, P=0.0004), whereas there was no statistically significant difference in the incidence of intraoperative awareness between BIS and non-BIS monitoring groups in patients with inhalation anesthesia (OR=1.13, 95% CI=0.56-2.26, P=0.73). In conclusion, our meta-analysis showed that BIS monitoring had no appreciable advantage in the reduction of the intraoperative awareness incidence in inhalation anesthesia, while showed a remarkable superiority in intravenous anesthesia.
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Affiliation(s)
- Wen-Wei Gao
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yu-Hong He
- Office of Infection Control, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Lian Liu
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Quan Yuan
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Ya-Feng Wang
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Bo Zhao
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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18
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Kim YS, Chung D, Oh SK, Won YJ, Lee IO. Unusual elevation in Entropy but not in PSI during general anesthesia: a case report. BMC Anesthesiol 2018; 18:22. [PMID: 29444638 PMCID: PMC5813332 DOI: 10.1186/s12871-018-0486-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 02/02/2018] [Indexed: 11/25/2022] Open
Abstract
Background EEG monitoring is useful for determining an adequate level of anesthesia. However it is sometimes interfered by various reasons. We describe a case in which we successfully confirmed the adequate depth of anesthesia by monitoring the patient state index (PSI), which was computed from the SedLine monitor data in Root (Masimo) during general anesthesia. Our case showed unusual elevations in entropy, but not in PSI. Case presentation A 34-year-old woman was scheduled for emergency surgery for a left tibial open fracture and a right femoral closed fracture, which were sustained during a traffic accident. Forty-five minutes after intubation, the response entropy abruptly increased up to 100 and state entropy to 91. Despite the absence of other abnormal events, the entropy data led to two types of incorrect decisions. The first was owing to the effect of the EMG and the second was misleading during the surgeon’s hammering. However, PSI from the SedLine monitor seemed to be less influenced by the same events. Conclusions In this report, we suggest that the PSI, derived from new-generation SedLine (Root, Masimo) may be a useful parameter for clinically determining the level of sedation. The use of two monitoring devices with different EEG algorithms might be helpful for determining the anesthetic depth and making decisions. Electronic supplementary material The online version of this article (10.1186/s12871-018-0486-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Young Sung Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Dongik Chung
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Seok Kyeong Oh
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Young Ju Won
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Il Ok Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
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20
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Yang X, Yang S, Hong C, Yu W, Guonian W. Panax Notoginseng Saponins attenuates sevoflurane‑induced nerve cell injury by modulating AKT signaling pathway. Mol Med Rep 2017; 16:7829-7834. [PMID: 28944861 DOI: 10.3892/mmr.2017.7519] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 07/26/2017] [Indexed: 11/06/2022] Open
Abstract
General anesthesia in patients with or at risk for neuronal injury remains challenging due to the neurotoxic effects of volatile anesthetics. One inhalation anesthetic, sevoflurane, induces neuronal damage, including neuroapoptosis, and learning and memory impairment. Panax Notoginseng Saponins (PNS) is the active ingredient of Sanqui and has been reported to exert neuroprotective effects. In the current study, the protective effect of PNS on sevoflurane‑induced nerve cell injury was explored. Cell proliferation was significantly reduced in a dose‑dependent manner following stimulation with sevoflurane. Furthermore, cell apoptosis and the protein expression of caspase‑3, caspase‑9 and Bax were significantly increased, while the expression of Bcl‑2 was decreased in the sevoflurane group compared with normal control. Furthermore, the protein level of Bace‑1, APP and Aβ were elevated in the sevoflurane group compared with the control group. By contrast, PNS treatment significantly reduced the neurotoxicity induced by sevoflurane. Additionally, sevoflurane reduced activation of the AKT signaling pathway, which was activated by PNS treatment. In conclusion, the results suggested that PNS attenuates sevoflurane‑induced neurotoxicity through by stimulating cell proliferation and inhibiting cell apoptosis. These effects were mediated, at least in part, by activating the AKT signaling pathway.
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Affiliation(s)
- Xu Yang
- Department of Anesthesiology, Cancer Hospital of Harbin Medical University, Harbin, Heilongjiang 150000, P.R. China
| | - Sun Yang
- Department of Anesthesiology, Heilongjiang Province Hospital, Harbin, Heilongjiang 150000, P.R. China
| | - Chen Hong
- Department of Anesthesiology, Cancer Hospital of Harbin Medical University, Harbin, Heilongjiang 150000, P.R. China
| | - Wang Yu
- Department of Anesthesiology, Cancer Hospital of Harbin Medical University, Harbin, Heilongjiang 150000, P.R. China
| | - Wang Guonian
- Department of Anesthesiology, Cancer Hospital of Harbin Medical University, Harbin, Heilongjiang 150000, P.R. China
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Cascella M, Fusco R, Caliendo D, Granata V, Carbone D, Muzio MR, Laurelli G, Greggi S, Falcone F, Forte CA, Cuomo A. Anesthetic dreaming, anesthesia awareness and patient satisfaction after deep sedation with propofol target controlled infusion: A prospective cohort study of patients undergoing day case breast surgery. Oncotarget 2017; 8:79248-79256. [PMID: 29108303 PMCID: PMC5668036 DOI: 10.18632/oncotarget.17238] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 03/21/2017] [Indexed: 12/17/2022] Open
Abstract
Background Anesthetic dreaming and anesthesia awareness are well distinct phenomena. Although the incidence of intraoperative awareness is more common among patients who reported a dream after surgery, the exact correlation between the two phenomena remains an unsolved rebus. The main purpose of this study was to investigate anesthetic dreaming, anesthesia awareness and psychological consequences eventually occurred under deep sedation. Intraoperative dreaming experiences were correlated with dream features in natural sleep. Methods Fifty-one patients, undergoing surgical excision of fibroadenomas under a Bispectral index-guided deep sedation anesthesia with propofol target controlled infusion, were enrolled into this prospective study. Psychological assessment was performed through the State Trait Anxiety Inventory. A questionnaire was adopted to register dreaming and anesthesia awareness. Data were collected after emergence (t0), 24 hours (t1), 1 month (t2), 6 months (t3). Results Six patients (12%) reported anesthetic dreaming at t0 confirming the response at each subsequent evaluation. One patient (2%) confirmed dreaming during anesthesia in all, but denied it at t0. There was a high correlation between the intraoperative dream contents and the features of dreams in natural sleep. No cases of anesthesia awareness were detected. A similar level of satisfaction was observed in dreaming and no-dreaming patients. Conclusions Anesthetic dreaming does not seem to influence satisfaction of patients undergoing deep sedation with propofol target controlled infusion. A psychological assessment would seem to improve the evaluation of possible psychological consequences in dreamer patient.
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Affiliation(s)
- Marco Cascella
- Department of Anesthesia, Endoscopy and Cardiology, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Roberta Fusco
- Department of Diagnostic Imaging, Radiant and Metabolic Therapy, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Domenico Caliendo
- Department of Anesthesia, Endoscopy and Cardiology, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Vincenza Granata
- Department of Diagnostic Imaging, Radiant and Metabolic Therapy, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Domenico Carbone
- Department of Emergency Medicine, Umberto I Hospital, Nocera Inferiore, Salerno, Italia
| | - Maria Rosaria Muzio
- Division of Infantile Neuropsychiatry, UOMI, Maternal and Infant Health, Torre del Greco, Napoli, Italia
| | - Giuseppe Laurelli
- Gynecologic Oncology Surgery, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Stefano Greggi
- Gynecologic Oncology Surgery, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Francesca Falcone
- Gynecologic Oncology Surgery, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Cira Antonietta Forte
- Psychology, Division of Pain Medicine, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Arturo Cuomo
- Department of Anesthesia, Endoscopy and Cardiology, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
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22
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Tao ZY, Gao P, Yan YH, Li HY, Song J, Yang JX. Osthole Enhances the Therapeutic Efficiency of Stem Cell Transplantation in Neuroendoscopy Caused Traumatic Brain Injury. Biol Pharm Bull 2017; 40:1043-1054. [DOI: 10.1248/bpb.b17-00072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Zhen-yu Tao
- School of Pharmacy, Liaoning University of Traditional Chinese Medicine
| | - Peng Gao
- The First Affiliated Hospital of Dalian Medical University
| | - Yu-hui Yan
- School of Pharmacy, Liaoning University of Traditional Chinese Medicine
| | - Hong-yan Li
- School of Pharmacy, Liaoning University of Traditional Chinese Medicine
| | - Jie Song
- School of Pharmacy, Liaoning University of Traditional Chinese Medicine
| | - Jing-xian Yang
- School of Pharmacy, Liaoning University of Traditional Chinese Medicine
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