Anesthesia Monitoring Research Articles

Peripheral Perfusion Index as a Predictor of Post-Spinal Hypotension in Patients Undergoing Lower Abdominopelvic Surgeries

Abstract Background One of the main complications of spinal anesthesia is post spinal hypotension. And since noninvasive hemodynamic & blood pressure monitoring are the standards in most surgical procedures, ensuring best & safest monitoring standards has been of utmost importance. The use of plethysmography in anesthesia monitoring has become one of the essential tools in any anesthetic procedures. However, its varying interpretations & usages haven't been explored to the fullest. Objective To assess predictability of baseline peripheral perfusion index to Post spinal hypotension in patients undergoing elective lower abdomino-pelvic surgeries. Methods This Prospective Observational study was conducted in Ain Shams University Hospitals’ operating rooms. And was conducted over a period of 6 months after approval of ethical committee of Faculty of Medicine, Ain Shams University, All patients undergoing elective lower abdominopelvic surgeries at El-demerdash Hospital of Surgery during the study period. Surgeries include inguinal / inguinoscrotal hernia repair, paraumbilical hernia repair, lower laparotomies, transurethral resection of bladder tumor, simple gynecological procedures. Results This study showed that Perfusion index can be used as a predictor for hypotension in patients undergoing elective lower abdominopelvic surgeries under spinal anesthesia. Patients with baseline PI > 0.9 are at greater risk of developing hypotension after spinal anesthesia when compared with those with baseline PI ≤ 0.9. Hence, peripheral perfusion index usage can be recommended in this regard. Conclusion This study concluded that Perfusion index can be used as a predictor for hypotension in patients undergoing elective lower abdominopelvic surgeries under spinal anesthesia. Patients with baseline PPI >0.9 are at greater risk of developing hypotension after spinal anesthesia when compared with those with baseline PPI ≤0.9 .Hence, peripheral perfusion index usage can be recommended in this regard.

Anaesthetic Management for Patient with Trigeminal Neuralgia underwent Microvascular Decompression (MVD)

Trigeminal neuralgia (TN) is a chronic pain with repeated brief episodes of electric shock-like pain affecting the fifth cranial nerve. Microvascular decompression (MVD) is one of treatments for TN. Anesthetic management for MVD requires special consideration to reduce brain volume (slack brain) and optimise Mean Arterial Pressure (MAP). Female 29-yo, 40kgbw with chief complaint: throbbing pain and intermittent stiffness in right facial area since 1 year ago. Brain MRI examination showed crossing of right superior cerebellar artery (RSCA) branch with right trigeminal nerve near the root entry zone and underwent MVD. Anesthesia using smooth intubation technique and maintenance using a combination of inhalational anaesthetics (sevoflurane 1 vol%) and intravenously (propofol 100mcg/kg/minute, remifentanil 0.2mcg/kgbw/min, and rocuronium 10mcg/kgbw/min). Target for MAP (90mmHg) and EtCO2 (30mmHg). We didn't use mannitol for slack brain. Early emergence with smooth extubation to prevent sudden haemodynamic changes and minimising coughing then for early neurological detection of intracranial complications.The combined use of sevoflurane < 1MAC and continuous propofol provides optimal visualisation of the operating area. This combination reduces cerebral blood flow which makes the brain slack and keeps MAP optimal to maintain cerebral perfusion pressure and reduce the risk of cerebral ischemia. The combination of these agents also makes early recovery for more rapid neurological assessments. Anaesthesia management for MVD uses neuroanesthesia principles, balanced anaesthesia, and strict haemodynamic monitoring. The combination of inhalation anaesthetic sevoflurane and intravenous propofol gave optimise visualisation in the operation area and the patient's recovery can be enhanced.

Pregnancy complicated by severe osteogenesis imperfecta poses a challenge for the anaesthetist: A case report.

Pregnant women with severe osteogenesis imperfecta (OI) are uncommon, and there are limited data regarding anaesthesia for caesarean section in these high-risk individuals. The presence of anatomical and physiological abnormalities can pose technical challenges for the anaesthetist. This report describes the successful implementation of epidural anaesthesia in a parturient with severe OI. To our knowledge, this is the first documented use of ultrasound-assisted neuraxial anaesthesia and wrist blood pressure monitoring in such patients undergoing caesarean section. Understanding the pathophysiological changes associated with OI is crucial for ensuring safe administration of anaesthesia to these women.

Wearable EEG-Based Depth of Anesthesia Monitoring: A Nonparametric Feature Set

Wearable EEG-Based Depth of Anesthesia Monitoring: A Nonparametric Feature Set

Effects of dental anxiety and anesthesia on vital signs during tooth extraction

BackgroundAnxiety is common preceding tooth extraction; hence, it is crucial to identify patients with dental anxiety (DA) and to manage DA. This study assessed the level of DA and influencing factors in tooth extraction patients in a dental hospital in China and changes in their blood pressure (BP) and heart rate (HR) during the tooth-extraction procedure.MethodsThe study was a cohort study. The Dental Anxiety Scale (DAS) was used to assess the level of DA of 120 patients before tooth extraction. A Demographics and Oral Health Self-Assessment Form was used to assess factors influencing DA. The correlations of DAS scores with HR and BP were measured. The effects of local anesthesia and general anesthesia on HR and BP were also compared using a Datex-Ohmeda anesthesia monitor to detect HR and BP continuously before and after anesthesia. Independent sample t-tests, OLS multiple regression model and one-way analysis of variance were applied to analysis the results.ResultsBased on the DAS score, 12.5% of the participants were identified as suffering from DA. DA was related to age, gender, and the self-assessment of oral health. The DAS score was correlated with increased BP (P < 0.05). BP showed an overall upward trend after local anesthesia, while it was generally stable after general anesthesia. The systolic BP at 4 and 5 min and the HR at 2 and 4 min increased remarkably (P < 0.05) after local anesthesia compared with those before anesthesia. The HR and BP of patients under local anesthesia were generally higher than those of patients under general anesthesia were during the operation.ConclusionsThe prevalence of DA in adults was 12.5% in this study population. DA was related to gender, age, and the self-assessment of oral health. The score of DAS was correlated with BP. Compare to local anesthesia, general anesthesia can make the vital signs of tooth extraction patients more stable.

Oxygen metabolism after cardiac arrest: Patterns and associations with survival

AimWhether changes in oxygen metabolism, as measured by oxygen consumption (VO2), carbon dioxide production (VCO2) and the respiratory exchange ratio (RER), are associated with survival after cardiac arrest is poorly understood. In this prospective observational study, we investigated the association between VO2, VCO2, and RER in the initial 12 and 24 h after return of spontaneous circulation (ROSC) and survival to hospital discharge. MethodsAdults with ROSC after cardiac arrest, admitted to the intensive care unit, requiring mechanical ventilation and treated with targeted temperature management were included. VO2 and VCO2 were measured continuously for 24 h after ROSC, using a noninvasive anesthesia monitor. Area under the curve for VO2, VCO2 & RER was calculated using all available values over 12 and 24 h after ROSC. Using logistic regression, we evaluated the relationship between these metabolic variables and survival to hospital discharge. Analyses were adjusted for temperature, vasopressors, and neuromuscular blockade. ResultsSixty four patients were included. Mean age was 64 ± 16 years, and 59% were women. There was no significant association between the area under the curve of VO2 or VCO2 and survival. A higher RER in the initial 12 h was associated with better survival (aOR = 3.97, 95% CI [1.01,15.6], p = 0.048). Survival was lower in those with median RER < 0.7 in the initial 12 h compared with those with a median RER ≥ 0.7 (25% vs 67%, p = 0.011). ConclusionHigher RER in the initial 12 h was associated with survival after cardiac arrest. The etiology of unusually low RERs in this patient population remains unclear.

#621 The effect of intra-operative mean arterial pressure on early graft function in deceased donor kidney transplantation

Abstract Background and Aims The adequate perfusion pressure to the graft is essential for proper graft function in kidney transplantation, especially in deceased donor kidney transplantation. In particular, Mean arterial pressure (MAP) during operation can affect early graft function because MAP is associated with renal blood flow and glomerular filtration rate. Therefore, the analysis of intra-operative parameters are necessary to evaluate adequate graft perfusion. The aim of this study is to investigate the relationship between intra-operative parameters including MAP and early graft function in deceased donor kidney transplantation. Method We retrospectively analyzed 363 recipients who underwent deceased donor kidney transplantation from March 2010 to December 2020. Anesthetic monitoring data during intraoperative period was analyzed and basic clinical parameters were evaluated. Results In total 363 recipients, the mean recipient age was 48.9 ± 10.3 and mean donor age was 48.2 ± 15.2. Anesthetic time was mean 285.9 ± 63.8 (min) and operation time was 226.4 ± 48.7 (min). Median value of baseline MAP and MAP at reperfusion were 124 mmHg and 88 mmHg. After initial analysis, the recipients were divided into two groups, high MAP group (n = 185) and low MAP group (n = 178), according to median value of baseline MAP (124 mmHg) and these two groups were analyzed. High MAP group showed higher estimated glomerular filtration rate (eGFR) and urine output compared to low MAP group during immediate postoperative 1 week. At postoperative day 5, eGFRs were 43.4 ± 26.7 and 37.3 ± 24.2 mL/min/1.73 m2 respectively (p = 0.022) and urine outputs were 2942.6 ± 1368.6 and 2474.3 ± 1199.1 mL respectively (p = 0.001). The incidences of delayed graft function showed no significant difference between two groups (2.2% vs 6.2%, p = 0.066). We additionally analyzed the effect of MAP at reperfusion, and the result showed that there was no significant relationship between MAP at reperfusion and early graft function. Conclusion In this retrospective study, MAP at reperfusion was not significantly related to early graft function and incidence of delayed graft function. In baseline MAP analysis, high baseline MAP group showed early recovery of eGFR and more urine output than low baseline MAP group. As a result, the recipients with high baseline MAP were related to early recovery of graft function in deceased donor kidney transplantation.

The management of goal-directed fluid therapy during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

Cytoreductive surgery is a surgical treatment approach that has been applied over the last 3 decades in patients with peritoneal metastases originating from intraabdominal organs. Goal-directed fluid therapy (GDFT) is an approach in which a patient fluid therapy during a medical procedure or surgery is carefully managed based on a specific goal. In this study, we aimed to present the results of GDFT in patients who underwent cytoreductive surgery for peritoneal carcinomatosis (PC) during the perioperative period. This retrospective study included 398 patients patient who underwent cytoreductive surgery + hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) due to PC originating from intraabdominal malignancies. Of the cases, 233 (58.6%) were female, and 165 (41.4%) were male patients. The mean age was 58.9. Perioperative findings revealed an average PC score of 12 (3-24), average lactate levels of 3 (2-7) mmol/L, Pao2/fio2 of 3.3 (2.4-4.1) mm Hg, mean arterial pressure (MAP) of 60 (55-70), average surgery duration of 6.5 hours (3-14), and average blood loss of 400 (200-4000) cc. The mean intraoperative fluid rate was 6.4 mL/kg/h (IQR 5.8-7.1). Sixteen (16.3%) patients experienced Clavien-Dindo Grade 3-4 adverse events. Within 30 days, 25 patients (6.3%) died. CRS + HIPEC procedures utilizing perioperative GDFT along with advanced anesthesia monitoring devices have shown successful application, offering an alternative to traditional and restrictive fluid management approaches.

What are standard monitoring devices for anesthesia in future?

Monitoring the patient's physiological functions is critical in clinical anesthesia. The latest version of the Japanese Society of Anesthesiologists' Guidelines for Safe Anesthesia Monitoring, revised in 2019, covers various factors, including electroencephalogram monitoring, oxygenation, ventilation, circulation, and muscle relaxation. However, with recent advances in monitoring technologies, the information provided has become more detailed, requiring practitioners to update their knowledge. At a symposium organized by the Journal of Anesthesia in 2023, experts across five fields discussed their respective topics: anesthesiologists need to interpret not only the values displayed on processed electroencephalogram monitors but also raw electroencephalogram data in the foreseeable future. In addition to the traditional concern of preventing hypoxemia, monitoring for potential hyperoxemia and the effects of mechanical ventilation itself will become increasingly important. The importance of using AI analytics to predict hypotension, assess nociception, and evaluate microcirculation may increase. With the recent increase in the availability of neuromuscular monitoring devices in Japan, it is important for anesthesiologists to become thoroughly familiar with the features of each device to ensure its effective use. There is a growing desire to develop and introduce a well-organized, integrated "single screen" monitor.

Risk prediction strategies using intraoperative physiological data in adults undergoing surgery: a systematic review study protocol

Abstract Postoperative mortality accounts for 7.7% of all global deaths, while postoperative complications increase 1-year mortality by 60%. Risk prediction models for postoperative complications and mortality can facilitate tailored risk mitigation strategies. However, most models incorporate only preoperative patient-related factors as predictors and do not capture dynamic risks or intraoperative events. This systematic review seeks to evaluate the predictive capability of intraoperative physiology derived from routine anaesthetic monitoring and the feature extraction methods for these variables. This review will include both prospective and retrospective studies that incorporate intraoperative physiological measurements into the development, validation or updating of a statistical prediction model, to identify those at risk of major end-organ (cardiovascular, pulmonary, renal and neurological) complications and mortality up-to 90 days postoperatively. We will identify models developed in two settings: those undergoing cardiac surgery and heterogeneous adult patient cohorts undergoing non-cardiac surgery. The review will be reported according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This review will evaluate the available literature on intraoperative physiology as predictor variables, to improve feature extraction methods for risk prediction models development while understanding how to capitalize on the vast routinely collected intraoperative physiological data sets that are increasingly available. This review is registered on PROSPERO, registration number CRD42023474384.

Analysis of Amplitude Modulation of EEG Based on Holo-Hilbert Spectrum Analysis During General Anesthesia.

The study aims to investigate the relationship between amplitude modulation (AM) of EEG and anesthesia depth during general anesthesia. In this study, Holo-Hilbert spectrum analysis (HHSA) was used to decompose the multichannel EEG signals of 15 patients to obtain the spatial distribution of AM in the brain. Subsequently, HHSA was applied to the prefrontal EEG (Fp1) obtained during general anesthesia surgery in 15 and 34 patients, and the α-θ and α-δ regions of feature (ROFs) were defined in Holo-Hilbert spectrum (HHS) and three features were derived to quantify AM in ROFs. During anesthetized phase, an anteriorization of the spatial distribution of AMs of α-carrier in brain was observed, as well as AMs of α-θ and α-δ in the EEG of Fp1. The total power ([Formula: see text]), mean carrier frequency ([Formula: see text]) and mean amplitude frequency ([Formula: see text]) of AMs changed during different anesthesia states. HHSA can effectively analyze the cross-frequency coupling of EEG during anesthesia and the AM features may be applied to anesthesia monitoring. The study provides a new perspective for the characterization of brain states during general anesthesia, which is of great significance for exploring new features of anesthesia monitoring.

Age-dependent coupling characteristics of bilateral frontal EEG during desflurane anesthesia.

Objectives.The purpose of this study is to investigate the age dependence of bilateral frontal electroencephalogram (EEG) coupling characteristics, and find potential age-independent depth of anesthesia monitoring indicators for the elderlies.Approach.We recorded bilateral forehead EEG data from 41 patients (ranged in 19-82 years old), and separated into three age groups: 18-40 years (n= 12); 40-65 years (n= 14), >65 years (n= 15). All these patients underwent desflurane maintained general anesthesia (GA). We analyzed the age-related EEG spectra, phase amplitude coupling (PAC), coherence and phase lag index (PLI) of EEG data in the states of awake, GA, and recovery.Main results.The frontal alpha power shows age dependence in the state of GA maintained by desflurane. Modulation index in slow oscillation-alpha and delta-alpha bands showed age dependence and state dependence in varying degrees, the PAC pattern also became less pronounced with increasing age. In the awake state, the coherence in delta, theta and alpha frequency bands were all significantly higher in the >65 years age group than in the 18-40 years age group (p< 0.05 for three frequency bands). The coherence in alpha-band was significantly enhanced in all age groups in GA (p< 0.01) and then decreased in recovery state. Notably, the PLI in the alpha band was able to significantly distinguish the three states of awake, GA and recovery (p< 0.01) and the results of PLI in delta and theta frequency bands had similar changes to those of coherence.Significance.We found the EEG coupling and synchronization between bilateral forehead are age-dependent. The PAC, coherence and PLI portray this age-dependence. The PLI and coherence based on bilateral frontal EEG functional connectivity measures and PAC based on frontal single-channel are closely associated with anesthesia-induced unconsciousness.

Anesthesiological provision in hip and knee joint replacement (a scientific literature review)

Effective pain management during hip and knee replacement ensures the efficient and fast recovery of patients. Joint replacement surgery is typically accompanied by the use of general anesthesia or spinal anesthesia. Spinal anesthesia, despite certain risks, demonstrates better effectiveness compared to general anesthesia in hip and knee replacements. In other words, spinal anesthesia entails fewer perioperative complications. The addition of sedation and anesthesia monitoring during joint replacements using spinal anesthesia is of particular importance. After a successful surgical procedure of joint replacement, achieving adequate pain relief in the postoperative period is crucial. This is achieved through intravenous patient-controlled analgesia or epidural analgesia. A multimodal analgesia strategy combines analgesics with different mechanisms of action to enhance pain management. Intraoperative periarticular administration of multimodal agents is one of the most important procedures in the perioperative pain control during total hip arthroplasty. Peripheral nerve blocks have emerged recently as an alternative analgesic approach. During hip and knee replacements, various nerve blocks are utilized, including lumbar plexus block, fascia iliaca block, femoral and sciatic nerve block, adductor canal block, quadratus lumborum block, erector spinae plane block. Given the entire perioperative process, the use of preventive and multimodal therapy along with peripheral nerve blocks can help reduce the intensity of postoperative pain, thereby improving the functional status and quality of life for patients.

Advances in The Assessment of the Sedative Effect of Remimazolam

Purpose of Review: Remimazolam is a new short-acting benzodiazepine in the final stages of clinical development. The methods of monitoring sedation and assessing the depth of anesthesia for benzodiazepine sedative drugs have been fraught with controversy in clinical work. As a newly released short-acting anesthetic sedative drug that can be continuously pumped, appropriate anesthetic monitoring and sedation depth assessment tools can better help anesthesiologists make clinical decisions and reduce the emergence of perioperative complications in patients. Recent Findings: Clinical trials of remimazolam have been completed at home and abroad in various phases, and much progress has been made, but the effective sedation monitoring means of remimazolam are still not conclusive. Summary: Remimazolam has a rapid onset of action and a high rate of metabolism in the body; tissue accumulation and delayed awakening are rare. At the same time, it can be safely applied to elderly patients with a low cardiopulmonary function inhibition rate, accurate anesthesia effect, and satisfactory quality of awakening. By comparing various methods of sedation depth monitoring, the data correlation is high, which can be of significant importance for remimazolam sedation depth monitoring.

Pericapsular Nervous Group Block versus Suprainguinal Fascia Iliaca Block Using the Same Injection Volume in Primary HIP Arthroplasty Prospective Observational Study

Objectives. To determine the pericapsular nerve group (PENG) block’s postoperative analgesic efficacy and safety compared to the suprainguinal fascia iliaca (SFI) block in patients undergoing primary hip arthroplasty using the same injectate volume. Material and Methods. Between January 2021 and March 2022, American Society of Anesthesiologists Physical Status (ASA-PS) classification I–III patients scheduled for hip arthroplasty were included in this study. After standard monitoring and subarachnoid anesthesia, an ultrasound-guided PENG or SFI block with 20 ml of 0.25% levobupivacaine was performed for postoperative analgesia. All patients were assessed with a numerical rating scale (NRS) at presurgery, upon arrival at the postanesthesia care unit (PACU), and in the postoperative period at 2, 4, 12, and 24 hours. The need for analgesic rescue and adverse effects was also assessed. Results. A total of 130 patients were included in the study (62 PENG block and 68 SFI block). Both blocks were equally effective in managing postoperative pain without any statistically significant differences except at 12 h (p=0.023), where the deviation found was not clinically relevant. The median total morphine consumption was 0 mg [0–2] in the PENG block group and 0 mg [0–2] in the SFI block group. A more significant motor block was found in the first 6 hours in the SFI block group (p=0.001). There was no significant difference in the ease of performing PENG (79%) or SFI (85%) blocks. No major complications were recorded in both groups, and patient satisfaction was high (83.9% for the PENG block group vs. 91.2% for the SFI block group). Discussion. Both blocks have been demonstrated to be effective for postoperative analgesia in hip arthroplasty and should be integrated as a multimodal analgesic strategy. The lesser degree of motor block recorded in the first hours with the PENG block makes it the most suitable option for early recovery. Both techniques were easy and safe to perform.

Real-time imaging of decompression gas bubble growth in the spinal cord of live rats.

To observe the growth and resolution of decompression gas bubbles in the spinal cord of live rats in real time using MRI. We constructed an MRI-compatible pressure chamber system to visualize gas bubble dynamics in deep tissues in real time. The system pressurizes and depressurizes rodents inside an MRI scanner and monitors their respiratory rate, heart rate, and body temperature while providing gaseous anesthesia under pressure during the experiments. We observed the formation of decompression gas bubbles in the spinal cord of rats after compression to 7.1 bar absolute and rapid decompression inside the MRI scanner while maintaining continuous gaseous anesthesia and vital monitoring. We have shown the direct observation of decompression gas bubble formation in real time by MRI in live, anesthetized rats.

Anesthetic Considerations for Patients with Hereditary Neuropathy with Liability to Pressure Palsies: A Narrative Review.

Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal dominant demyelinating neuropathy characterized by an increased susceptibility to peripheral nerve injury from trauma, compression, or shear forces. Patients with this condition are unique, necessitating distinct considerations for anesthesia and surgical teams. This review describes the etiology, prevalence, clinical presentation, and management of HNPP and presents contemporary evidence and recommendations for optimal care for HNPP patients in the perioperative period. While the incidence of HNPP is reported at 7-16:100,000, this figure may be an underestimation due to underdiagnosis, further complicating medicolegal issues. With the subtle nature of symptoms associated with HNPP, patients with this condition may remain unrecognized during the perioperative period, posing significant risks. Several aspects of caring for this population, including anesthetic choices, intraoperative positioning, and monitoring strategy, may deviate from standard practices. As such, a tailored approach to caring for this unique population, coupled with meticulous preoperative planning, is crucial and requires a multidisciplinary approach.

End-Tidal Carbon Dioxide Monitoring in Anesthesia: Unraveling the Mysteries of Respiratory and Circulatory Physiology

The present article underscored the indispensable significance of end-tidal carbon dioxide (ETCO2) monitoring in anesthesia and critical care, offering critical insights into both ventilation and metabolism dynamics. The meticulous management of tidal volume, respiratory rate, and inspired oxygen levels during anesthesia plays a pivotal role in maintaining optimal arterial oxygen and carbon dioxide concentrations. Effective ventilation is imperative for proper gas exchange within the alveoli and maintaining a stable acid-base balance. In the context of circulatory physiology during anesthesia, cardiac output, blood pressure, and tissue perfusion hold paramount importance. The present article highlights how anesthesia-induced alterations in vascular tone and cardiac function could influence circulation and tissue oxygenation, impacting parameters like blood pressure, heart rate, and ETCO2. Monitoring these parameters provides essential data for assessing circulatory status, guiding anesthesia management, and averting complications. ETCO2 monitoring has evolved into a standard practice in anesthesia and critical care settings, offering real-time, non-invasive insights. The present article delved into the extensive clinical applications, challenges, and future directions of ETCO2 monitoring. Encompassing fundamental principles, technological nuances, clinical implications, limitations, and avenues for research, this article advanced the understanding of this monitoring technique and its positive impact on patient care. The present article also discussed how ETCO2 levels reflect alveolar ventilation, providing critical data for assessing ventilation adequacy, readiness for extubation, and identification of impending respiratory distress. Furthermore, it delved into how ETCO2 levels serve as an indicator of cardiac output and tissue perfusion, guiding management strategies in various shock states and offering prognostic insights during CPR. Challenges and limitations associated with ETCO2 monitoring were clarified, with emphasis on technical considerations, patient populations with specific challenges, and potential interpretation pitfalls. The article outlines the exciting future directions of ETCO2 monitoring, encompassing wearable technology, remote monitoring capabilities, artificial intelligence integration, and potential applications beyond traditional realms. Keywords: Anesthesia; Capnography; Critical care; End-tidal carbon dioxide; ETCO2 monitoring

Perioperative echocardiographic strain analysis: what anesthesiologists should know.

Echocardiographic strain analysis by speckle tracking allows assessment of myocardial deformation during the cardiac cycle. Its clinical applications have significantly expanded over the last two decades as a sensitive marker of myocardial dysfunction with important diagnostic and prognostic values. Strain analysis has the potential to become a routine part of the perioperative echocardiographic examination for most anesthesiologist-echocardiographers but its exact role in the perioperative setting is still being defined. This clinical report reviews the principles underlying strain analysis and describes its main clinical uses pertinent to the field of anesthesiology and perioperative medicine. Strain for assessment of left and right ventricular function as well as atrial strain is described. We also discuss the potential role of strain to aid in perioperative risk stratification, surgical patient selection in cardiac surgery, and guidance of anesthetic monitor choice and clinical decision-making in the perioperative period. Echocardiographic strain analysis is a powerful tool that allows seeing what conventional 2D imaging sometimes fails to reveal. It often provides pathophysiologic insight into various cardiac diseases at an early stage. Strain analysis is readily feasible and reproducible thanks to the use of highly automated software platforms. This technique shows promising potential to become a valuable tool in the arsenal of the anesthesiologist-echocardiographer and aid in perioperative risk-stratification and clinical decision-making.

Quantification of EEG Characteristics for Epileptic Seizure Detection and Monitoring of Anaesthesia Using Spectral Analysis

Epilepsy is considered one of the primary neurological disorders, and its treatment requires abundant technological assistance. General Anaesthesia induces distinct patterns in brain activity, with the most common being a gradual increase in low-frequency signals as the level of Anaesthesia deepens. In this instance, a method of validating epileptic seizures and Anaesthesia through the utilization of electroencephalogram (EEG) data, acquired non-invasively, is introduced. Epileptic seizures and detection of the presence of Anaesthesia approaches make use of discrete Laplace Transformation (LT), Discrete Cosine Transformation (DCT), and Fast Fourier Transform (FFT). Here, it is discussed how power spectral analysis (PSA) helps study EEG characteristics in detecting epileptic behavior and the presence of Anaesthesia. A dataset of EEG (Epileptic and Anaesthesia), which is available publicly [1,2], has been used in the propounded technique using FIR filters and LT, DCT, and FFT are used to store and process 16 channel data. Power Spectrum Density (PSD) and its average were contrasted against a specific spectrum and frequency range of a typical EEG signal to obtain the results. This work uses a technique to determine whether the patient being studied is epileptic and awake or anesthetized.