Arousal Time Research Articles

Prospective Randomized Controlled Trial Comparing Anesthetic Management With Remimazolam Besylate and Flumazenil Versus Propofol During Awake Craniotomy Following an Asleep-awake-asleep Method.

Awake craniotomy is performed to resect brain tumors in eloquent brain areas to maximize tumor reduction and minimize neurological damage. Evidence suggests that intraoperative anesthetic management of awake craniotomy with remimazolam is safe. We compared the time to arousal and efficacy of anesthetic management with remimazolam and propofol during awake craniotomy. In a single-institution randomized, prospective study, patients who underwent elective awake craniotomy were randomized to receive remimazolam and reversal with flumazenil (group R) or propofol (group P). The primary end point was time to awaken. Secondary end points were time to loss of consciousness during induction of anesthesia, the frequency of intraoperative complications (pain, hypertension, seizures, nausea, vomiting, and delayed arousal), and postoperative nausea and vomiting. Intraoperative task performance was assessed using a numerical rating scale (NRS) score. Fifty-eight patients were recruited, of which 52 (26 in each group) were available for the efficacy analysis. Patients in group R had faster mean (±SD) arousal times than those in the P group (890.8±239.8 vs. 1075.4±317.5s; P=0.013)and higher and more reliable intraoperative task performance (NRS score 8.81±1.50 vs. 7.69±2.36; P=0.043). There were no significant intraoperative complications. Compared with propofol, remimazolam was associated with more rapid loss of consciousness and, after administration of flumazenil, with faster arousal times and improved intraoperative task performance.

The lower correlated color temperature with higher illuminance nocturnal light environment improves cognitive performance and sleep quality

Well-designed nocturnal light environment could boost performance on the cognitive tasks and promote sleep quality after light exposure. We optimized and fabricated a four-channel mixed white light with peak wavelengths of 429, 523, 591, and 621 nm. Comparing with common white light emitting diode (LED) (5798 K, 212.7 lx), the mixed white light has lower correlated color temperature (CCT) (2799 K), higher illuminance (356.2 lx), similar melanopic illuminance, and better color fidelity. We conducted experiments on 14 healthy young subjects (7 males and 7 females; age 18–25 years) to investigate the effects of nocturnal light environments on the cognitive performances and sleep quality. In consistent with the α-opic flux model, the mixed white light with higher illuminance shrinks the pupil size and has less melanopic flux, which results in more melatonin for subjects. More melatonin before sleep benefits the sleep quality by decreasing arousal times and improving sleep continuity. The higher illuminance light environment also promotes the inhibition ability and working memory. Moreover, it presents better color discrimination and less visual fatigue. Therefore, the lower CCT with higher illuminance nocturnal light environment effectively promotes both cognitive performances in the evening and the following sleep quality.

A retrospective comparative study of anesthesia with remimazolam and remifentanil versus dexmedetomidine and remifentanil for transcatheter aortic valve replacement

Remimazolam, an ultrashort-acting benzodiazepine, allows for rapid and reliable arousal. Rapid awakening using remimazolam may be beneficial in transcatheter aortic valve replacement (TAVR), as it allows rapid detection of neurologic deficits. The purpose of this study was to compare arousal time and outcomes between monitored anesthesia care (MAC) with remimazolam and remifentanil and conventional MAC with dexmedetomidine, propofol, and remifentanil. This study was a single center retrospective study. All TAVR cases performed under MAC (MAC-TAVR) at our institution between 2019 and 2021 were included. Patients were classified by anesthesia method into remimazolam and dexmedetomidine groups. Among 258 MAC-TAVR patients, 253 were enrolled. After propensity score matching, 76 patients were assigned to each group. The time from end of drug-administration to arousal [20.0 (16.0, 24.0) min vs. 38.5 (30.0, 56.3) min, p < 0.0001] and the time from attempted-arousal to arousal [1.0 (1.0, 1.0) min vs. 12.5 (3.0, 26.8) min, p < 0.0001] were significantly shorter in the remimazolam group. There was no significant difference in the length of ICU stay [2.0 (2.0, 2.0) days vs. 2.0 (2.0, 2.0) days, p = 0.157] and postoperative hospital stay [6.0 (4.0, 9.0) days vs. 5.0 (4.0, 8.0) days, p = 0.262].Trial registration: Clinical trial number: R03-123, Registry URL: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000051635Registration number: UMIN000045195, Principal investigator's name: Atsuhiro Kitaura,Date of registration: 20 August 2021.

Comparison between Effects of Propofol and Dexmedetomidine as Sedative in Elective Caesarean Section under Subarachnoid Anaesthesia

Background: The use of spinal (subarachnoid) anaesthesia is often limited by the unwillingness of patients to remain awake during surgery. Objective: This study was undertaken to compare propofol and dexmedetomidine in terms of onset and recovery of sedation, haemodynamic effects, respiratory effects and adverse effects of both the drugs during elective Caesarian section under spinal anaesthesia. Methodology: This randomized clinical trial included 60 ASA (American Society of Anaesthesiologists) grade I patients undergoing elective Caesarean sections under Subarachnoid anaesthesia during the period January 2022 to June 2022. Patients were randomly allocated to one of two groups designated as Propofol group (Group A, n=30), who received Propofol in a single dose of 0.5mg/kg and Dexmedetomidine group (Group B, n=30), who received Dexmedetomidine in a single dose of 2mcg/kg. The onset of sedation i.e. time from iv (intravenous) injection of propofol or dexmedetomidine to closure of eye lids (OAA/S score of 3) and the arousal time from sedation i.e. time from closing of the eye lids to OAA/S score of 5 (patient is awake clinically) were noted. Any complication during operation was documented. Results: There was no significant difference of mean blood pressure and mean heart rate between the two groups in different time intervals (P&gt;0.05). Time of onset of sedation was significantly delayed in Dexmedetomidine group (P&lt;0.05). The arousal time i.e. duration of sedation was significantly longer with Dexmedetomidine than Propofol (P&lt;0.05). Propofol was associated with significantly higher incidence of some adverse effects like pain in arm during drug administration than Dexmedetomidine (46.66% vs 10.0%, P&lt;0.05). Significant percentage of patients was satisfied with dexmedetomidine than propofol (86.66% vs 13.33%, P&lt;0.001). Conclusion: Duration of sedation is significantly longer with dexmedetomidine than propofol which is beneficial for the patient in single dose technique for sedation. Journal of National Institute of Neurosciences Bangladesh, January 2023;9(1):65-70

Comparison between Effects of Fentanyl and Dexmedetomidine as Sedative in Elective Caesarean Section Under Subarachnoid Anaesthesia

Background: Regional anaesthesia has become an important anaesthetic technique now a days. The use of spinal (Subarachnoid) anaesthesia is often limited by the unwillingness of patients to remain awake during surgery. Pharmacologically induced tranquility improves acceptance of regional technique. This study compares Fentanyl and Dexmedetomidine in terms of onset and recovery of sedation, haemodynamic effects, respiratory effects and adverse effects of both the drugs during elective Caesarian section under spinal anaesthesia.&#x0D; Materials and methods: This randomized clinical trial included 60 ASA (American Society of Anaesthesiologists) grade I patients between age 20-40 years undergoing elective caesarean sections under subarachnoid anaesthesia during the period January 2022 to June 2022.Patients were randomly allocated to one of two groups: Fentanyl group (Group F, n=30), who received Fentanyl in a single dose of 0.5mcg/kg and Dexmedetomidine group (Group D, n=30), who received Dexmedetomidine in a single dose of 2mcg/kg. Spinal anaesthesia was conducted by injecting a hyperbaric solution of 0.5% bupivacaine 3ml through a 25G spinal needle at L3-4 level. All parameters were documented at 5 min intervals until arousal of the patient. The onset of sedation i.e. time from iv (Intravenous) injection of Fentanyl or Dexmedetomidine to closure of eye lids (OAA/S score of 3) and the arousal time from sedation i.e. time from closing of the eye lids to OAA/S score of 5 (Patient is awake clinically) were noted. Any complication during operation was documented. The patient’s satisfaction with the sedation was assessed by the 5 point ‘Likert verbal rating scale.’&#x0D; Results: There was no significant difference of mean blood pressure and mean heart rate between the two groups in different time intervals (p&gt;0.05). Time of onset of sedation was comparable between Fentanyl and Dexmedetomidine (p value 0.210). The arousal time i.e. duration of sedation was significantly longer with Dexmedetomidine than Fentanyl (p&lt;0.05). Fentanyl was associated with significantly higher incidence of some adverse effects like nausea, vomiting than Dexmedetomidine (46.66% vs 13.33%, p&lt;0.05). Significant percentage of patients was satisfied with Dexmedetomidine than Fentanyl (86.66% vs 20%,p&lt;0.001).&#x0D; Conclusion: The study showed that the arousal time i.e. duration of sedation was significantly longer with Dexmedetomidine which is beneficial for the patient in single dose technique for sedation. Moreover, Fentanyl was associated with high incidence of some adverse effects like nausea, vomiting. Thus it is recommended that Dexmedetomidine is a better choice than Fentanyl for sedation in single dose technique during subarachnoid block for caesarean section.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 48-52

(034) Are All Orgasms Created Equally Regardless of Age?

Abstract Introduction Female orgasm has been described as “a sense of throbbing once a second, due to rhythmic contraction and relaxation of the pelvic floor muscles…”1. Physiologic measurement of pelvic floor muscle (PFM) activity has been reported utilized electromyography2 as well as rectal and vaginal pressure biofeedback. 3 None have reported on the specificity of PFM variability during arousal and orgasm or variability across the life cycle. Likewise, there’s been no correlation between these physiologic responses to the subjective nature of orgasm. While knowledge of neuroendocrinology and neuroimaging contribute to some understanding of the physiology of the sexual cycle, research on variability and correlation of physiologic responses of PFMs to the subjectivity of orgasm across is lacking. Objective The purpose is to objectively measure, compare, and correlate the following physiologic responses: a) time to orgasm; b) peak orgasmic force; and c) length of orgasm and correlate those findings with subjective orgasm characteristics utilizing the Orgasmic Rating Scale (ORS) (report to follow). Methods Objective data recorded by in-home users of Lioness (SmartBod Incorporated), an intravaginal, pressure biofeedback device capable of recording PFM activity in response to clitoral vibration. Arousal and orgasmic activity were recorded to users’ phones and a secure SmartBod server. Users were identified by a unique device number with no personal identifiers. Additional demographic data and ORS responses from 26 consenting users were collected and a secondary analysis of the data was performed by the first author. One-hundred-sixty-two biofeedback tracings were included in the review. Data was grouped according to age range, orgasmic type (volcano, avalanche, wave), and by length of time to orgasm regardless of age. Results Ages ranged from 21-60. 17/26 were nulliparous; 5 were peri- or post-menopausal. Review of age grouped data averages showed those 31-40 took the longest to orgasm (598sec) but produced the longest orgasmic response (30sec). Those 51-60 took the least time, 219sec, however created the greatest orgasmic force of 1425gm/f. When comparing averages of the 3 orgasmic types, volcano and avalanche patterns were equally dispersed among all groups with the 51-60s patterning only seen as wave. Those identified as having an avalanche pattern took the longest achieve an orgasm (30sec) but produced the longest orgasmic response (30sec). Those with the wave pattern produced the greatest peak force at 940.8gm/f. The median time to orgasm was 483 sec (8min). Those below the median in time (less time to orgasm) took 227sec (4min) on average to orgasm with peak forces of 783gm/f. Those above the median, on average took 789sec (13min) to reach orgasm when a peak orgasmic force of 722gm/ was produced. Conclusions Orgasmic patterns from this small sample of women suggest that those in the 31-40 age range have the longest orgasms and need the most arousal to get there; however, those in the 51-60 year range produced the great peak orgasmic force. Those with the avalanche patterned orgasm take the longest to get there as but have the longest orgasm. Taking less arousal time overall appears to create the strongest orgasmic response. This likely indicates that women in this condition are more sexually aroused to begin with. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: SmartBod.

Comparison between Effects of Ketofol and Dexmedetomidine as Sedative in Elective Caesarean Section under Subarachnoid Anaesthesia

Background: Regional anaesthesia has become an important anaesthetic technique now a days. The use of spinal(subarachnoid) anaesthesia is often limited by the unwillingness of patients to remain awake during surgery.Pharmacologically induced tranquility improves acceptance of regional technique. Objective: This study compares Ketofol (Ketamine + Propofol) and Dexmedetomidine in terms of onset and recovery ofsedation, haemodynamic effects, respiratory effects and adverse effects of both the drugs during elective Caesariansection under spinal anaesthesia. Materials and Methods: This randomized clinical trial included 60 ASA (American Society of Anaesthesiologists)grade I and II patients between age 20-40 years undergoing elective Caesarean sections under Subarachnoidanaesthesia during the period January 2022 to June 2022. Patients were randomly allocatedto one of two groups:Ketofol group (Group KP, n=30), who received Ketofol in a single dose of 0.5mg/kg (Ketamine-0.5mg/ kg+Propofol-0.5mg/kg) and Dexmedetomidine group (Group D, n=30), who received Dexmedetomidine in a single dose of 2mcg/kg.Spinal anaesthesiawas conducted by injecting a hyperbaric solution of 0.5% bupivacaine 3ml through a 25G spinalneedle at L3-4 level. All parameters were documented at 5 min intervals until arousal of the patient. The onset ofsedation i.e. time from iv (intravenous) injection of Ketofol or Dexmedetomidine to closure of eye lids (OAA/S score of3) and the arousal time from sedation i.e. time from closing of the eye lids to OAA/S score of 5 ( patient is awakeclinically) were noted. Any complication during operation was documented. Patient’s satisfaction with the sedation wasassessed by the 5 point ‘Likert verbal rating scale’. Results: There was no significant difference of mean blood pressure and mean heart rate between the two groups indifferent time intervals (P&gt;0.05). Time of onset of sedation was significantly delayed in Dexmedetomidine group(P&lt;0.001). The arousal time i.e. duration of sedation was comparable between the two groups (P&gt;0.05). Ketofol wasassociated with significantly higher incidence of some adverse effects like pain in arm during drug administration thanDexmedetomidine (33.33% vs 10%, P&lt;0.05). Satisfaction with sedation was comparable between the two groups(66.66% vs 86.66%, P value 0.136). Conclusion: As duration of sedation was comparable between the two drugs but adverse effects was less withDexmedetomidine, it is recommended that Dexmedetomidine is a better choice than Ketofol for sedation in single dosetechnique during Subarachnoid block for Caesarean section. Bangladesh Crit Care J March 2023; 11 (1): 13-18

Comparison Between Effects of Ketofol and Fenofol as Sedative in Elective Caesarean Section Under Subarachnoid Anaesthesia

Background: Regional anaesthesia has become an important anaesthetic technique now a days. The use of spinal (subarachnoid) anaesthesia is often limited by the unwillingness of patients to remain awake during surgery. Pharmacologically induced tranquility improves acceptance of regional technique. Objective: This study compares Ketofol (Ketamine+Propofol) and Fenofol (Fentanyl+ Propofol) in terms of onset and recovery of sedation, haemodynamic effects, respiratory effects and adverse effects of both the drugs during elective Caesarian section under spinal anaesthesia. Methods: This randomized clinical trial included 60 ASA (American Society of Anaesthesiologists) grade I or II patients between age 20-40 years undergoing elective Caesarean sections under Subarachnoid anaesthesia during the period of January 2022 to June 2022. Patients were randomly allocated to one of two groups: Ketofol group (Group KP, n=30), who received Ketofol in a single dose of 0.5mg/kg (Ketamine- 0.5mg/kg+Propofol-0.5mg/kg) and Fenofol group (Group FP, n=30), who received Fenofol in a single dose of Fentanyl-0.5mcg/kg+Propofol-0.5mg/kg. Spinal anaesthesia was conducted by injecting a hyperbaric solution of 0.5% bupivacaine 3ml through a 25G spinal needle at L3-4 level. All parameters were documented at 5 min intervals until arousal of the patient. The onset of sedation i.e. time from iv (intravenous) injection of Ketofol or Fenofol to closure of eye lids and the arousal time from sedation i.e. time from closing of the eye lids to OAA/S score of 5 (patient is awake clinically) were noted. Any complication during operation was documented. Patient’s satisfaction with the sedation was assessed by the 5 point ‘Likert verbal rating scale. Results: There was no significant difference of mean blood pressure and mean heart rate between the two groups (P&gt;0.05). Time of onset of sedation was comparable between the two groups (P&gt;0.05). Duration of sedation was significantly less in Fenofol group (p value=&lt;0.001). Significant percentage of patients required oxygen supplementation after sedation with Fenofol due to hypoventilation (66.66% vs 10%, p value &lt;0.001). Incidence of nausea and vomiting was significantly more with Fenofol (46.66% vs 10%, p value &gt;0.001). Conclusion: The study showed that the arousal time i.e. duration of sedation was significantly more with Ketofol than Fenofol which is beneficial for the patient in single dose technique for sedation. Fenofol was associated with significantly high incidence of nausea, vomiting. Moreover, significantly higher percentage of patients required O2 supplementation due to hypoventilation during sedation with Fenofol. Thus it is recommended that Ketofol is a better choice than Fenofol for sedation in single dose technique during subarachnoid block for Caesarean section. J Rang Med Col. March 2023; Vol. 8, No. 2:20-26

Establishment of a chronic insomnia rat model of sleep fragmentation using unstable platforms surrounded by water.

Chronic fragmented sleep is a very common type of insomnia that affects the daily lives of numerous people around the world. However, its pathogenesis is not very clear and a corresponding rat model has not been reported for this purpose at present. The present study aimed to establish a rat model of chronic insomnia with sleep fragmentation using self-made multiple strings of unstable platforms surrounded by shallow water. During the establishment of the models, changes in body weight and differences in food and water intake in the daytime and at night were acquired. The rat models were assessed using several tests, including the Morris water maze test, pentobarbital sodium-induced sleep, infrared monitoring and electroencephalogram/electromyography during sleep. The expression levels of certain inflammatory factors and orexin A were detected in the serum and brain tissues using ELISAs, immunohistochemistry and immunofluorescence. The expression levels of orexin 1 receptor (orexin 1r) were also detected in the brain. Polysomnography indicated that the model rats were successfully prepared with reduced non-rapid eye movement (non-REM) sleep in the daytime, which was increased at night, and considerably lower REM duration during the day and night. The number of instances of sleep arousals were also increased in the day and at night, and the average duration of each sleep bout was decreased in the daytime. The body weights of the model rats increased at a normal rate. However, the reduction of body weight in the daytime and increased in body weight at night were significantly less than those of the control rats. The daytime food and water consumption of the model rats increased significantly compared with that of the control rats, but was similar to that of the control group at night. The Morris water maze test indicated that the model rats were slow to learn to escape the platforms and performed a lower number of target crossings. The pentobarbital-induced sleep experiment confirmed that the model rats exhibited a longer sleep latency and shorter sleep time. The serum IL-1β, IL-6, TNF-α and orexin A levels of the model rats were significantly increased, whereas their serum IL-10 levels were significantly decreased compared with those of the control rats. The expression levels of IL-1β, IL-6, orexin A and orexin 1r in the brain tissues of the model rats were also significantly increased. In conclusion, these data indicate that learning and memory function, sleep time, arousal times, diurnal and nocturnal body weight changes, food and water intake, and expression levels of the specific inflammatory factors orexin A and orexin 1r were altered in the model rats. This suggests the chronic insomnia rat model with sleep fragmentation was successfully established using multiple strings of unstable platforms surrounded by water.

Comparison between Effects of Fentanyl and Fenofol as Sedative in Elective Caesarean Section under Subarachnoid Anaesthesia

Background: Regional anaesthesia has become an important anaesthetic technique now a days. Pharmacologically induced tranquility improves acceptance of regional technique. Objective: To compare Fentanyl and Fenofol (Fentanyl+Propofol) in terms of onset and recovery of sedation, haemodynamic effects, respiratory effects and adverse effects of both the drugs during elective Caesarian section under spinal(subarachnoid) anaesthesia. Materials and Methods: This randomized clinical trial included 60 ASA (American Society of Anaesthesiologists) grade I or II patients between age 20-40 years undergoing elective Caesarean sections under Subarachnoid anaesthesia during the period January 2022 to June 2022. Patients were randomly allocated to one of two groups: Fentanyl group (Group F, n=30), who received Fentanyl in a single dose of 0.5mcg/kg and Fenofol group (Group FP, n=30), who received Fenofol in a single dose of Fentanyl-0.5mcg/kg+Propofol-0.5mg/kg. Spinal anaesthesia was conducted by injecting a hyperbaric solution of 0.5% bupivacaine 3ml through a 25G spinal needle at L3-4 level. All parameters were documented at 5 min intervals until arousal of the patient. The onset of sedation i.e. time from iv (intravenous) injection of Fentanyl or Fenofol to closure of eye lids (OAA/S score of 3) and the arousal time from sedation i.e. time from closing of the eye lids to OAA/S score of 5 ( patient is awake clinically) were noted. Any complication during operation was documented. The patient’s satisfaction with the sedation was assessed by the 5 point ‘Likert verbal rating scale.’ Results: There was no significant difference of mean blood pressure and mean heart rate between the two groups in different time intervals (P&gt;0.05). Time of onset of sedation and the arousal time i.e. duration of sedation was comparable between the two groups (P&gt;0.05). Significant percentage of patients required O2 supplementation in Fenofol group due to hypoventilation (66.66% vs 10%, P&lt;0.001). Pain in arm during drug administration was significantly more with Fenofol (46.66% vs 6.66%, P&lt;0.001). Conclusion: As a significantly higher percentage of patients required O2 supplementation during sedation with Fenofol and pain in arm during drug administration was significantly more in Fenofol group, it is recommended that Fentanyl is a better choice than Fenofol for sedation in single dose technique during subarachnoid block for Caesarean section. KYAMC Journal Vol. 13, No. 04, January 2023: 234-239

SIK3–HDAC4 in the suprachiasmatic nucleus regulates the timing of arousal at the dark onset and circadian period in mice

Mammals exhibit circadian cycles of sleep and wakefulness under the control of the suprachiasmatic nucleus (SCN), such as the strong arousal phase-locked to the beginning of the dark phase in laboratory mice. Here, we demonstrate that salt-inducible kinase 3 (SIK3) deficiency in gamma-aminobutyric acid (GABA)-ergic neurons or neuromedin S (NMS)-producing neurons delayed the arousal peak phase and lengthened the behavioral circadian cycle under both 12-h light:12-h dark condition (LD) and constant dark condition (DD) without changing daily sleep amounts. In contrast, the induction of a gain-of-function mutant allele of Sik3 in GABAergic neurons exhibited advanced activity onset and a shorter circadian period. Loss of SIK3 in arginine vasopressin (AVP)-producing neurons lengthened the circadian cycle, but the arousal peak phase was similar to that in control mice. Heterozygous deficiency of histone deacetylase (HDAC) 4, a SIK3 substrate, shortened the circadian cycle, whereas mice with HDAC4 S245A, which is resistant to phosphorylation by SIK3, delayed the arousal peak phase. Phase-delayed core clock gene expressions were detected in the liver of mice lacking SIK3 in GABAergic neurons. These results suggest that the SIK3-HDAC4 pathway regulates the circadian period length and the timing of arousal through NMS-positive neurons in the SCN.

Comparison between Effects of Midazolam and Dexmedetomidine as Sedative in Elective Caesarean Section under Spinal Anaesthesia

This randomized clinical trial compares midazolam and dexmedetomidine in terms of onset and recovery of sedation, haemodynamic effects, respiratory effects, and adverse effects of both the drugs in elective Caesarian section under spinal anaesthesia. The study included 60 ASA grade-I patients between age 20- and 40-years undergoing elective Caesarean sections under subarachnoid anaesthesia, from January 2022 to June 2022. Patients were randomly allocated to one of the two groups: midazolam group (Group-I, n=30), who received midazolam in a single dose of 0.10mg/kg and Dexmedetomidine group (Group-II, n=30), who received dexmedetomidine in a single dose of 2mcg/kg. Spinal anaesthesia was conducted by injecting a hyperbaric solution of 0.5% bupivacaine 3ml through a 25G spinal needle at L3-4 level. All parameters were documented at 5-minute intervals until arousal of the patient. The onset of sedation i.e., time from IV (intravenous) injection of Midazolam or Dexmedetomidine to closure of eye lids (OAA/S score of 3) and the arousal time from sedation i.e., time from closing of the eye lids to OAA/S score of 5 (patient is awake clinically) were noted. Any complication during operation was documented. The patient’s satisfaction with the sedation was assessed by the 5-point ‘Likert verbal rating scale’. There was no significant difference of mean blood pressure and mean heart rate between the two groups at different time intervals (P&gt;0.05). Time of onset of sedation was significantly delayed in dexmedetomidine group (P&lt;0.05). Duration of sedation was comparable between the two groups (P&gt;0.05). Incidence of peroperative complications were comparable between the two groups (P&gt;0.05). Haemodynamic effects and adverse effects of two drugs were comparable. Therefore, it is recommended that either midazolam or dexmedetomidine can be used for sedation in single dose technique during subarachnoid block for Caesarean section.&#x0D; CBMJ 2023 January: Vol. 12 No. 01 P: 99-106

Effects of saccadic and scent stimulations on driver attentiveness in automated driving systems

Level 3 automated driving requires a driver to operate a vehicle in response to a takeover request according to the Society of Automotive Engineers; therefore, the driver should maintain a state of wakefulness. The study aimed to evaluate and verify whether the presented stimuli, i.e., saccade-inducing stimuli (SaS) as visual stimuli, scent stimuli (ScS) as olfactory stimuli, and a combination of saccade-inducing and scent stimuli (CoS), can maintain the wakeful state of a driver. A driving simulator (DS) that can reproduce the actual movement of a motor vehicle using a turn table and six-axis motion device is used to simulate driving under four different conditions: no stimulation, SaS, ScS, and CoS. The percentage of eye closure (PERCLOS) and the electroencephalogram (EEG) analysis were used for the quantitative evaluation, while the participants were subjected to subjective evaluation. The results showed that the average increase in arousal time for each condition was 30.2, 53.7, and 82.3% for the SaS, ScS, and CoS cases, respectively. The average reduction rate in the EEG readings was 39.9, 41.0, and 71.4% for the SaS, ScS, and CoS cases, respectively. All participants indicated that the CoS had the highest effect of arousal as a driver stimulation tool.

Green nanotechnology for controlling bacterial load and heavy metal accumulation in Nile tilapia fish using biological selenium nanoparticles biosynthesized by Bacillus subtilis AS12.

Heavy metal accumulation and pathogenic bacteria cause adverse effects on aquaculture. The active surface of selenium (Se) nanoparticles can mitigate these effects. The present study used Se-resistant Bacillus subtilis AS12 to fabricate biological Se nanoparticles (Bio-SeNPs). The double-edged Bio-SeNPs were tested for their ability to reduce the harmful effects of heavy metals and bacterial load in Nile tilapia (Oreochromis niloticus) and their respective influences on fish growth, behavior, and health. The Bio-SeNPs have a spherical shape with an average size of 77 nm and high flavonoids and phenolic content (0.7 and 1.9 g g-1 quercetin and gallic acid equivalents, respectively), resulting in considerable antioxidant and antibacterial activity. The Bio-SeNPs (3-5 μg ml-1) in the current study resolved two serious issues facing the aquaculture industry, firstly, the population of pathogenic bacteria, especially Aeromonas hydrophilia, which was reduced by 28-45% in fish organs. Secondly, heavy metals (Cd and Hg) at two levels (1 and 2 μg ml-1) were reduced by 50-87% and 57-73% in response to Bio-SeNPs (3-5 μg ml-1). Thus, liver function parameters were reduced, and inner immunity was enhanced. The application of Bio-SeNPs (3-5 μg ml-1) improved fish gut health, growth, and behavior, resulting in fish higher weight gain by 36-52% and a 40% specific growth rate, compared to controls. Furthermore, feeding and arousal times increased by 20-22% and 28-53%, respectively, while aggression time decreased by 78% compared to the control by the same treatment. In conclusion, Bio-SeNPs can mitigate the accumulation of heavy metals and reduce the bacterial load in a concentration-dependent manner, either in the fish media or fish organs.

Arousal Time from Sedation during Spinal Anaesthesia Given with Propofol and Midazolam for Elective Infraumbilical Surgeries

Background: Arousal time is variable after sedation with spinal anesthesia after infraumbilical surgeries. Propofol and midazolam have been studied individually using the Observer’s Assessment of Awareness/Sedation (OAA/S) score and different other ways. So this present study was designed to compare the arousal time of sedation for propofol and midazolam using OAA/S scores.&#x0D; Materials and methods: A total of 60 patients were randomly assigned to receive either propofol (Group A, n =30) or midazolam (Group B, n = 30). All patients of Group A received bolus of propofol (1 mg/kg) followed by infusion at 3 mg/kg/h, Group B received bolus of midazolam (0.05 mg/kg), followed by infusion at 0.06 mg/kg/h. OAA/S score was noted at beginning and again during recovery. The time to achieve OAA/S score 5 was noted. Changes of pulse rate, O2 saturation and satisfaction score were noted.&#x0D; Results: Among the 60 patients gender distributions where male and female distributed evenly. Age group distributions revealed more patients were gathered in age group 31- 40 years and &gt;51 years. Regarding physical status most of the patients were at ASA physical status 1. It was found that propofol had better outcome than midazolam in terms of arousal time score and patient’s satisfaction score after surgery.&#x0D; Conclusions: A shorter arousal time from sedation during spinal anaesthesia can be achieved using propofol than arousal time with midazolam.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.21 (2); July 2022; Page 18-21

Comparison between effects of Clonazepam and Dexmedetomidine as sedative in elective Caesarean section under Subarachnoid anaesthesia

Background: Regional anaesthesia has become an important anaesthetic technique now a days. Theuse of spinal (subarachnoid) anaesthesia is often limited by the unwillingness of patients to remainawake during surgery. Pharmacologically induced tranquility improves acceptance of regionaltechnique. This study compares Clonazepam and Dexmedetomidine in terms of onset and recovery ofsedation, haemodynamic effects, respiratory effects and adverse effects of both the drugs during electiveCaesarian section under spinal anaesthesia. Materials and Methods: This randomized clinical trial included 60 ASA (American Society ofAnaesthesiologists) grade I patients between age 20-40 years undergoing elective Caesarean sectionsunder Subarachnoid anaesthesia during the period January 2022 to June 2022. Patients wererandomly allocated to one of two groups: Clonazepam group (Group C, n=30), who received Clonazepamin a single dose of 0.015mg/kg and Dexmedetomidine group (Group D, n=30), who receivedDexmedetomidine in a single dose of 2mcg/kg. Spinal anaesthesia was conducted by injecting ahyperbaric solution of 0.5% bupivacaine 3ml through a 25G spinal needle at L3-4 level. All parameterswere documented at 5 min intervals until arousal of the patient. The onset of sedation i.e. time from iv(intravenous) injection of Clonazepam or Dexmedetomidine to closure of eye lids (OAA/S score of 3) andthe arousal time from sedation i.e. time from closing of the eye lids to OAA/S score of 5 ( patient isawake clinically) were noted. Any complication during operation was documented. The patient’ssatisfaction with the sedation was assessed by the 5 point ‘Likert verbal rating scale.’ Results: There was no significant difference of mean blood pressure and mean heart rate between thetwo groups at different time intervals (P&gt;0.05). Time of onset of sedation was significantly delayed inDexmedetomidine group (P&lt;0.05). Duration of sedation was comparable between the two groups (Pvalue 0.326). Incidence of peroperative complications were comparable between the two groups (P&gt;0.05). Conclusion: Although onset of sedation was significantly delayed in Dexmedetomidine group,duration of sedation was not significantly different between Clonazepam and Dexmedetomidine insingle dose technique for sedation during Caesarean section. Haemodynamic effects and adverse effectsof two drugs were comparable. Thus it is recommended that either Clonazepam or Dexmedetomidinecan be used for sedation during subarachnoid block for Caesarean section. JBSA 2022; 35 (2) : 30-36

Pharmacologic Microglial Depletion Disrupts Breathing and Body Temperature Regulation During Torpor in 13‐lined Ground Squirrels

Mammalian hibernation initiates dramatic changes in physiology that include large reductions in ventilation (V̇E), heart rate, oxygen consumption rate (V̇o2), and body temperature (Tb) upon entrance into torpor, effects that reverse upon arousal. Several physiologic processes must maintain function throughout a wide range of temperatures. Recent evidence indicates that neuronal synapses loosen and retract in regions of the brain that are silenced during a torpor bout, although little is understood yet about how these connections are regulated during hibernation. Microglia, brain resident immune cells, are potential facilitators of these essential neural homeostatic activities due to their critical roles in neuronal support and synaptic strengthening and pruning. Thus, we hypothesized that microglia are required for maintaining normal ventilatory neural control during hibernation. To test this, we treated 13‐lined ground squirrels with either vehicle or colony‐stimulating factor receptor‐1 (CSF1R) antagonist, PLX3397 (80mg/kg, po), a receptor whose activation is necessary for microglial survival in the adult nervous system, and measured V̇E, V̇o2, and Tb throughout a torpor bout. During entrance, PLX‐treated squirrels took ~1.5 hours longer to reach their minimum torpor temperature (Tb; 12°C) compared to control animals (Tb; 9.3°C) (ambient temperature; 5‐6°C). Similarly, arousal time in microglia‐depleted animals was as much as 1 hour longer relative to controls, despite starting at a higher minimum Tb. In both treatment groups, V̇o2 during entrance fell and spiked periodically. However, in PLX‐treated animals, these spikes were much greater and more frequent. Minimum V̇o2 in torpor was ~3 times greater in PLX‐treated animals compared to control animals. Upon arousal from torpor, V̇o2 remained elevated, longer, in PLX‐treated squirrels. Total V̇E tended to be elevated in PLX‐treated animals through entrance, steady state torpor, and arousal, but it was most striking during steady state torpor, where V̇E in PLX‐treated animals was 15‐fold higher than control animals. The net result in torpor was an elevated air convection requirement, thus microglia‐depleted animals hyperventilated throughout the torpor bout. Together, these results suggest that microglia play an important regulatory role in normal ventilatory and temperature control throughout torpor and influence the rate at which animals enter into and arouse from torpor. Mechanisms whereby microglia contribute to hibernation neurophysiology are currently under investigation.

Sleep Misperception and Associated Factors in Patients With Anxiety-Related Disorders and Complaint of Insomnia: A Retrospective Study.

PurposeData on sleep parameters by polysomnography (PSG) in patients with anxiety-related disorders are limited. Although the disturbance and risk factors of sleep misperception have been implicated in psychopathology, its role in anxiety-related disorders remains unclear. This retrospective study aimed to explore the characteristics and sleep parameters in patients with anxiety-related disorders and different sleep perception types, and to explore the associated factors for sleep misperception.MethodsPatients with anxiety-related disorders who had complaint of insomnia for more than 3 months were collected at Wuhan Mental Health Center between December 2019 and July 2021. Patients underwent a two-night PSG monitoring and completed a self-reported sleep questionnaire. Behaviors were assessed using 30-item Nurses' Observation Scale for Inpatient Evaluation (NOSIE-30). Patients were divided into normal sleep perception (NSP), positive sleep perception abnormality [PSPA; overestimation of total sleep time (TST) >60 min], and negative sleep perception abnormality (NSPA; underestimation of TST >60 min) groups. PSG indicators and NOSIE-30 scores were compared among groups using the one-way analysis of variance and the Kruskal-Wallis test. Multiple linear regression analysis was performed to determine the associated factors for misperception index.ResultsThe subjective and objective TST were 5.5 ± 1.9 h and 6.4 ± 1.7 h in 305 patients, respectively. Sixty-nine (22.6%) had PSPA, 80 (26.2%) had NSP, and 156 (51.1%) had NSPA. Subjective TST and objective sleep parameters were significantly different among groups. No statistical differences in NOSIE-30 subscale and total scores were observed among groups. Sex, rapid eye movement (REM)/TST (%), sleep efficiency, number of awakenings, Non-rapid eye movement of stage 2 sleep (NREM)/TST (%), REM spontaneous arousal times, sleep latency, diagnosis, social competence, and manifest psychosis were associated with sleep misperception.ConclusionSleep misperception is common in patients with anxiety-related disorders. Various sleep perception types have different PSG profiles, but similar personal and social behaviors. These data may be helpful to conduct personalized treatment.

Arousal characteristics in different OSAHS populations

Objective:This study sought to explore the effect of age on arousal index in patients with OSAHS, and the significance of arousal index among different phenotypes identified through cluster analysis according to clinical symptoms and complications. Methods:A total of 607 adult patients with OSAHS who received polysomnography in the Second Affiliated Hospital of Xi'an Jiaotong University from July 2020 to July 2021 were selected. All patients registered basic human data, symptoms, complaints and complications, completed the Epworth Sleepiness Scale. We explored the distribution of several PSG parameters in different age groups, and included typical symptoms and complications into cluster analysis to explore the parameter differences in patients with different phenotypes. Results:Young patients had the lowest arousal index and arousal frequency in NREM stage, in middle-aged patients, the arousal index was relatively higher, the arousal times during NREM with oxygen desaturation were the highest. Among elderly patients, the wakefulness after sleep onset（WASO） was the longest, the arousal times in REM sleep was the lowest, and the spontaneous arousal times in NREM sleep were the highest（P<0.05）. Among the 3 types according to the cluster analysis, phenotype Ⅰwas characterised by maximally complications, excessive daytime sleepiness and obesity, while memory and attention impairment were obvious in phenotype Ⅱ. Phenotype Ⅲhad minimal complications, relatively better mental state with shorter time-course of snoring and apnea. Phenotype I differed significantly by higher severity, more severe hypoxemia, higher arousal index and longer WASO time（P<0.05）. Conclusion:the arousal index distribution varies among OSAHS patients with different age, and cluster analysis shows that patients with severe symptoms and more complications tend to have higher arousal index.

The Clinical Effect of Blue Light Therapy on Patients with Delayed Sleep-Wake Phase Disorder

ObjectiveTo investigate the feasibility and patient acceptance of applying blue light glasses to treat delayed sleep-wake phase disorder (DSWPD).MethodsFifteen patients with DSWPD were collected as the observation group and 15 healthy people as the control group. The patients wore blue light glasses with a continuous radiation wavelength of about 470 nm for 1h to 2h during the period from 06:30 to 09:00 in the morning after waking up, respectively. Assessment of Hamilton Anxiety Scale 14 items (HAMA14), Hamilton Depression Rating Scale 24 items (HAMD24), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Morningness–Eveningness Questionnaire (MEQ), and Insomnia Severity Index (ISI) scores before and after 1 week of treatment. Pearson correlation was used to analyze the correlation between the efficacy of patients with sleep-wake phase delay disorder and HAMA14, HAMD24, PSQI, ISI, ESS, MEQ, SL (sleep time), TST (total sleep time), TTiB (total time in bed), SQ (sleep quality), TOA (total arousal time), WASO (wake after sleep onset), AAT (average arousal time), and SE (sleep efficiency percent). Multi-factor logistic regression analysis of factors influencing the efficacy of patients with sleep-wake phase delay disorder.ResultsAfter treatment, PSQI-G scores, number of nighttime awakenings and time of awakening recorded in the sleep diary decreased significantly in the observation group (P < 0.05), and subjective sleep quality and MEQ scores increased (P < 0.05). MEQ score shifted from “moderate night type” to “intermediate type”, sleep-wake phase tended to shift forward. The total PSQI score and Pittsburgh Sleep Quality Index Global (PSQI-G) score were significantly lower in the control group after treatment (P < 0.05). By Pearson correlation analysis, the efficacy of patients with sleep-wake phase delay disorder was significantly correlated with HAMA14, HAMD24, PSQI, ISI, ESS, MEQ, SL, TST, TTiB, SQ, TOA, WASO, AAT, and SE. Multifactorial logistic regression analysis revealed that the factors influencing the efficacy of patients with sleep-wake phase delay disorder were PSQI, ISI, ESS, MEQ, SL, TST, TTiB, SQ, TOA, WASO, AAT, and SE.ConclusionBlue light therapy has a positive effect on improving subjective sleep quality, reducing the number of nocturnal awakenings and the duration of nocturnal awakenings, improving daytime function, and shifting the sleep phase forward in patients with DSWPD. Blue light therapy improves subjective sleep quality and daytime function the following day in normal individuals.