Monitoring Depth Of Anesthesia Research Articles

National survey on perioperative cognitive dysfunction

BackgroundPerioperative cognitive dysfunction (PCD) is a very prevalent clinical syndrome due to the progressive aging of the surgical population.The aim of our study is to evaluate the clinical practice of Spanish anesthesiologists surveyed regarding this entity. Material and methodsProspective online survey conducted by the Neurosciences Section and distributed by SEDAR. Results544 responses were obtained, with a participation rate of 17%. 54.4% of respondents never make a preoperative assessment of cognitive impairment, only 7.5% always do it. 79.6% lack an intraoperative management protocol for the patient at risk of PCD. In the anesthetic planning, only 23.3% of the patients was kept in mind. Eighty-nine percent considered regional anesthesia with or without sedation preferable to general anesthesia for the prevention of PCD. 88.8% considered benzodiazepines to present a high risk of PCD. 71.7% considered that anesthetic depth monitoring could prevent postoperative cognitive deficit. Routine evaluation of postoperative delirium is low, only 14%. More than 80% recognize that PCD is underdiagnosed. ConclusionsAmong Spanish anesthesiologists surveyed, PCD is still a little known and underappreciated entity. It is necessary to raise awareness of the need to detect risk factors for PCD, as well as postoperative assessment and diagnosis. Therefore, the development of guidelines and protocols and the implementation of continuing education programs in which anesthesiologists should be key members of multidisciplinary teams in charge of perioperative care are suggested.

Depth of anesthesia monitoring in Norway-A web-based survey.

The bispectral index (BIS) monitor is the most frequently used electroencephalogram (EEG)-based depth of anesthesia (DoA) technology in Norwegian hospitals. However, there is limited knowledge regarding the extent and clinical impact of its use and how anesthesiologists and nurse anesthetists use the information provided by the DoA monitors in their clinical practice. This cross-sectional survey on the use of DoA monitors in Norway used a web-based questionnaire distributed to anesthesia personnel in all hospitals in Norway. Participation was voluntary and anonymized, and the web form could not track IP sources or respondents' locations. Three hundred and ninety-one nurse anesthetists (n = 324) and anesthesiologists (n = 67) responded. Among the EEG-based DoA monitoring tools, BIS was most often used to observe and assess patients' DoA (98%). Raw EEG waveform analysis (10%), EEG-spectrogram (9%), and suppression rate (10%) were seldom used. Twenty-seven percent of the anesthesia personnel were able to recognize a burst suppression pattern on EEG and its significance. Fifty-eight percent of the respondents considered clinical observations more reliable than BIS. Almost all respondents reported adjusting anesthetic dosage based on the BIS index values (80%). However, the anesthetic dose was more often increased (90%) because of high BIS index values than lowered (55%) because of low BIS index values. Despite our respondents' extensive use of DoA monitoring, the anesthesia personnel in our survey did not use all the information and the potential to guide the titration of anesthetics the DoA monitors provide. Thus, anesthesia personnel could generally benefit from increased knowledge of how EEG-based DoA monitoring can be used to assess and determine individual patients' need for anesthetic medication.

Literature Review: Gambaran Monitoring Kedalaman Anestesi Pada Anestesi Umum

The term "depth of anesthesia" refers to the extent to which a general anesthetic agent anesthetizes the central nervous system with a specific concentration of force at the time the drug is administered. The depth level of anesthesia plays an important role in determining surgical complications, and it is very important to keep the depth level of anesthesia under control for the operation to be successful. The purpose of this study is to determine the Monitoring Picture of Anesthesia Depth in General Anesthesia. The literature search will be conducted between 2018 and 2023. The methodof journals and scientific articles contained in this study are national and international journals that have been accounted for their validity. Sources of information obtained from databases are Google Scholar, Science Direct, and PubMed. Anesthesia depth monitoring with the most popular modern technique in practice is the Bixpectral Index Score (BIS) monitor. Anesthesia depth monitoring using BIS is more accurate than traditional anesthesia depth monitoring. Objective assessment of the depth of sedation can use the BIS tool that provides the best prediction of the patient's degree of consciousness to] prevent the patient from waking up and remember actions, drug additions, and wake predictions more accurately by looking at changes in brain electrical activity depicted through EEG

EEG-Messung in Narkose

Based on the existing literature, the application of designated, processed EEG-monitors to measure anesthetic depth and the associated clinical implications are explained. EEG-monitors quantify the hypnotic portion of anesthesia, but not the nociceptive properties of anesthetics. Depth of anesthesia monitoring is common practice in many German hospitals and helps to visualize the interindividual variability of anesthetics, especially of propofol. Although deep anesthesia is associated with increased long-term mortality, this relation seems not to be causally related. Nevertheless, depth of anesthesia monitors help to identify patients being especially susceptible to anesthetics. Moreover, they have shown to reduce the incidence of intraoperative awareness and postoperative delirium. The application of processed EEG-monitors to reduce the incidence of postoperative delirium is currently recommended by the European Society of Anaesthesiology and Intensive Care.

Effect of Somatostatin on hepatic blood flow: preliminary results

Background: Somatostatin (SOMATO) administration affects hepatic blood flow (HBF); however, its clinical effect remains ill-defined. The aim of this study is to assess the clinical effects of SOMATO administration on HBF during major abdominal surgery by comparing HBF in patients with and without intra-operative SOMATO admin-istration. Methods: This retrospective analysis used data from two separate prospective studies including patients undergoing pancreaticoduodenectomy and was approved by the Ghent University Hospital ethical committee. All patients received total intravenous an-esthesia, using target-controlled infusion, and guided by a depth of anesthesia monitor. Schnider model was used for propofol, and Minto model was used for remifentanil. All patients received goal-directed hemodynamic therapy guided and recorded by Pul-sioFlex monitoring (Getinge Group). Portal vein blood flow and arterial hepatic blood flow were measured using ultrasound transit time flow measurements (Medi-Stim®). Both PVF and HAF were indexed using cardiac index. Patients were divided in two groups, receiving SOMATO (group S) versus control group not receiving SOMATO (group C). The Shapiro-Wilk test was used for testing normal distribution. Statistical testing was done using a Welch T-test or a Wilcoxon test. Results: From 6/2017 to 10/2020, a total of thirty-seven patients were analyzed. Twenty-five patients received SOMATO (group S) whereas twelve patients did not (group C). In Group S, PVFi was significantly reduced in patients receiving SOMATO compared to the control group (p = 0.005). HAFi was similar in both groups. The net effect on total HBFi was significantly lower in group S (p = 0.027). Hemodynamic parameters did not differ between both groups. Conclusions: SOMATO significantly reduced PVFi in the surgical patients while HAFi remained similar in both groups. As a result, total HBFi was significantly lower in SO-MATO-treated patients.

Association between cumulative duration of deep anesthesia and postoperative acute kidney injury after noncardiac surgeries: a retrospective observational study

Background Bispectral index (BIS) is a processed electroencephalography monitoring tool and is widely used in anesthetic depth monitoring. Deep anesthesia exposure may be associated with multiple adverse outcomes. However, the relationship between anesthetic depth and postoperative acute kidney injury (AKI) remains unclear. We sought to determine the effect of BIS-based deep anesthesia duration on postoperative AKI following noncardiac surgery. Methods This retrospective study used data from the Vital Signs DataBase, including patients undergoing noncardiac surgeries with BIS monitoring. The BIS values were collected every second during anesthesia. Restricted cubic splines and logistic regression were used to assess the association between the cumulative duration of deep anesthesia and postoperative AKI. Results 4774 patients were eligible, and 129 (2.7%) experienced postoperative AKI. Restricted cubic splines showed that a cumulative duration of BIS < 45 was nonlinearly associated with postoperative AKI (P-overall = 0.033 and P-non-linear = 0.023). Using the group with the duration of BIS < 45 less than 15 min as the reference, ORs of postoperative AKI were 2.59 (95% confidence interval [CI]:0.60 to 11.09, p = 0.200) in the 15–100 min group, and 4.04 (95%CI:0.92 to 17.76, p = 0.064) in the ≥ 100 min group after adjusting for preoperative and intraoperative covariates in multivariable logistic regression. Conclusions The cumulative duration of BIS < 45 was independently and nonlinearly associated with the risk of postoperative AKI in patients undergoing noncardiac surgery.

The arousal effect of sugammadex reversal of neuromuscular blockade differs with anesthetic depth in propofol-remifentanil anesthesia: a randomized controlled trial

Sugammadex reverses neuromuscular blockade by encapsulating steroidal neuromuscular blockers; therefore, it does not pharmacologically affect sedation levels. However, some clinicians avoid using it because of sudden unwanted acting out or patient arousal. Previous studies suggested sugammadex-induced awakening, but frontal muscle contraction after sugammadex administration compromised reliability of results obtained from EEG-based anesthesia depth monitoring tools like bispectral index (BIS). We hypothesized that sugammadex would affect patients’ arousal depending on their baseline levels of sedation. We evaluated arousal signs after sugammadex administration with BIS between 25 − 35 and 45 − 55 under steady-state propofol-remifentanil anesthesia at the end of a surgery (n = 33 in each group). After sugammadex administration, twelve patients with a BIS of 45 − 55 showed clinical signs of awakening but none with a BIS of 25 − 35 (36.4% vs. 0%, P = 0.001). The distribution of the modified observer’s assessment of alertness/sedation scale scores was also significantly different between the two groups (P < 0.001). Changes in the BIS were significantly greater in the BIS 45 − 55 than in the 25 − 35 group (median difference, 7; 95% CI 2 − 19, P = 0.002). Arousal after sugammadex was affected by patient sedation levels, and clinical signs of awakening appeared only in those with BIS 45 − 55. Unwanted arousal of the patient should be considered when using sugammadex under shallow anesthesia.Clinical trial registry number: Clinical Trial Registry of Korea (https://cris.nih.go.kr; Principal investigator: Jieae Kim; Registration number: KCT0006248; Date of first registration: 11/06/2021).

4 Characterizing Cognitive Profiles and Postoperative Cognitive Risk in Older Adults Presenting for Elective Surgery

Objective:Older adults represent 50% of surgical patients and are disproportionately at risk of poor cognitive outcomes after surgery including delirium, accelerated cognitive decline, and dementia. Delirium alone is estimated to occur in up to 50% of older adults postoperatively, while research indicates it is preventable in 30-40% of cases. Individuals with pre-existing cognitive impairments or neurodegenerative diseases are at the highest risk of such outcomes, but (1) cognitive diagnoses are grossly underrepresented in patients' medical records, and (2) routine preoperative cognitive clearance remains rare. The purpose of this presentation is to demonstrate the extent and nature of cognitive vulnerability in older adults preparing for elective surgery within a tertiary care hospital. A case series is also reviewed to illustrate varying surgical outcomes with and without consideration of preoperative cognitive risk.Participants and Methods:This presentation incorporated IRB-approved and data honest broker management to assess diagnoses and cognitive profiles of adults age 65 and older electing surgery with anesthesia between January 2018 and December 2019. Data were assessed across two phases of the Perioperative Cognitive Anesthesia Network (PeCAN) program within the University of Florida and UF Health. First, data from the preoperative anesthesia clinic were reviewed for the percentage of patients with cognitive difficulties within the patient problem list. Second, based on neuropsychological domains, the cognitive profiles of patients assessed by neuropsychologists within the preoperative anesthesia clinic were divided into primary attention, primary memory, or combined memory attention. From these patients, the presenter highlight cases to demonstrate how individuals with cognitive difficulties can be provided care by a multidisciplinary team to mitigate the presence of postoperative complications.Results:Of 14,794 older adults entering the tertiary care medical center for surgical procedures, 4% (n=591) of the sample had ICD cognitive or neurodegenerative codes in the record. When a comprehensive neurobehavioral assessments were conducted on 1,363 of these presurgical patients, 70% had confirmed cognitive deficits on neuropsychological testing. These deficits included primary attention and executive deficits (12%), primary memory impairment (27%), or both attention and memory impairment (31%). Cases from these patients are reviewed and highlight how preoperative cognitive risk status can inform conservative perioperative practices including opioid-sparing analgesia, depth of anesthesia monitoring, and postoperative inpatient geriatric medicine consultation.Conclusions:Medical records listed cognitive diagnoses in 4% of hospital preoperative medical records, yet neuropsychological assessment of a subset of cases revealed a markedly higher rate of impairment. Patients with preoperative cognitive assessment show cognitive symptoms consistent with known neurological disorders of aging including Alzheimer's disease and cerebrovascular disease. Appreciation of pre-existing neurocognitive disorders can alter perioperative practices to prevent or reduce the risk of delirium and other postoperative neurocognitive changes. These data and cases reviewed will highlight how neuropsychology can be involved in perioperative care and champion perioperative interventions for perioperative "rescues".

EEG spectral slope: A reliable indicator for continuous evaluation of consciousness levels during propofol anesthesia

The level of consciousness undergoes continuous alterations during anesthesia. Prior to the onset of propofol-induced complete unconsciousness, degraded levels of behavioral responsiveness can be observed. However, a reliable index to monitor altered consciousness levels during anesthesia has not been sufficiently investigated. In this study, we obtained 60-channel EEG data from 24 healthy participants during an ultra-slow propofol infusion protocol starting with an initial concentration of 1 μg/ml and a stepwise increase of 0.2 μg/ml in concentration. Consecutive auditory stimuli were delivered every 5 to 6 s, and the response time to the stimuli was used to assess the responsiveness levels. We calculated the spectral slope in a time-resolved manner by extracting 5-second EEG segments at each auditory stimulus and estimated their correlation with the corresponding response time. Our results demonstrated that during slow propofol infusion, the response time to external stimuli increased, while the EEG spectral slope, fitted at 15–45 Hz, became steeper, and a significant negative correlation was observed between them. Moreover, the spectral slope further steepened at deeper anesthetic levels and became flatter during anesthesia recovery. We verified these findings using an external dataset. Additionally, we found that the spectral slope of frontal electrodes over the prefrontal lobe had the best performance in predicting the response time. Overall, this study used a time-resolved analysis to suggest that the EEG spectral slope could reliably track continuously altered consciousness levels during propofol anesthesia. Furthermore, the frontal spectral slope may be a promising index for clinical monitoring of anesthesia depth.

Differences in the EEG Power Spectrum and Cross-Frequency Coupling Patterns between Young and Elderly Patients during Sevoflurane Anesthesia.

Electroencephalography (EEG) is widely used for monitoring the depth of anesthesia in surgical patients. Distinguishing age-related EEG features under general anesthesia will help to optimize anesthetic depth monitoring during surgery for elderly patients. This retrospective cohort study included 41 patients aged from 18 to 79 years undergoing noncardiac surgery under general anesthesia. We compared the power spectral signatures and phase-amplitude coupling patterns of the young and elderly groups under baseline and surgical anesthetic depth. General anesthesia by sevoflurane significantly increased the spectral power of delta, theta, alpha, and beta bands and strengthened the cross-frequency coupling both in young and elderly patients. However, the variation in EEG power spectral density and the modulation of alpha amplitudes on delta phases was relatively weaker in elderly patients. In conclusion, the EEG under general anesthesia using sevoflurane exhibited similar dynamic features between young and elderly patients, and the weakened alteration of spectral power and cross-frequency coupling patterns could be utilized to precisely quantify the depth of anesthesia in elderly patients.

A novel recognition of artificial intelligence in regional anaesthesia

Mechanised analysis of algorithms for problem solving, object recognition and decision-making assistance defines the general concept underlining artificial intelligence (AI).[1] The former presents notable applications in perioperative medicine across diverse situations like depth of anaesthesia monitoring, closed-loop anaesthesia delivery, risk-predictive models, pain-management through objective analgo-scoring, operating-room planning logistics and, guidance of perioperative ultrasonography. The recent Food and Drug Administration (FDA) approval[2] of the Scan Nav™ Anatomy Peripheral Nerve Block (PNB) system (Intelligent Ultrasound Group, Cardiff, United Kingdom)[3] only emerges as a novel recognition of the potential of AI in regional anaesthesia. Worthwhile to mention, Hemmerling et al.[4] described an encouraging seminal use of the robotic ultrasound-guided nerve block system or the Magellan system, almost a decade ago. Employing the same system, Morse et al.[5] went on to compare the performance parameters (learning curve and success rates) and subjective performance variability of manual versus robot-assisted ultrasonographic nerve blocks in a phantom model. The authors found that assistance of nerve blocks, enabled significant faster needle guidance (1.8 [1.6] seconds vs. 0.3 [0.3] seconds; P = 0.007), than for manual blocks. Inter-subject performance variability was also found to be considerably attenuated. Specific to the context of the recently FDA approved software medical device, ScanNav™ Anatomy PNB system uses deep-learning AI technology. During performance of a peripheral nerve block the ScanNav™ system identifies and grades a live ultrasound image using this technology. A distinctive colour overlay of the key sono-anatomical structures during a live ultrasound scan is a characteristic valuable attribute of the system.[3] This enhances standardisation and accuracy of the ultrasound image interpretation. This device colour highlights anatomy of 10 vital regions relevant to ultrasound-guided regional anaesthesia namely Interscalene, Supraclavicular, Axillary and Superior Trunk Brachial plexus of the upper limb; Erector Spinae Plane, Rectus Sheath and Supra-inguinal Fascia Iliaca sheath of truncal structures; and Femoral Nerve, Adductor canal and Popliteal nerve sheath of the lower limb. Furthermore, a 3-dimension inbuilt reference material provides a review of the relevant anatomy, probe-positioning technique; and demonstrates a virtual scan of the selected anatomical region. The system enables adjustments in the intensity of coloured highlighting according to user preference and allows for viewing the unmodified and highlighted images side-by-side for better comprehension of the sono-anatomy. The use of ScanNav™ system thereby facilitates as a labelling device alongside real-time anatomy visualisation during regional anaesthesia. The system also has inbuilt virtual scans that assist the clinician functioning as a 3D reference material of the relevant PNB anatomy scanned. Notably so, the software is compatible with the general-purpose ultrasound systems in addition to being a stand-alone device. Talking of the literature relevant to the ScanNav™ Anatomy PNB system, Bowness et al.[6] compared 240 ultrasound scans performed across 15 expert versus non-expert regional anaesthesia providers on evaluating its' role in promoting the uptake and generalisability of ultrasound-guided regional anaesthesia. The authors outlined that non-experts were more likely to submit positive feedback and less likely to submit negative reviews than the experts (P = 0.001). Positive feedbacks were obtained on the role of the device in training (37/60, 61.7%) and utility for teaching (30/60, 50.0%). Meanwhile the non-experts appreciated the anatomic structure identification and learning, as the contextual benefits, some nonexperts and experts thought the device could decrease the scanning confidence. Additionally, expert providers reported a potentially increased, yet insignificant, risk in 12/254 (4.7%) vs. 8/254 (3.1%, P = 0.362) scans for needle trauma to “safety” structures. The discussion elaborates the tremendous opportunity AI has to offer in guiding regional anaesthesia, awaiting prospective validation outside the core 10 block areas. The utility of this device can be further extended to sympathetic blocks like the stellate-ganglion, celiac-plexus and other blocks for treatment of chronic pain syndromes like complex regional pain syndrome. The times might not be distant when perioperative physicians have routine access to ultrasound machines integrated with AI-assisted colour reframing for anatomical landmark “coding” side by side with the present B-mode, M-mode and colour/pulse Doppler profiling.

Consistency of the anesthesia consciousness index versus the bispectral index during laparoscopic gastrointestinal surgery with sevoflurane anesthesia: A prospective multi-center randomized controlled clinical study.

This study aimed to compare the consistency of anesthesia consciousness index (Ai) with that of bispectral index (BIS) in monitoring the depth of anesthesia (DOA) during sevoflurane anesthesia, to reveal the optimal cutoff values in different states of consciousness, and explore the stability of DOA monitoring during intraoperative injurious stimulation. We enrolled 145 patients (97 men and 48 women) from 10 medical centers. General anesthesia was induced using intravenous anesthetics and maintained with sevoflurane. Ai and BIS values were recorded. The mean difference between the Ai and BIS was-0.1747 (95% confidence interval, -0.6660 to 0.3166; p = 0.4857). The regression equation of Ai and BIS from the Deming regression analysis was y = 5.6387 + 0.9067x (y is BIS, x is Ai), and the slope and intercept were statistically significant. Meanwhile, the receiver operating characteristic curve analysis of anesthesia-induced unconsciousness, loss of consciousness, and recovery of consciousness revealed that the accuracy of Ai and BIS were similar. In addition, the optimal cutoff values of the different states of consciousness were not sensitive to age, and both Ai and BIS had no correlation with hemodynamics. We conclude that Ai and BIS show no systematic deviation in readings with high consistency, similar accuracy, and good stability; these insights provide more data for clinical application.

Considerations for Satisfactory Sedation during Dental Implant Surgery.

Implant surgery is a lengthy dental procedure, and sedation is often used to reduce discomfort. The effectiveness of sedation has traditionally been evaluated in terms of patient and surgeon satisfaction, but the most important goal is not to induce a deep sleep in the patient, but rather to ensure that the surgery is performed safely and as planned. Additionally, adequate pain control is a necessary requirement for patient and surgeon satisfaction. Most patients undergoing implant surgery are middle-aged or older, and a relatively large number of them have cardiovascular disease. Infiltration anesthesia using articaine or lidocaine in combination with adrenaline is widely used, but its use in patients with cardiovascular disease is limited because of adrenaline's effects on the cardiovascular system. The use of long-acting local anesthetics and the potential efficacy of ultrasound-guided jaw nerve block have been investigated to enhance analgesia without resorting to adrenaline. Midazolam and propofol are usually used for sedation, but dexmedetomidine, which causes less respiratory depression, and the ultrashort-acting benzodiazepine remimazolam are emerging as potential alternatives. Monitoring of anesthetic depth using electroencephalography is effective in maintaining a constant level of sedation. In addition, sedation promotes the stabilization of heart rate and blood pressure, reducing the risks associated with adrenaline and allowing for safer management.

Anesthesia Depth Monitoring Based on Anesthesia Monitor with the Help of Artificial Intelligence

To use the low-cost anesthesia monitor for realizing anesthesia depth monitoring, effectively assist anesthesiologists in diagnosis and reduce the cost of anesthesia operation. Propose a monitoring method of anesthesia depth based on artificial intelligence. The monitoring method is designed based on convolutional neural network (CNN) and long and short-term memory (LSTM) network. The input data of the model include electrocardiogram (ECG) and pulse wave photoplethysmography (PPG) recorded in the anesthesia monitor, as well as heart rate variability (HRV) calculated from ECG, The output of the model is in three states of anesthesia induction, anesthesia maintenance and anesthesia awakening. The accuracy of anesthesia depth monitoring model under transfer learning is 94.1%, which is better than all comparison methods. The accuracy of this study meets the needs of perioperative anesthesia depth monitoring and the study reduces the operation cost.

Application of fuzzy learning in IoT-enabled remote healthcare monitoring and control of anesthetic depth during surgery

Smart remote patient monitoring and early disease diagnosis systems have made huge progresses after the introduction of Internet of Things (IoT) and Artificial Intelligence (AI) concepts. This paper proposes an AI-enabled IoT system to monitor and adjust the depth of anesthesia via network channels. More precisely, fuzzy learning systems are employed to develop a control system for the depth of anesthesia in surgeries. This scheme is composed of variable structure control and adaptive type-II fuzzy systems. Therefore, the controller is adaptive and robust to any perturbations and disturbances that may happen during a patient’s surgery. The adaptive type-II fuzzy system is designed as an intelligent online estimator to approximate patient model uncertainties. This estimation helps in boosting the performance of the variable structure control system. An artificial neuron is also designed to reduce chattering for the proposed control system. The designed control system can efficiently adjust the anesthesia drug infusion rate and regulate the Bispectral index. The networked structure of the proposed system makes remote tuning of drug infusion possible. Performance of the designed controller is evaluated on several patient models. Simulation results confirm the validity and effectiveness of the proposed remote drug delivery system.

Implication of age-related changes on anesthesia management.

Elderly patients have a high risk of perioperative morbidity and mortality. Pluri-morbidities, polypharmacy, and functional dependence may have a great impact on intraoperative management and request specific cautions. In addition to surgical stress, several perioperative noxious stimuli such as fasting, blood loss, postoperative pain, nausea and vomiting, drug adverse reactions, and immobility may trigger a derangement leading to perioperative complications. Older patients have a high risk of major hemodynamic derangement due to aging of the cardiovascular system and associated comorbidities. The hemodynamic monitoring as well as fluid therapy should be the most accurate as possible. Aging is accompanied by decreased renal function, which is related to a reduction in renal blood flow, renal mass, and the number and size of functioning nephrons. Drugs eliminated predominantly by the renal route need dosage adjustments based on residual renal function. Liver mass, hepatic blood flow, and intrinsic metabolic activity are decreased in the elderly, and all drugs metabolized by the liver have a variable half-life, thus requiring dose reduction. Decreased neural plasticity contributes to a high risk for postoperative delirium. Monitoring of anesthesia depth should be mandatory to avoid overdosage of hypnotic drugs. Prevention of postoperative pulmonary complications requires both protective ventilation strategies and adequate recovery of neuromuscular function at the end of surgery. Avoidance of hypothermia cannot be missed. The aim of this review is to describe comprehensive strategies for intraoperative management plans tailored to meet the unique needs of elderly surgical patients, thus improving outcomes in this vulnerable population.

Experience with the use of an anesthesia depth monitor to objectify the level of consciousness in a patient with a suspected psychiatric disorder

Experience with the use of an anesthesia depth monitor to objectify the level of consciousness in a patient with a suspected psychiatric disorder

Perception and practices of depth of anesthesia monitoring and intraoperative awareness event rate among Jordanian anesthesiologists: a cross-sectional study

BackgroundIntraoperative awareness is the second most common complication of surgeries, and it negatively affects patients and healthcare professionals. Based on the limited previous studies, there is a wide variation in the incidence of intraoperative awareness and in the practices and attitudes toward depth of anesthesia (DoA) monitoring among healthcare systems and anesthesiologists. This study aimed to evaluate the Jordanian anesthesiologists’ practice and attitudes toward DoA monitoring and estimate the event rate of intraoperative awareness among the participating anesthesiologists.MethodsA descriptive cross-sectional survey of Jordanian anesthesiologists working in public, private, and university hospitals was utilized using a questionnaire developed based on previous studies. Practice and attitude in using DoA monitors were evaluated. Anesthesiologists were asked to best estimate the number of anesthesia procedures and frequency of intraoperative awareness events in the year before. Percentages and 95% Confidence Intervals (95%CI) were reported and compared between groups using chi-square tests.ResultsA total of 107 anesthesiologists responded and completed the survey. About one-third of the respondents (34.6%; 95% CI 26.1–44.2) had never used a DoA monitor and only 6.5% (95% CI 3.1–13.2) reported using it as a “daily practice”. The use of a DoA monitor was associated with experience and type of health sector. However, 81.3% (95% CI 66.5–83.5) believed that currently available DoA monitors are effective for DoA monitoring and only 4.7% (95%CI 1.9–10.8) reported it as being “invalid”. Most respondents reported that the main purpose of using a DoA monitor was to prevent awareness (86.0%; 95%CI 77.9–91.4), guide the delivery of anesthetics (63.6%; 95%CI 53.9–72.2), and reduce recovery time (57%; 95%CI 47.4–66.1). The event rate of intraoperative awareness was estimated at 0.4% among participating anesthesiologists. Most Jordanian hospitals lacked policy intending to prevent intraoperative awareness.ConclusionsMost anesthesiologists believed in the role of DoA monitors in preventing intraoperative awareness, however, their attitudes and knowledge are inadequate, and few use DoA monitors in routine practices. In Jordan, large efforts are needed to regulate the use of DoA monitoring and reduce the incidence of intraoperative awareness.

Age-dependent Electroencephalogram Characteristics During Different Levels of Anesthetic Depth.

Objective The monitoring of anesthetic depth based on electroencephalogram derivation is not currently adjusted for age. Here we analyze the influence of age factors on electroencephalogram characteristics. Methods Frontal electroencephalogram recordings were obtained from 80 adults during routine clinical anesthesia. The characteristics of electroencephalogram with age and anesthesia were observed during four kinds of anesthesia. Results The slow wave power, δ power, Bispectral Index (BIS) and approximate entropy can be used to distinguish different states of anesthesia (P < 0.05). In the deep and very deep anesthesia states, δ power decreased with age (P < 0.0001). In the very deep anesthesia state, θ power decreased with age (P < 0.05). In the deep and very deep anesthesia states, α power decreased with age (P = 0.0002). In the light and deep anesthesia states, β power decreased with age (P = 0.003). In the deep anesthesia state, γ power decreased with age (P = 0.002). In the very deep anesthesia state, permutation entropy increased significantly with age (P = 0.0001). In the very deep anesthesia state, BIS value increased with age (P = 0.006). The slow wave power, approximate entropy, and sample entropy did not show age-dependent changes. Conclusions The influence of age should be considered when using BIS and δ power to monitor the depth of anesthesia, while the influence of age should not be considered when using slow wave power and approximate entropy to monitor the depth of anesthesia.

TO EVALUATE AND COMPARE THE POSSIBLE ANALGESIC PROPERTIES OF SEVOFLURANE WITH DESFLURANE IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMIES UNDER VOLATILE INDUCTION AND MAINTENANCE ANAESTHESIA (VIMA)

Introduction: Sevourane and desurane have been successfully used in labour analgesia. Need more evidence to prove their analgesic properties, intraoperatively and postoperatively, when used in volatile induction maintenance Anaesthesia (VIMA) for laparoscopic cholecystectomy. So, a randomized study single blinded comparative study was carried out. After obtaining appropriate approvals, 50 Method: consenting patients of either gender were randomly, equally allocated to two groups to be anaesthetized with VIMA, using either sevourane and desurane. Monitoring included, in addition to routine multiparametric monitoring, the depth of anaesthesia monitoring using Conox, qCON/qNOX kept between 40-60. Rest of the anaesthesia technique was similar, inclusive of Inj. Fentanyl, in both the groups. Pain was scored using, visual analogue scale (VAS), just before induction (T0), just after extubation (T1), as shifted to Post Anaesthesia Care Unit (PACU) (T2), and on demand of rescue analgesia/2 hours in PACU, whichever came rst (T3). With achievement of adequate modied Aldrete score, adequate rescue analgesia was administered before shifting to the ward. Demographically, pati Results: ents in both the groups were similar. Except for lowering of mean pulse rate intraoperatively as compared to before induction, the haemodynamic parameters remained steadfastly stable, suggesting, potentiation of fentanyl analgesia with appropriate depth of anaesthesia maintained. VAS scores were consistently lower (1-3), at all the timepoints. Recovery although far superior in the desurane group was also adequate even in sevourane group. In face of low VAS, the rescue analgesia, had to be given pre-emptively before shifting to the ward. It appears that, both the IAAs Conclusion: , seem to have signicant intraoperative and postoperative analgesic efcacy. Desurane has rapid onset of analgesia, starting from time of induction. Amongst themselves the efcacy is similar, but recovery in desurane group appears to be faster than sevourane.