scholarly journals Verification of the performance of the Bispectral Index as a hypnotic depth indicator during dexmedetomidine sedation

2021 ◽  
Author(s):  
Seunghee Ki ◽  
Dongeon Lee ◽  
Wonjin Lee ◽  
Kwangrae Cho ◽  
Yongjae Han ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Bispectral Index ◽  
Operating Characteristic ◽  
Elective Surgery ◽  
Vital Signs ◽  
Characteristic Analysis ◽  
Prediction Probability ◽  
The Mean ◽  
Age Range ◽  
Dexmedetomidine Infusion

Background: Differences in the effects of propofol and dexmedetomidine sedation on electroencephalogram patterns have been reported previously. However, the reliability of the Bispectral Index (BIS) value for assessing the sedation caused by dexmedetomidine remains debatable. The purpose of this study is to evaluate the correlation between the BIS value and the Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) scale in patients sedated with dexmedetomidine. Methods: Forty-two patients (age range, 20–80 years) who were scheduled for elective surgery under spinal anesthesia were enrolled in this study. Spinal anesthesia was performed using 0.5% bupivacaine, which was followed by dexmedetomidine infusion (loading dose, 0.5–1 μg/kg for 10 min; maintenance dose, 0.3–0.6 μg/kg/h). The MOAA/S score was used to evaluate the level of sedation, and the Vital Recorder program was used to collect data (vital signs and BIS values). Results: A total of 215082 MOAA/S scores and BIS data pairs were analyzed. The baseline variability of the BIS value was 7.024%, and the decrease in the BIS value was associated with a decrease in the MOAA/S score. The correlation coefficient and prediction probability between the two measurements were 0.566 (P < 0.0001) and 0.636, respectively. The mean ± standard deviation values of the BIS were 87.22 ± 7.06, 75.85 ± 9.81, and 68.29 ± 12.65 when the MOAA/S scores were 5, 3, and 1, respectively. Furthermore, the cut-off BIS values in the receiver operating characteristic analysis at MOAA/S scores of 5, 3, and 1 were 82, 79, and 73, respectively. Conclusion: The BIS values were significantly correlated with the MOAA/S scores. Thus, the BIS along with the clinical sedation scale might prove useful in assessing the hypnotic depth of a patient during sedation with dexmedetomidine.

scholarly journals Neural network analysis of clinical variables predicts escalated care in COVID-19 patients: a retrospective study

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e11205
Author(s):  
Joyce Q. Lu ◽  
Benjamin Musheyev ◽  
Qi Peng ◽  
Tim Q. Duong
Keyword(s):  
Operating Characteristic ◽  
Vital Signs ◽  
Area Under The Curve ◽  
Blood Gases ◽  
Characteristic Analysis ◽  
Test Dataset ◽  
Clinical Variables ◽  
Icu Admission ◽  
Reactive Protein ◽  
Laboratory Variables

This study sought to identify the most important clinical variables that can be used to determine which COVID-19 patients hospitalized in the general floor will need escalated care early on using neural networks (NNs). Analysis was performed on hospitalized COVID-19 patients between 7 February 2020 and 4 May 2020 in Stony Brook Hospital. Demographics, comorbidities, laboratory tests, vital signs and blood gases were collected. We compared those data obtained at the time in emergency department and the time of intensive care unit (ICU) upgrade of: (i) COVID-19 patients admitted to the general floor (N = 1203) vs. those directly admitted to ICU (N = 104), and (ii) patients not upgraded to ICU (N = 979) vs. those upgraded to the ICU (N = 224) from the general floor. A NN algorithm was used to predict ICU admission, with 80% training and 20% testing. Prediction performance used area under the curve (AUC) of the receiver operating characteristic analysis (ROC). We found that C-reactive protein, lactate dehydrogenase, creatinine, white-blood cell count, D-dimer and lymphocyte count showed temporal divergence between COVID-19 patients hospitalized in the general floor that were upgraded to ICU compared to those that were not. The NN predictive model essentially ranked the same laboratory variables to be important predictors of needing ICU care. The AUC for predicting ICU admission was 0.782 ± 0.013 for the test dataset. Adding vital sign and blood-gas data improved AUC (0.822 ± 0.018). This work could help frontline physicians to anticipate downstream ICU need to more effectively allocate healthcare resources.

scholarly journals Comparative Study of Children's' Blood Sugar in Fluid Therapy with Dextrose Saline, Ringer and Normal Saline 0.9% Serums and its Relationship with Depth of Anesthesia in Elective Surgery

2021 ◽  
pp. 91-102
Author(s):  
Farhad Nanaei ◽  
Morteza Habibi Moghadam ◽  
Zahra Eslamifar ◽  
Hadi Bahrami ◽  
Mohammad Hasan Bigdeli ◽  
...  
Keyword(s):  
Blood Sugar ◽  
Fluid Therapy ◽  
Normal Saline ◽  
Elective Surgery ◽  
Vital Signs ◽  
Depth Of Anesthesia ◽  
Double Blind ◽  
Significant Difference ◽  
The Mean ◽  
Group B

Background: This study was aimed to determine the children's' blood sugar level in fluid therapy with DSS (dextrose saline serum), RS (ringer serum) and NS 0.9% serums (normal saline 0.9%) and its relationship with the depth of anesthesia in elective surgery. Method: This double-blind experimental study was performed with 90 children referred to the surgical ward, including: group A (receiving DSS), group B (receiving NS 0.9%) and group C (receiving RS) that the blood sugar of each group in 5 steps was measured: half an hour before induction of anesthesia, during induction of anesthesia, half and one hour after induction of anesthesia and after complete awakening in recovery. In addition, the monitoring the vital signs, measuring depth of anesthesia, pulse oximetry and electrocardiogram were performed for all groups. Results: The results showed that the mean blood sugar in the 5 steps measured had a significant difference in three groups under study (P <0.05). The mean blood sugar in the group receiving DSS was significantly higher than the two groups receiving RS and NS 0.9%. Also the mean depth of anesthesia in three groups did not show a significant difference. Conclusion: Finally, according to this study, the use of DSS from the beginning of anesthesia, RS half an hour after the start of anesthesia and NS 0.9% one hour after the start of anesthesia can increase blood sugar in children. Therefore, the use of DSS is not recommended due to the stressful nature of anesthesia and operating room and the possibility of hyperglycemia.

scholarly journals The Effectiveness of Ondansetron in Preventing Hypotension and Bradicardia in Spinal Anestesia

2020 ◽  
Vol 5 (8) ◽  
pp. 1611-1614
Author(s):  
Albert; Akhyar Hamonangan Nasution ◽  
Qadri Fauzi Tanjung
Keyword(s):  
Spinal Anesthesia ◽  
Serotonin Receptors ◽  
Elective Surgery ◽  
Control Group ◽  
P Value ◽  
Control Group Design ◽  
Group Design ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Spinal anesthesia was typically used for elective surgery and was associated with the incidence of hypotension and bradycardia due to sympathetic block. Bezold-Jarisch reflex (BJR) is a reflex that contributes to cause hypotension and bradycardia mediated by serotonin receptors (5-HT3). Ondansetron, a 5-HT3 receptor antagonist, is assumed to inhibit the effect of serotonin and BJR. To assess the effectiveness of ondansetron in preventing hypotension and bradycardia after spinal anesthesia. This study was an experimental study with a "posttest with control group" design conducted at Haji Adam Malik General Hospital and USU Hospital in February 2020 to June 2020. Seventy study subjects who underwent lower abdominal, gynecology, lower extremities under spinal anesthesia were selected by consecutive sampling and were divided into 2 groups. Group 1 received 4 mg ondansetron, while group 2 received 2 cc normal saline, both interventions were given 30 minutes before spinal anesthesia Baseline and minimum mean arterial pressure were higher in the ondansetron group at 97.07 ± 5.09 mmHg and 85.20 ± 6.48 mmHg compared to the control group (p-value <0.05). Hypotension was more common in the control group (51.43%) than in ondansetron group (20%) (p-value <0.05). The mean baseline and minimum heart rate were higher in the ondansetron group at 81,09 ± 9,62 bpm and 79.7 ± 8.75 bpm compared to the control group (p<0.05). The incidence of bradycardia was more common in the control group (17.1%) compared to the ondansetron group (2.9%) (pvalue <0.05). Ondansetron 4 mg, given intravenously, is effective in lowering the incidence of hypotension and bradycardia under spinal anesthesia

Comparative Study of Children's' Blood Sugar in Fluid Therapy with Dextrose Saline, Ringer and Normal Saline 9.0% Serums and its Relationship with Depth of Anesthesia in Elective Surgery

2021 ◽  
Author(s):  
Farhad nanaei ◽  
Morteza Habibi Moghadam ◽  
Zahra eslamifar ◽  
Hadi bahrami ◽  
Mohammad Hasan Bigdeli ◽  
...  
Keyword(s):  
Blood Sugar ◽  
Fluid Therapy ◽  
Elective Surgery ◽  
Vital Signs ◽  
Depth Of Anesthesia ◽  
Double Blind ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract Background: This study was aimed to determine the children's' blood sugar level in fluid therapy with DSS, RSand NS 0.9% serums and its relationship with the depth of anesthesia in elective surgery.Method: This double-blind experimental study was performed with 90 children referred to the surgical ward, including: group A (receiving DSS), group B (receiving NS 0.9%) and group C (receiving RS) that the blood sugar of each group in 5 steps was measured: half an hour before induction of anesthesia, during induction of anesthesia, half and one hour after induction of anesthesia and after complete awakening in recovery. In addition, the monitoring the vital signs, measuring depth of anesthesia, pulse oximetry and electrocardiogram were performed for all groups.Results: The results showed that the mean blood sugar in the 5 steps measured had a significant difference in three groups under study (P <0.05). The mean blood sugar in the group receiving DSS was significantly higher than the two groups receiving RS and NS 0.9%. Also the mean depth of anesthesia in three groups did not show a significant difference.Conclusion: Finally, according to this study, the use of DSS from the beginning of anesthesia, RS half an hour after the start of anesthesia and NS 0.9% one hour after the start of anesthesia can increase blood sugar in children. Therefore, the use of DSS is not recommended due to the stressful nature of anesthesia and operating room and the possibility of hyperglycemia.

Changes in the Auditory Evoked Potentials and the Bispectral Index following Propofol or Propofol and Alfentanil

2000 ◽  
Vol 92 (5) ◽  
pp. 1300-1310 ◽  
Author(s):  
Irene A. Iselin-Chaves ◽  
Habib E. El Moalem ◽  
Tong Joo Gan ◽  
Brian Ginsberg ◽  
Peter S. A. Glass
Keyword(s):  
Evoked Potentials ◽  
Bispectral Index ◽  
Auditory Evoked Potentials ◽  
Sedation Score ◽  
Loss Of Consciousness ◽  
Prediction Probability ◽  
Effect Site Concentration ◽  
Sedation Scores ◽  
The Mean ◽  
To Receive

Background Midlatency auditory evoked potentials (MLAEP) show graded changes with increasing doses of hypnotics but little change with opioids. The effect of their combination on the MLAEP was evaluated. Also, the bispectral index (BIS) was compared with the ability of MLAEP to correlate with sedation and predict loss of consciousness. Methods Twenty healthy volunteers were randomly assigned to receive stepped increases in propofol concentration (10 subjects) or propofol plus alfentanil 100 ng/ml (10 subjects). At baseline and at each targeted effect site concentration the mean MLAEP, BIS, measures of sedation, and drug concentration were obtained. The relation among MLAEP, BIS, and sedation score was determined. The prediction probability (Pk) was calculated and compared for BIS and MLAEP. Results The BIS and MLAEP patterns showed significant changes (Pa and Nb decreased in amplitude and increased in latency) with increasing level of sedation (P &lt; 0.0001). The BIS correlated better with sedation scores (0.884) than did the MLAEP (P &lt; 0.05). Pa and Nb latencies showed the best correlation with sedation levels (0.685 and 0.658, respectively). The addition of alfentanil did not affect the relation between MLAEP and loss of consciousness (P &gt; 0.15). The BIS (Pk = 0.952) was a better predictor of loss of consciousness than were Pa and Nb amplitude (P &lt; 0.05) but were comparable to Pa and Nb latency (Pk = 0.869 and 0. 873, respectively). Conclusion MLAEP changes, like the BIS, correlate well with increasing sedation produced by propofol, and these changes in the MLAEP are independent of the presence of an opioid. Among all the MLAEP parameters, Pa and Nb latencies are the best predictors of increasing sedation and loss of consciousness.

Comparison of Efficacy of Intravenous Tramadol versus Normal Saline in Suppression of Postoperative Shivering in Patients undergoing Elective Surgery

2021 ◽  
Vol 15 (8) ◽  
pp. 2006-2009
Author(s):  
Riffat Saeed ◽  
Nasir Ali ◽  
Syed Mehmood Ali ◽  
Iram Qamar ◽  
Amer Latef ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Regional Anesthesia ◽  
Normal Saline ◽  
Elective Surgery ◽  
Control Group ◽  
P Value ◽  
Thermoregulatory System ◽  
The Mean ◽  
Randomized Control ◽  
One Year

Background: Shivering in the post anesthesia care unit is a common and distressing complication for patients after receiving general or regional anesthesia. Perioperative hypothermia has been associated with an increase in morbidity and mortality. Both central and peripheral thermoregulation is impaired by regional anesthesia. Thermoregulatory system synchronizes with defense system to maintain body’s heat and coolness within the narrow range, thus improving the normal functioning. Objective: To compare the efficacy of intravenous tramadol versus normal saline in suppression of postoperative shivering in patients undergoing elective surgery. Design: It was a randomized control trial. Study Settings: Trial was conducted at Department of Anesthesiology and ICU, Sheikh Zayed Hospital, Lahore, for a period of one year w.e.f 7-11-2019 to 7-11-20. Patients and Methods: A total of 50 patients with age 18 years and above from both the genders undergoing elective surgery under general anesthesia were included in the study and divided into two equal groups randomly. Patients in tramadol group were given tramadol 0.5mg/kg I/V and patients of control group were given 0.9% normal saline 5ml I/V. Results: In tramadol groups the mean age of patients was 27.88±2.79 years while the mean age of the patients from placebo group was 27.84±4.23 years. In this study the efficacy was achieved in 37(74.0%) patients. In control group the efficacy was achieved in 15(60%) patients and in tramadol group the efficacy was achieved in 22(88.0%) patients (p-value<0.05). Conclusion: According to this study the intravenous tramadol is safe and effective drug in suppression of postoperative shivering in patients undergoing elective surgery under spinal anesthesia. Keywords: Intravenous Tramadol, Spinal Anesthesia, Shivering, Elective Surgery.

scholarly journals Cognitive Performance and Its Associations with Dental Caries: Results from the Dental, Oral, Medical Epidemiological (DOME) Records-Based Nationwide Study

Biology ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 178
Author(s):  
Itzhak Abramovitz ◽  
Avraham Zini ◽  
Matan Atzmoni ◽  
Ron Kedem ◽  
Dorit Zur ◽  
...  
Keyword(s):  
Dental Caries ◽  
Cognitive Performance ◽  
Odds Ratio ◽  
Allocation Of Resources ◽  
Cross Sectional ◽  
Intelligence Score ◽  
Health Related ◽  
The Mean ◽  
Nationally Representative ◽  
Age Range

Relatively few studies have analyzed the association between cognitive performance and dental status. This study aimed to analyze the association between cognitive performance and dental caries. Included were data from the dental, oral, medical epidemiological (DOME) study; cross-sectional records-based research, which integrated large socio-demographic, medical, and dental databases of a nationally representative sample of young to middle-aged military personnel (N = 131,927, mean age: 21.8 ± 5.9 years, age range: 18–50). The cognitive function of draftees is routinely measured at age 17 years using a battery of psychometric tests termed general intelligence score (GIS). The mean number of decayed teeth exhibited a gradient trend from the lowest (3.14 ± 3.58) to the highest GIS category (1.45 ± 2.19) (odds ratio (OR) lowest versus highest = 5.36 (5.06–5.68), p < 0.001). A similar trend was noted for the other dental parameters. The associations between GIS and decayed teeth persisted even after adjusting for socio-demographic parameters and health-related habits. The adjustments attenuated the OR but did not eliminate it (OR lowest versus highest = 3.75 (3.38–4.16)). The study demonstrates an association between cognitive performance and caries, independent of the socio-demographic and health-related habits that were analyzed. Better allocation of resources is recommended, focusing on populations with impaired cognitive performance in need of dental care.

scholarly journals Operating Rooms efficiency: leveraging data to improve management of elective surgery

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Quercioli ◽  
G A Carta ◽  
G Cevenini ◽  
G Messina ◽  
N Nante ◽  
...  
Keyword(s):  
Historical Data ◽  
Elective Surgery ◽  
District General Hospital ◽  
Operating Rooms ◽  
Accurate Estimation ◽  
Surgical Time ◽  
Accurate Analysis ◽  
Management Efficiency ◽  
Scheduling Model ◽  
The Mean

Abstract Background Careful scheduling of elective surgery Operating Rooms (ORs) is crucial for their efficient use, to avoid low/over utilization and staff overtime. Accurate estimation of procedures duration is essential to improve ORs scheduling. Therefore analysis of historical data about surgical times is fundamental to ORs management. We analyzed the effect, in a real setting, of an ORs scheduling model based on estimated optimum surgical time in improving ORs efficiency and decreasing the risk of overtime. Methods We studied all the 2014-2019 elective surgery sessions (3,758 sessions, 12,449 interventions) of a district general hospital in Siena's Province, Italy. The hospital had3 ORs open 5 days/week 08:00-14:00. Surgery specialties were general surgery, orthopedics, gynecology and urology. Based on a pilot study conducted in 2016, which estimated a 5 times greater risk of having an OR overtime for sessions with a surgical time (incision-suture)&gt;200 minutes, from 2017 all the ORs were scheduled using a maximum surgical time of 200 minutes calculated summing the mean surgical times for intervention and surgeon (obtained from 2014-2016 data). We carried out multivariate logistic regression to calculate the probability of ORs overtime (of 15 and 30 minutes) for the periods 2014-2016 and 2017-2019adjusting for raw ORs utilization. Results The 2017-2019 risk of an OR overtime of 15 minutes decreased by 25% compared to the 2014-2016 period (OR = 0.75, 95%CI=0.618-0.902, p = 0.003); the risk of a OR overtime of 30 minutes decreased by 33% (OR = 0.67, 95%CI= 0.543-0.831, p &lt; 0.001). Mean raw OR utilization increase from 62% to 66% (p &lt; 0.001). Mean number of interventions per surgery sessions increased from 3.1 to 3.5 (p &lt; 0.001). Conclusions This study has shown that an analysis of historical data and an estimate of the optimal surgical time per surgical session could be helpful to avoid both a low and excessive use of the ORs and therefore to increase the efficiency of the ORs. Key messages An accurate analysis of surgical procedures duration is crucial to optimize operating room utilization. A data-based approach can improve OR management efficiency without extra resources.

scholarly journals Adolescents’ Bipolar Experiences and Suicide Risk: Well-Being and Mental Health Difficulties as Mediators

2021 ◽  
Vol 18 (6) ◽  
pp. 3024
Author(s):  
Ascensión Fumero ◽  
Rosario J. Marrero ◽  
Alicia Pérez-Albéniz ◽  
Eduardo Fonseca-Pedrero
Keyword(s):  
Behavioral Problems ◽  
Suicide Risk ◽  
Well Being ◽  
Self Report ◽  
Emotional Difficulties ◽  
Subjective Well Being ◽  
Mediation Analyses ◽  
Mental Health Difficulties ◽  
The Mean ◽  
Age Range

Bipolar disorder is usually accompanied by a high suicide risk. The main aim was to identify the risk and protective factors involved in suicide risk in adolescents with bipolar experiences. Of a total of 1506 adolescents, 467 (31%) were included in the group reporting bipolar experiences or symptoms, 214 males (45.8%) and 253 (54.2%) females. The mean age was 16.22 (SD = 1.36), with the age range between 14 and 19. Suicide risk, behavioral and emotional difficulties, prosocial capacities, well-being, and bipolar experiences were assessed through self-report. Mediation analyses, taking gender as a moderator and controlling age as a covariate, were applied to estimate suicide risk. The results indicated that the effect of bipolar experiences on suicide risk is mediated by behavioral and emotional difficulties rather than by prosocial behavior and subjective well-being. Specifically, emotional problems, problems with peers, behavior problems, and difficulties associated with hyperactivity were the most important variables. This relationship was not modulated by gender. However, the indirect effects of some mediators varied according to gender. These results support the development of suicide risk prevention strategies focused on reducing emotional difficulties, behavioral problems, and difficulties in relationships with others.

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