DOCSLIB.ORG

Practice Advisory for Intraoperative Awareness and Brain Function

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Practice Advisory for Intraoperative Awareness and Brain Function Ⅵ SPECIAL ARTICLES Anesthesiology 2006; 104:847–64 © 2006 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Practice Advisory for Intraoperative Awareness and Brain Function Monitoring A Report by the American Society of Anesthesiologists Task Force on Intraoperative Awareness PRACTICE advisories are systematically developed re- Methodology ports that are intended to assist decision making in areas A. Definitions of patient care. Advisories provide a synthesis and anal- Intraoperative awareness under general anesthesia is a ysis of expert opinion, clinical feasibility data, open rare occurrence, with a reported incidence of 0.1–0.2%.1–4 forum commentary, and consensus surveys. Advisories Significant psychological sequelae (e.g., post–traumatic are not intended as standards, guidelines, or absolute stress disorder) may occur after an episode of intraopera- requirements. They may be adopted, modified, or re- tive awareness, and affected patients may remain severely jected according to clinical needs and constraints. disabled for extended periods of time.5 However, in some The use of practice advisories cannot guarantee any circumstances, intraoperative awareness may be unavoid- specific outcome. Practice advisories summarize the able to achieve other critically important anesthetic goals. state of the literature and report opinions derived from a The following terms or concepts discussed in this synthesis of task force members, expert consultants, Advisory include: consciousness, general anesthesia, open forums, and public commentary. Practice adviso- depth of anesthesia or depth of hypnosis, recall, amne- ries are not supported by scientific literature to the same sia, intraoperative awareness, and brain function moni- degree as are standards or guidelines because sufficient tors. Consistent definitions for these terms are not avail- numbers of adequately controlled studies are lacking. able in the literature. For purposes of this Advisory, Practice advisories are subject to periodic revision as these terms are operationally defined or identified as warranted by the evolution of medical knowledge, tech- follows: nology, and practice. 1. Consciousness. Consciousness is a state in which a patient is able to process information from his or her surroundings. Consciousness is assessed by observing a Additional material related to this article can be found on the patient’s purposeful responses to various stimuli. Identi- ANESTHESIOLOGY Web site. Go to http://www.anesthesiology. fiers of purposeful responses include organized move- org, click on Enhancements Index, and then scroll down to ments following voice commands or noxious/painful find the appropriate article and link. Supplementary material stimuli.* For example, opening of the eyes is one of can also be accessed on the Web by clicking on the “Arti- clePlus” link either in the Table of Contents or at the top of several possible identifiers or markers of consciousness. the HTML version of the article. Purposeful responses may be absent when paralysis is present as a consequence of neurologic disease or the administration of a neuromuscular blocking drug. Developed by the American Society of Anesthesiologists Task Force on Intra- 2. General Anesthesia. General anesthesia is defined operative Awareness: Jeffrey L. Apfelbaum, M.D. (Chair), Chicago, Illinois; James F. Arens, M.D., Houston, Texas; Daniel J. Cole, M.D., Phoenix, Arizona; Richard as a drug-induced loss of consciousness during which T. Connis, Ph.D., Woodinville, Washington; Karen B. Domino, M.D., Seattle, patients are not arousable, even by painful stimulation.† Washington; John C. Drummond, M.D., San Diego, California; Cor J. Kalkman, M.D., Ph.D., Utrecht, The Netherlands; Ronald D. Miller, M.D., San Francisco, The ability to maintain ventilatory function indepen- California; David G. Nickinovich, Ph.D., Bellevue, Washington; Michael M. Todd, dently is often impaired. Patients often require assistance M.D., Iowa City, Iowa. Submitted for publication October 31, 2005. Accepted for publication October 31, 2005. Supported by the American Society of Anesthesi- in maintaining a patent airway, and positive-pressure ologists under the direction of James F. Arens, M.D., Chair, Committee on ventilation may be required because of depressed spon- Practice Parameters. Approved by the House of Delegates on October 25, 2005. A complete list of references used to develop this Advisory is available by writing taneous ventilation or drug-induced depression of neu- to the American Society of Anesthesiologists. romuscular function. Cardiovascular function may be Address correspondence to the American Society of Anesthesiologists: 520 impaired. North Northwest Highway, Park Ridge, Illinois 60068-2573. This Practice Advi- sory, as well as all published ASA Practice Parameters, may be obtained at no cost 3. Depth of Anesthesia. Depth of anesthesia or depth through the Journal Web site, www.anesthesiology.org. of hypnosis refers to a continuum of progressive central * Reflex withdrawal from a painful stimulus is not considered a purposeful nervous system depression and decreased responsive- response, as indicated by the “Continuum of depth of sedation, definition of general anesthesia, and levels of sedation/analgesia,” American Society of Anes- ness to stimulation. thesiologists Standards, Guidelines, and Statements, October 27, 2004. 4. Recall. For the purpose of this Advisory, recall is the † American Society of Anesthesiologists: Continuum of depth of sedation, patient’s ability to retrieve stored memories. Recall is definition of general anesthesia, and levels of sedation/analgesia, American Soci- ety of Anesthesiologists Standards, Guidelines, and Statements, October 27, 2004. assessed by a patient’s report of previous events, in Anesthesiology, V 104, No 4, Apr 2006 847 848 PRACTICE ADVISORY particular, events that occurred during general anesthe- ance for the intraoperative use of brain function sia. Explicit memory is assessed by the patient’s ability monitors as they relate to intraoperative awareness. to recall specific events that took place during general anesthesia. Implicit memory is assessed by changes in C. Focus performance or behavior without the ability to recall This Advisory focuses on the perioperative treatment specific events that took place during general anesthesia of patients who are undergoing a procedure during that led to those changes.6 A report of recall may be which general anesthesia is administered. This Advisory spontaneous or it may only be elicited in a structured is not intended for the perioperative management of interview or questionnaire. This Advisory does not ad- minimal, moderate, or deep sedation in the operating dress implicit memory. room or intensive care unit; regional or local anesthesia 5. Amnesia. Amnesia is the absence of recall. Many without general anesthesia; monitored anesthesia care; anesthetic drugs produce amnesia at concentrations well tracheal intubation of patients or those undergoing re- below those necessary for suppression of consciousness. suscitation in emergency trauma after the administration Anterograde amnesia is intended when a drug with am- of a neuromuscular block, or intentional intraoperative nestic properties is administered before induction of wake-up testing (e.g., for the purposes of assessing intra- anesthesia. Retrograde amnesia is intended when a drug operative neurologic function). In addition, this Advisory such as a benzodiazepine is administered after an event is not intended to address the perioperative treatment of that may have caused or been associated with intraop- pediatric patients. erative consciousness in the hope that it will suppress memory formation and “rescue” from recall. D. Application 6. Intraoperative Awareness. Intraoperative aware- This Advisory is intended for use by anesthesiologists, ness occurs when a patient becomes conscious during a other physicians who supervise the administration of procedure performed under general anesthesia and sub- general anesthesia, and all other individuals who admin- sequently has recall of these events. For the purpose of ister general anesthesia. The Advisory may also serve as this Advisory, recall is limited to explicit memory and a resource for other physicians and healthcare profes- does not include the time before general anesthesia is sionals who are involved in the perioperative manage- fully induced or the time of emergence from general ment of patients receiving general anesthesia. anesthesia, when arousal and return of consciousness are intended. Dreaming is not considered intraoperative E. Task Force Members and Consultants awareness. The American Society of Anesthesiologists (ASA) ap- 7. Brain Function Monitors. Brain function moni- pointed this Task Force of 10 members to (1) review and tors are devices that record or process brain electrical assess the currently available scientific literature on in- activity and convert these signals mathematically into a traoperative awareness, (2) obtain expert consensus and continuous measure typically scaled from 0 to 100. In public opinion, and (3) develop a practice advisory. The addition to monitoring spontaneous cortical electrical Task Force is comprised of anesthesiologists from vari- activity (electroencephalogram [EEG]), these devices ous geographic areas of the United States, an anesthesi- may also record and process evoked cortical and subcor- ologist from The Netherlands, and two methodologists tical activity (auditory
Load more

Recommended publications
  • Powering Your Performance
    POWERING YOUR PERFORMANCE B105M | B125M | B155M Modular Patient Monitors gehealthcare.com Advanced capabilities. Simple scalability. Dependable technology. B1x5M range of modular patient monitors deliver premium clinical performance across care areas. Scalable platform You can monitor essential vital signs (ECG, SpO2, Temp, NIBP, RR) and easily scale to advanced parameter modules like respiratory gases and Clinical precision anesthetic agents, NMT and Entropy™ – up to three advanced parameters simultaneously. These accurate, reliable, and easy-to-use monitors Intuitive design enable simple and intuitive workflow with a choice of 10-, 12- or 15-inch touch screen displays. B1x5M range of monitors come with Value Dependable technology Software Platform (VSP 3.0). Legacy of premium clinical performance. Excellence of advanced features. Timely clinical decisions. GE Healthcare’s more than 45 years of clinical excellence in The B1x5M range of modular patient monitors helps you quickly designing reliable patient monitoring systems provides you with take charge of patient conditions like arrhythmia and high/low advanced features, such as: blood pressure, and efficiently assess the level of consciousness. They seamlessly integrate with the CARESCAPE Ecosystem for centralized alarm management and efficient workflow. • DINAMAP™ SuperSTAT™ NIBP • EK-Pro v14 algorithm The solutions allow you to effectively monitor deteriorating • CO sidestream and cardiac output patient conditions and make timely interventions by tracking the 2 National Early Warning
    [Show full text]
  • Data Driven Investigation of Bispectral Index Algorithm
    www.nature.com/scientificreports OPEN Data Driven Investigation of Bispectral Index Algorithm Hyung-Chul Lee, Ho-Geol Ryu, Yoonsang Park , Soo Bin Yoon, Seong Mi Yang, Hye-Won Oh & Chul-Woo Jung Received: 7 January 2019 Bispectral index (BIS), a useful marker of anaesthetic depth, is calculated by a statistical multivariate Accepted: 9 September 2019 model using nonlinear functions of electroencephalography-based subparameters. However, only Published: xx xx xxxx a portion of the proprietary algorithm has been identifed. We investigated the BIS algorithm using clinical big data and machine learning techniques. Retrospective data from 5,427 patients who underwent BIS monitoring during general anaesthesia were used, of which 80% and 20% were used as training datasets and test datasets, respectively. A histogram of data points was plotted to defne fve BIS ranges representing the depth of anaesthesia. Decision tree analysis was performed to determine the electroencephalography subparameters and their thresholds for classifying fve BIS ranges. Random sample consensus regression analyses were performed using the subparameters to derive multiple linear regression models of BIS calculation in fve BIS ranges. The performance of the decision tree and regression models was externally validated with positive predictive value and median absolute error, respectively. A four-level depth decision tree was built with four subparameters such as burst suppression ratio, power of electromyogram, 95% spectral edge frequency, and relative beta ratio. Positive predictive values were 100%, 80%, 80%, 85% and 89% in the order of increasing BIS in the fve BIS ranges. The average of median absolute errors of regression models was 4.1 as BIS value.
    [Show full text]
  • Using Entropy in the General Anesthesia Managements
    Research Article Clinics in Surgery Published: 07 Jul, 2017 Using Entropy in the General Anesthesia Managements Elif Büyükerkmen, Remziye Gül Sivaci and Elif Doğan Baki* Departement of Anesthesiology and Reanimation, Afyon Kocatepe University, Afyonkarahisar, Turkey Abstract Purpose: We aimed to investigate the effects of three general anesthesic management on depth of anesthesia, anesthesic quality, agent consumption and postoperative recovery. Materials and Methods: 90 patients scheduled for elective tympanoplasty and septoplasty surgery with American Society of Anesthesiologist (ASA) pysical status between I-III were included in this study. Neuromuscular transmission (NMT), surgical pleth index (SPI) and entropy were monitorized in addition to standart monitoring. Entropy was recorded as state entropy (SE) and response entropy (RE). After standart anesthesia induction, patients were divided into three groups according to maintenance of anesthesia using a sealed envelope system. Propofol 3-5 mg/kg/h iv infusion was performed to Group 1 (Group P, n=30), Desflurane 1MAC was used to Group 2 (Group D, n=30) and Sevoflurane to Group 3 (Group S, n=30). Also, rocuronium and remifentanyl infusion were used in maintenance. While desflurane and sevoflurane consumption were recorded from the anesthesia directly, propofol consumption was calculated through the consumption of perfusors and recorded at the end of the surgery. Total cost of anesthetics that used were calculated by multiplying the unit price with their consumption. Apart from these, hemodynamic values of all patients, recovery time, alertness levels in the recovery room (according to Ramsey Scale) were recorded. Results: Significant differences were found between the three groups in terms of cost. While the cost of propofol was significantly lower, it was significantly higher in desfluane group.
    [Show full text]
  • The Effect of Spectral Entropy Monitoring on Propofol Use and Recovery in Children
    Anesth Pain Med 2014; 9: 138-143 ￭Clinical Research￭ The effect of spectral entropy monitoring on propofol use and recovery in children Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine, *Myung Sung Pain Clinic, Busan, Korea Ji-yeon Lee, So Ron Choi, Chan Jong Chung, Ji Hyeon Lee, Ji-hye Park, and Chang-Yeoul Baik* Background: The evaluation of anesthetic depth using electro- use. Now, however, anesthesia depth can be measured using encephalography showed reduction in recovery time from anesthe- electroencephalography (EEG)-based devices, such as bispectral sia and decrease in the amount of anesthesia used. This research index (BIS), and spectral entropy; these monitors can indicate compared the dosage of propofol and the recovery characteristics when anesthesia was controlled using spectral entropy monitoring the level of consciousness during anesthesia [1-4]. One study and when it was controlled by hemodynamic changes. demonstrated that the control of anesthesia using BIS monitoring Methods: Seventy children of the American Society of Anesthes- decreased the anesthetic use and shortened recovery time [5]. iologists physical class I–II, ages 3–10, that were scheduled for general anesthesia were randomly distributed into two groups. The Entropy measurements reflect EEG signal irregularity. With children were sedated with midazolam (0.15 mg/kg), and anesthesia increasing anesthesia depth, EEG patterns change regularly while was induced with fentanyl (2.0 μg/kg), propofol (2.5 mg/kg), and entropy decreases. Because EEG-based monitoring systems cal- rocuronium (0.6 mg/kg). Anesthesia was maintained with propofol culate an index that reflects the hypnotic component of anest- continuous IV infusion under N2O in O2.
    [Show full text]
  • A Comparative Study Between Entropy and Clinical Response To
    Med. J. Cairo Univ., Vol. 87, No. 3, June: 2025-2031, 2019 www.medicaljournalofcairouniversity.net A Comparative Study between Entropy and Clinical Response to Determine the Requirement of Propofol for Induction of General Anesthesia in Geriatric Patients MAI A.K. NIDA, M.Sc.; WESAM F. MOUSA, M.D.; AHMED S. ELGEBALY, M.D. and HESHAM E. EL-ASHRY, M.D. The Department Anesthesiology and Surgical Intensive Care, Faculty of Medicine, Tanta University Abstract Key Words: Entropy – Clinical response – Requirement of propofol – Geriatric patients. Background: Anesthesia under dosage causes awareness, while over dosage results in drug complications. Endotracheal intubation must be after an adequate level of anesthesia. Introduction Propofol is an IV short-acting anesthetic which causes hypo- tension in a dose dependent effect. With entropy, SE level 40- ANESTHESIA under dosage causes awareness, 60 and RE-SE difference <10 are the target during anesthesia. while over dosage results in drug complications Geriatrics are different in EEG spectral patterns than young [1] patients and are more vulnerable to complications of endotra- . Endotracheal intubation must be after an ade- cheal intubation and propofol. quate level of anesthesia as light anesthesia leads to sympathetic stimulation, laryngospasm, bron- Aim of Study: The aim of this study was to compare chospasm, and traumatization of airway and over between the conventional clinical end-point of hypnosis and entropy on the dosage requirement of propofol and hemody- dosage of anesthetics with delay in intubation leads namic during propofol induction of general anesthesia in to bradycardia, arrhythmia, hypotension and at geriatric patients. last, respiratory and cardiovascular arrest [2] .
    [Show full text]
  • Taylor V. Crawford
    Case 2:05-cv-04173-FJG Document 202-1 Filed 07/24/2006 Page 1 of 20 IN THE UNITED STATES DISTRICT COURT WESTERN DISTRICT OF MISSOURI CENTRAL DIVISION MICHAEL ANTHONY TAYLOR ) ) Plaintiff, ) ) v. ) No. 05-4173-CV-W-FJG ) LARRY CRAWFORD, et al., ) ) Defendants. ) ____________________________________) PLAINTIFF’S OPPOSITION TO DEFENDANTS’ PROPOSED PROTOCOL JOHN WILLIAM SIMON DONALD B. VERRILLI, JR. J.D., PH.D. MATTHEW S. HELLMAN GINGER D. ANDERS ERIC BERGER 2683 South Big Bend Blvd, # 12 JENNER & BLOCK LLP St. Louis, Missouri 63143 601 13th Street NW (314) 645-1776 Washington, DC 20005 FAX: (314) 645-2125 (202) 639-6000 FAX: (202) 661-4983 Counsel for Plaintiff Case 2:05-cv-04173-FJG Document 202-1 Filed 07/24/2006 Page 2 of 20 TABLE OF CONTENTS TABLE OF AUTHORITIES .......................................................................................................... ii INTRODUCTION ...........................................................................................................................1 I. THE STATE’S PROPOSED PROTOCOL MUST BE REJECTED. .................................2 A. Monitoring Anesthetic Depth. .................................................................................2 B. IV Access.................................................................................................................5 C. Mixing the Chemicals..............................................................................................7 D. Drug Administration. ...............................................................................................8
    [Show full text]
  • New Indications for Peripheral Pulse Wave Acta Universitatis Tamperensis 2408
    JARKKO HARJU New Indications for Peripheral Pulse Wave JARKKO HARJU New Indications for Peripheral Pulse Wave Acta Universitatis Tamperensis 2408 JARKKO HARJU New Indications for Peripheral Pulse Wave AUT 2408 AUT JARKKO HARJU New Indications for Peripheral Pulse Wave ACADEMIC DISSERTATION To be presented, with the permission of the Faculty Council of the Faculty of Medicine and Life Sciences of the University of Tampere, for public discussion in the auditorium of Finn-Medi 5, Biokatu 12, Tampere, on 14 September 2018, at 12 o’clock. UNIVERSITY OF TAMPERE JARKKO HARJU New Indications for Peripheral Pulse Wave Acta Universitatis Tamperensis 2408 Tampere University Press Tampere 2018 ACADEMIC DISSERTATION University of Tampere, Faculty of Medicine and Life Sciences Tampere University Hospital, Department of Anaesthesia Finland Supervised by Reviewed by Professor Arvi Yli-Hankala Docent Vesa Kontinen University of Tampere University of Turku Finland Finland Professor Niku Oksala Professor Tarmo Lipping University of Tampere Tampere University of Technology Finland Finland The originality of this thesis has been checked using the Turnitin OriginalityCheck service in accordance with the quality management system of the University of Tampere. Copyright ©2018 Tampere University Press and the author Cover design by Mikko Reinikka Acta Universitatis Tamperensis 2408 Acta Electronica Universitatis Tamperensis 1918 ISBN 978-952-03-0821-6 (print) ISBN 978-952-03-0822-3 (pdf) ISSN-L 1455-1616 ISSN 1456-954X ISSN 1455-1616 http://tampub.uta.fi Suomen Yliopistopaino Oy – Juvenes Print Tampere 2018 441 729 Painotuote To Eeva, Anna and Olli List of original publications This thesis is based on the following four original publications, referred to in the text by their Roman numerals (I-IV): I Matthias Gruenewald, M.*, Harju, J.*, Preckel, B., Molnár, Z., Yli- Hankala, A., Roßkopf, F., Koers, L., Orban, A., Bein, B.
    [Show full text]
  • The Bispectral Index Response to Tracheal Intubation Is Similar In
    458 GENERAL ANESTHESIA The bispectral index response to tracheal intuba- tion is similar in normotensive and hypertensive patients [La réponse de l’index bispectral à l’intubation endotrachéale est similaire chez les patients normotendus et hypertendus] Masayasu Nakayama MD,* Hiromichi Ichinose MD,† Shuji Yamamoto MD,† Noriaki Kanaya MD,* Akiyoshi Namiki MD PhD* Purpose: To compare the hemodynamic and bispectral index (BIS) Conclusion : Les patients hypertendus ou non réagissent par la même responses to tracheal intubation in normotensive and hypertensive réaction d’éveil (mesurée par le BIS) à l’intubation endotrachéale mal- patients. gré l’augmentation de la réponse vasopressive chez les hypertendus. Method: Three minutes after induction of anesthesia with thiamy- lal and fentanyl, tracheal intubation was performed in 24 nor- motensive and 22 hypertensive patients. Heart rate (HR), mean arterial pressure (MAP), and BIS were measured every minute. HE bispectral index (BIS), obtained from Results: Tracheal intubation increased HR, MAP, and BIS in both bispectral analysis of the electroencephalo- normotensive and hypertensive patients. The increase in MAP was gram (EEG), reflects the hypnotic compo- significantly greater in hypertensive patients than in normotensive nent of anesthesia.1–3 Previous studies have patients, but there were no differences in HR or BIS in the two T shown that tracheal intubation is associated with groups of patients. increases in BIS as well as heart rate (HR) and blood Conclusion: Patients with and without hypertension exhibit the pressure.4–6 Therefore, intubation is likely to affect same arousal response (as measured by BIS) to tracheal intubation both the hypnotic and antinociceptive components of despite the enhanced vasopressor response in hypertensive anesthesia.
    [Show full text]
  • Adequacy of Anaesthesia (Aoa) Clinical Brochure Adequacy of Anaesthesia (Aoa)
    GE Healthcare Adequacy of Anaesthesia (AoA) Clinical brochure Adequacy of Anaesthesia (AoA) AoA parameters provide continuous non-invasive measurement of: Adequacy of Anaesthesia (AoA) is a • Depth of anaesthesia with SPECTRAL ENTROPY™ concept made up of various parameters • Patient’s response to surgical stimuli and analgesic medications with SURGICAL PLETH INDEX (SPI)™ to help you assess patients’ individual • Muscle relaxation/recovery with NEUROMUSCULAR responses to the delivery of inhaled TRANSMISSION (NMT) and intravenous hypnotics, opioids, and The AoA split screen view incorporates values and trends obtained from the SPI, Entropy (State Entropy SE, Response Entropy RE and NMBAs during general anaesthesia. Burst Suppression Ratio BSR) and Neuromuscular Transmission (NMT) modules, providing a holistic view of the patient’s response to anaesthesia. When seconds counts in an intensive and multitasking enviroment, the BalanceView is guidance for prompt visualization of the patients’ responses to changes of anaesthesia conditions and may help save valuable time on responsiveness to analgesia/depth of anaesthesia optimization for each individual patient. The “white dot” that moves drastically away from the target zone may indicate inadequate hypnosis or analgesia level. Target Region Level of conciousness of Level Nociception-Antinociception Balance. Current data support SPI target range 20-50. Target at present reflects only the user preference. Spectral Entropy™ Control Entropy Entropy monitoring provides two indexes: parameters such as the EEG raw signal The GE Healthcare Entropy module, Figure 1 - Propofol consumption μg/kg/min • State Entropy (SE): Steady and robust which can help for in depth and more 120 E-ENTROPY, and accessories are -9% signal. The State Entropy value is always comprehensive analysis of state of brain.
    [Show full text]
  • Powering Your Performance
    POWERING YOUR PERFORMANCE B105M | B125M | B155M Modular Patient Monitors gehealthcare.com Advanced capabilities. Simple scalability. Integrated technology. B1x5M, B125M and B155M represent an additional solution to GE Healthcare’s monitoring platforms. Clinical precision It delivers a premium clinical performance across various care areas inherited from decades of research and innovation done with customer support. Scalable platform With B1x5M, you can monitor essential vital signs like ECG, SpO , Temperature, Non Invasive Blood Pressure, 2 Intuitive Respiration and you can also easily scale up your design monitoring capabilities using modules to monitor with precision respiratory gases and anesthetic agents, NMT and Entropy™ – with up to three advanced Integrated parameters simultaneously. technologies These precise, trustworthy, and easy-to-use monitors enable simple and Intuitive workflows with a choice of 10-, 12- or 15- inch touch screen displays to address your clinical and workflow related challenges. Legacy of premium clinical performance. Excellence of advanced features. Because every heartbeat counts… With decades of expertise designing The B1x5M range of modular patient monitors helps you quickly manage patient changing advanced and proven clinical algorithms conditions like arrhythmias and high/low blood pressure, and efficiently assess the level of and measurement technologies, this consciousness. range of monitors benefits parameter These monitors seamlessly integrate with your CARESCAPE Ecosystem to centralize patient innovations. It features: data, alarms, and to automatically capture and document vital signs. It decreases manual tasks, unnecessary movements, and as a result, improving workflows. • DINAMAP™ B1x5M range allows you to effectively monitor deteriorating patient conditions and make • SuperSTAT™ timely interventions by tracking the National Early Warning Score (NEWS).
    [Show full text]
  • The Introduction of Bispectral Index (BIS) in Anesthesia Practice
    EDITORIAL VIEW The introduction of bispectral index (BIS) in anesthesia practice Dario Galante, MD, Matteo Melchionda, MD University Department of Anesthesia and Intensive Care University Hospital Ospedali Riuniti, Foggia, Italy Correspondance: Dario Galante, MD, University Department of Anesthesia and Intensive Care, University Hospital Ospedali Riuniti, Foggia (Italy); E-mail: [email protected] SUMMARY During every surgical procedure we must keep the anesthetic level at an appropriate level so that the patient will neither feel pain nor remember the operation. Yet this anesthetic depth must be balanced against the negative effects and consequences of excess anesthetic and the associated potential for delayed wake up. A wide range of monitoring devices allows us to to avoid the risks of pain, unwanted movements, hemodynamic changes as well as awareness. During the past few years processed EEG signals have become available that help gauge the depth of anesthesia by generating a score linked to EEG activity, which becomes depressed as anesthesia deepens. The bispectral index (BIS) represents one of these innovative methods of monitoring in anesthesia, even if more studies are still needed to make it more precise, especially in pediatric patients and neonates where reliability has yet to be well established. Key words: Bispectral index; Neurological monitoring; Awareness; Depth of anesthesia Citation: Galante D, Melchionda M. The introduction of bispectral index (BIS) in anesthesia practice. Anaesth Pain & Intensive Care 2012;16(3):235-236 The Bispectral IndexTM (Aspect Medical Systems Inc., b) It calculates the index of the state of sedation due to Newton, Mass) is a complex EEG parameter that changes induced by anesthetics by an algorithm combines power spectrum analysis, time domain analysis c) It obtains the value that is recorded by means of a and it values their changes over time.
    [Show full text]
  • INHALATIONAL ANAESTHETIC AGENTS (A) to Describe the Principles of Vaporisation of Inhalational Agents
    INHALATIONAL ANAESTHETIC AGENTS (a) To describe the principles of vaporisation of inhalational agents. Overview of inhaled anaesthetic agents: - Volatile anaesthetic agents (Eg. desflurane, isoflurane, sevoflurane, Etc.) are volatile liquids that require vaporisation into vapours to achieve GA - N2O and Xe are true gases (Ie. do not need vaporisation) to achieve GA Note – Gas and vapour are defined based upon a substance in gaseous state with respect to its “critical temperature” (temperature above which a gas cannot be liquefied by pressure alone): - Gas → defined as a substance in a gaseous state when ambient temperature is ABOVE its critical temperature - Vapour → defined as a substance in a gaseous state when ambient temperature is AT or BELOW its critical temperature Physical principles in process of vaporisation: - “Latent heat of vaporisation” o Defined as energy required to convert a substance from a liquid to gaseous phase o With liquid cooling (Ie. liquid evaporation in a vaporiser) → latent heat of vaporisation ↑↑↑ → this means more energy is needed to vapourise a liquid → this poses an issue with vaporisers o This is issue is circumvented by constructing vaporisers from metals with a high thermal conductivity (Ie. heat is able to flow through substance easily) → allows heat flow form atmosphere into liquid volatile agent to supply external energy for “latent heat of vaporisaiton” - “Saturated vapour pressure” (SVP) of a volatile anaesthetic: o Defined as the partial pressure exerted by the vapour phase when in equilibrium with the liquid phase (Ie. when equal # molecules is leaving and entering each phase per unit time) o It is dependent on: . (i) Temperature (usually measured at 20°C) → SVP ↑ with ↑ temperature (Ie.
    [Show full text]