Anaesthetic depth and delirium: a challenging balancing act

Author(s):  
Elizabeth L. Whitlock ◽  
Eric R. Gross ◽  
C. Ryan King ◽  
Michael S. Avidan
Keyword(s):  
Author(s):  
Markus Klimek ◽  
Francisco A. Lobo ◽  
Luzius A. Steiner ◽  
Cor J. Kalkman

Neuroanaesthesia is the subspecialty of anaesthesiology that deals with patients undergoing surgical procedures in or close to the brain and the spinal cord. Neuroanaesthesia can be challenging, because sometimes apparently contradictory demands must be managed, for example, achieving optimal conditions for neurophysiological monitoring while maintaining sufficient anaesthetic depth, or maintaining oxygen delivery to neuronal tissue and simultaneously preventing high blood pressures that might induce local bleeding. Atypical patient positioning, management of increased intracranial pressure, and the need for early postoperative neurological evaluation are other typical challenges. This chapter addresses the general principles of neuroanaesthesia and special aspects of the most relevant procedures. A section on anaesthesia for electroconvulsive therapy is also included.


2018 ◽  
Vol 52 (5) ◽  
pp. 515-525 ◽  
Author(s):  
Avishag Tuval ◽  
Liora Las ◽  
Yael Shilo-Benjamini

Egyptian fruit bats are increasingly used as model animals in neuroscience research. Our aim was to characterize suitable injectable anaesthesia for this species, possibly replacing inhalant anaesthesia, thus minimizing occupational health hazards. Eight bats were randomly assigned by a crossover design for subcutaneously administered combinations of medetomidine-midazolam with: saline (MM-Sal), ketamine (MM-Ket), fentanyl (MM-Fen), morphine (MM-Mor), or butorphanol (MM-But). The anaesthetic depth and vital signs were monitored at baseline and every 10 min until bats recovered. If after 180 min the bats did not recover, atipamezole was administered. Mean induction times were 7–11.5 min with all combinations. Twitching during induction was common. All combinations produced anaesthesia, with significantly decreased heart rate (from 400 to 200 bpm) and respiratory rate (from 120–140 to 36–65 rpm). Arrhythmia and irregular breathing patterns occurred. MM-Fen, MM-Mor, and MM-But depressed respiration significantly more than MM-Sal. Time to first movement with MM-Ket and MM-But lasted significantly longer than with MM-Sal. Recovery time was significantly shorter in the MM-Sal (88 min) in comparison to all other treatments, and it was significantly longer in the MM-But (159 min), with atipamezole administered to four of the eight bats. In conclusion, all five anaesthetic protocols are suitable for Egyptian fruit bats; MM-Ket produces long anaesthesia and minimal respiratory depression, but cannot be antagonized completely. MM-Fen, MM-Mor, and MM-But depress respiration, but are known to produce good analgesia, and can be fully antagonized. Administration of atipamezole following the use of MM-But in Egyptian fruit bats is recommended.


2011 ◽  
Vol 38 (6) ◽  
pp. 536-543 ◽  
Author(s):  
Elise H Bleijenberg ◽  
Hugo van Oostrom ◽  
Louise C Akkerdaas ◽  
Arie Doornenbal ◽  
Ludo J Hellebrekers

2021 ◽  
Author(s):  
Dominik Schmidt ◽  
Gwendolyn English ◽  
Thomas Gent ◽  
Mehmet Fatih Yanik ◽  
Wolfger von der Behrens

To improve animal welfare and data quality and reproducibility during research conducted under anaesthesia, anaesthetic depth in laboratory animals must be precisely monitored and controlled. While a variety of methods have been developed to estimate the depth of anaesthesia in humans, such tools for monitoring anaesthetic depth in laboratory animals remain limited. Here we propose an epidural electrocorticogram-based monitoring system that accurately tracks the depth of anesthesia in mice receiving inhalable isoflurane anaesthesia. Several features of the electrocorticogram signals exhibit robust modulation by the concentration of the administered anesthetic, notably, corticocortical coherence serves as an excellent indicator of anaesthetic depth. We developed a gradient boosting regressor framework that utilizes the extracted features to accurately estimate the depth of anaesthesia. Our method for feature extraction and estimation is conducted with a latency of only ten seconds, establishing a system for the real-time tracking of anaesthetic depth in mice.


Author(s):  
Jeremy Prout ◽  
Tanya Jones ◽  
Daniel Martin

This chapter outlines the basic science related to the nervous and musculoskeletal systems which particularly apply to the conduct of anaesthesia. Consciousness, sleep and anaesthetic depth are discussed with the measurement of anaesthetic depth using bispectral index and evoked potentials. Factors which influence cerebral blood flow and intracerebral pressure are detailed, allowing understanding of neuroanaesthesia techniques. Pharmacological and anaesthetic management of seizures is also described. Diseases affecting the autonomic nervous system, testing for these disorders and the implication for anaesthesia are included. Physiological consequences of spinal cord injury with patterns of injury are described. Neuromuscular blocking agents, monitoring of blockade and implications for patients with neuromuscular disease is also explained.


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