scholarly journals High Incidence of Burst Suppression during Propofol Sedation for Outpatient Colonoscopy: Lessons Learned from Neuromonitoring

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Jamie Bloom ◽  
David Wyler ◽  
Marc C. Torjman ◽  
Tuan Trinh ◽  
Lucy Li ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Lessons Learned ◽  
Burst Suppression ◽  
University Hospital ◽  
Institutional Practice ◽  
Anesthesia Providers ◽  
Processed Eeg ◽  
High Incidence ◽  
Patient State ◽  
State Index

Background. Although anesthesia providers may plan for moderate sedation, the depth of sedation is rarely quantified. Using processed electroencephalography (EEG) to assess the depth of sedation, this study investigates the incidence of general anesthesia with variable burst suppression in patients receiving propofol for outpatient colonoscopy. The lessons learned from neuromonitoring can then be used to guide institutional best sedation practice. Methods. This was a prospective observational study of 119 outpatients undergoing colonoscopy at Thomas Jefferson University Hospital (TJUH). Propofol was administered by CRNAs under anesthesiologists’ supervision. The Patient State Index (PSi™) generated by the Masimo SedLine® Brain Root Function monitor (Masimo Corp., Irvine, CA) was used to assess the depth of sedation. PSi data correlating to general anesthesia with variable burst suppression were confirmed by neuroelectrophysiologists’ interpretation of unprocessed EEG. Results. PSi values of <50 consistent with general anesthesia were attained in 118/119 (99.1%) patients. Of these patients, 33 (27.7%) attained PSi values <25 consistent with variable burst suppression. The 118 patients that reached PSi <50 spent a significantly greater percentage (53.1% vs. 42%) of their case at PSi levels <50 compared to PSi levels >50 (p=0.001). Mean total propofol dose was significantly correlated to patient PSi during periods of PSi <25 (R=0.406, p=0.021). Conclusion. Although providers planned for moderate to deep sedation, processed EEG showed patients were under general anesthesia, often with burst suppression. Anesthesiologists and endoscopists may utilize processed EEG to recognize their institutional practice patterns of procedural sedation with propofol and improve upon it.

scholarly journals Evaluation of Anesthetic Specific EEG Dynamics during State Transitions between Loss and Return of Responsiveness

2021 ◽  
Vol 12 (1) ◽  
pp. 37
Author(s):  
Matthias Kreuzer ◽  
Tobias Kiel ◽  
Leonie Ernst ◽  
Marlene Lipp ◽  
Gerhard Schneider ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Dynamic State ◽  
Permutation Entropy ◽  
State Transitions ◽  
Emergence Period ◽  
Emergence Patterns ◽  
Processed Eeg ◽  
Inhalational Anesthetic ◽  
Cortical Depression ◽  
State Index

Purpose: electroencephalographic (EEG) information is used to monitor the level of cortical depression of a patient undergoing surgical intervention under general anesthesia. The dynamic state transitions into and out of anesthetic-induced loss and return of responsiveness (LOR, ROR) present a possibility to evaluate the dynamics of the EEG induced by different substances. We evaluated changes in the EEG power spectrum during anesthesia emergence for three different anesthetic regimens. We also assessed the possible impact of these changes on processed EEG parameters such as the permutation entropy (PeEn) and the cerebral state index (CSI). Methods: we analyzed the EEG from 45 patients, equally assigned to three groups. All patients were induced with propofol and the groups differed by the maintenance anesthetic regimen, i.e., sevoflurane, isoflurane, or propofol. We evaluated the EEG and parameter dynamics during LOR and ROR. For the emergence period, we focused on possible differences in the EEG dynamics in the different groups. Results: depending on the substance, the EEG emergence patterns showed significant differences that led to a substance-specific early activation of higher frequencies as indicated by the “wake” CSI values that occurred minutes before ROR in the inhalational anesthetic groups. Conclusion: our results highlight substance-specific differences in the emergence from anesthesia that can influence the EEG-based monitoring that probably have to be considered in order to improve neuromonitoring during general anesthesia.

scholarly journals Pulmonary Aspiration During Induction of General Anesthesia

2020 ◽  
Vol 67 (4) ◽  
pp. 214-218
Author(s):  
Reina Hayashi ◽  
Shigeru Maeda ◽  
Taninishi Hideki ◽  
Hitoshi Higuchi ◽  
Takuya Miyawaki
Keyword(s):  
General Anesthesia ◽  
Chest Radiograph ◽  
Lower Lobe ◽  
Pulmonary Aspiration ◽  
University Hospital ◽  
Clear Fluid ◽  
Incisive Canal ◽  
Anesthesia Providers ◽  
Patient Reported ◽  
Gastric Contents

Perioperative pulmonary aspiration of gastric contents can induce complications of varying severity, including aspiration pneumonitis or pneumonia, which may be lethal. A 34-year-old man with no significant medical history presented to Okayama University Hospital for extraction of the third molars and incisive canal cystectomy under general anesthesia. He experienced pulmonary aspiration of clear stomach fluid during mask ventilation after induction. After aspiration occurred, the patient was immediately intubated, and suctioning was performed through the endotracheal tube (ETT). An anteroposterior (AP) chest radiograph was obtained that demonstrated atelectasis in the left lower lobe, in addition to increased peak airway pressures being noted, although SpO2 remained at 96% to 99% at an FiO2 of 1.0. The decision was made to proceed, and the scheduled procedures were completed in approximately 2 hours. A repeat AP chest radiograph obtained at the end of the operation revealed improvement of the atelectasis, and no residual atelectasis was observed on the next day. Although the patient reported following standard preoperative fasting instructions (no fluids for 2 hours preoperatively), more than 50 mL of clear fluid remained in his stomach. Because vomiting can occur despite following NPO guidelines, the need for continued vigilance by anesthesia providers and proper timely management is reinforced.

Actimetry-documented persistent Periodic Limb Movements during EEG-confirmed deep General Anesthesia: a case report.

2019 ◽  
Author(s):  
Friedrich Lersch ◽  
Pascal Jerney ◽  
Heiko Kaiser ◽  
Cédric Willi ◽  
Katharina Steck ◽  
...  
Keyword(s):  
Case Report ◽  
Motor Activity ◽  
General Anesthesia ◽  
Burst Suppression ◽  
Periodic Limb Movements ◽  
Deep Sclerectomy ◽  
Limb Movements ◽  
Periodic Leg Movements ◽  
Increase Motor Activity ◽  
Leg Movements

Motor activity during general anesthesia (GA) without curarization is often interpreted as reflecting insufficient analgosedation. Here we present the case of an octogenarian scheduled for deep sclerectomy receiving opioid-sparing electroencephalography-(EEG)-guided anesthesia. Periodic Leg Movements (PLM) made their appearance with ongoing surgery while his raw EEG displayed a pattern of deep GA (burst suppression). To the best of our knowledge, this is the first description of actimetry-documented persisting PLM during EEG-monitored GA. Recognizing PLM in the context of GA is of importance for anesthesiologists, as increasing sedation may increase motor activity.

scholarly journals A retrospective study of electroencephalography burst suppression in children undergoing general anesthesia

2021 ◽  
Author(s):  
Zhengzheng Gao ◽  
Jianmin Zhang ◽  
Xiaoxue Wang ◽  
Mengnan Yao ◽  
Lan Sun ◽  
...  
Keyword(s):  
Retrospective Study ◽  
General Anesthesia ◽  
Burst Suppression

EEG-based indices of anaesthesia: correlation between bispectral index and patient state index?

2004 ◽  
Vol 21 (1) ◽  
pp. 6-12 ◽  
Author(s):  
G. Schneider ◽  
A. Mappes ◽  
T. Neissendorfer ◽  
M. Schabacker ◽  
H. Kuppe ◽  
...  
Keyword(s):  
Bispectral Index ◽  
Patient State ◽  
State Index ◽  
Patient State Index

Recurrence of First Afebrile Unprovoked Seizure and Parental Consanguinity: A Hospital-Based Study

2020 ◽  
Vol 35 (10) ◽  
pp. 643-648
Author(s):  
Miral A. Al Momani ◽  
Basima Almomani ◽  
Salar Bani Hani ◽  
Andrew Lux
Keyword(s):  
University Hospital ◽  
Unprovoked Seizure ◽  
Recurrent Attack ◽  
Parental Consanguinity ◽  
Pediatric Clinic ◽  
Increased Risk ◽  
High Incidence ◽  
History Of

Purpose: The aim of the current study was to determine the incidence, clinical characteristics, and risk factors associated with the recurrence of first unprovoked seizure in children. Methods: A retrospective, observational study was conducted at King Abdullah University Hospital in Jordan. Children aged from 1 month to 16 years old who attended the hospital between January 2013 to December 2017 were evaluated on the basis of medical records, from the first visit and for a 1-year follow-up period. Results: During the study period, a total of 290 cases with first unprovoked seizure were included. The incidence of first unprovoked seizure was 441 cases per 100 000 patient visits to the pediatric clinic. More than half of the cases developed a second attack (55.3%). Children with parental consanguinity were almost 3 times more likely to develop a second attack of seizure compared to those without parental consanguinity (odds ratio [OR] = 2.785, 95% confidence interval [CI] = 1.216-6.378, P = .015) and patients who had a history of focal type of seizure were almost twice as likely to develop seizure recurrence (OR = 1.798, 95% CI = 1.013-3.193, P = .045). Conclusions: The current results showed a high incidence of first unprovoked seizure among children in Jordan. Parental consanguinity and focal seizure were associated with the increased risk of recurrent attack. This finding highlights the need for public education regarding the outcomes of parental consanguinity to improve the patient’s quality of life.

Dynamic Cortical Connectivity during General Anesthesia in Healthy Volunteers

2019 ◽  
Vol 130 (6) ◽  
pp. 870-884 ◽  
Author(s):  
Duan Li ◽  
Phillip E. Vlisides ◽  
Max B. Kelz ◽  
Michael S. Avidan ◽  
George A. Mashour ◽  
...  
Keyword(s):  
Functional Connectivity ◽  
General Anesthesia ◽  
Healthy Volunteers ◽  
Transition Probabilities ◽  
Burst Suppression ◽  
Occurrence Rate ◽  
Connectivity Pattern ◽  
Phase Lag ◽  
Cortical Connectivity ◽  
Isoflurane Anesthesia

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Recent studies of anesthetic-induced unconsciousness in healthy volunteers have focused on functional brain connectivity patterns, but the protocols rarely parallel the depth and duration of surgical anesthesia. Furthermore, it is unknown whether there is a single functional connectivity pattern that correlates with general anesthesia for the duration of prolonged anesthetic exposure. Methods The authors analyzed electroencephalographic data in 30 healthy participants who underwent induction of anesthesia with propofol followed by 3 h of isoflurane anesthesia at age-adjusted 1.3 minimum alveolar concentration. Functional connectivity was assessed by frequency-resolved weighted phase lag index between frontal and parietal channels and between prefrontal and frontal channels, which were classified into a discrete set of states through k-means cluster analysis. Temporal dynamics were evaluated by the occurrence rate and dwell time distribution for each state as well as the transition probabilities between states. Results Burst suppression was present, with mean suppression ratio reducing from 44.8 ± 32.3% to 14.0 ± 20.2% (mean ± SD) during isoflurane anesthesia (P &lt; 0.001). Aside from burst suppression, eight connectivity states were classified by optimizing the reproducibility of clustering solutions, with each characterized by distinct properties. The temporal progression of dominant states revealed a successive shifting trajectory from the state associated with alpha frontal-parietal connectivity to those associated with delta and alpha prefrontal-frontal connectivity during induction, which was reversed during emergence. Cortical connectivity was dynamic during maintenance period, and it was more probable to remain in the same state (82.0 ± 8.3%) than to switch to a different state (P &lt; 0.001). However, transitions to other states were structured, i.e., occurred more frequently than expected by chance. Conclusions Anesthesia-induced alterations of functional connectivity are dynamic despite the stable and prolonged administration of isoflurane, in the absence of any noxious stimuli. Changes in connectivity over time will likely yield more information as a marker or mechanism of surgical anesthesia than any single pattern.

Sign in / Sign up

Export Citation Format

Share Document