A Crossover Comparison of the Sensitivity and the Specificity between BIS and AEP in Predicting Unconsciousness in General Anesthesia

Background. There is an increasing concern of awareness and recall during general anesthesia for both the patient and the anesthetist. The bispectral index (BIS) is used to assess the level of sedation and depth of anesthesia and detect consciousness in different anesthetic drugs. Middle-latency auditory evoked potentials (AEPs) also quantify action of anesthetic drugs and detect the transition from consciousness to unconsciousness. We aim to compare the sensitivity and specificity between BIS and AEP in predicting unconsciousness in inhalational sevoflurane anesthesia and intravenous propofol anesthesia. Methods. Totally, 40 patients were randomly allocated into two groups: propofol or sevoflurane group. In the propofol group, anesthesia was induced with target-controlled infusion propofol. In the sevoflurane group, anesthesia was induced by increasing concentrations of sevoflurane. There were 3 end points during induction: sedation, unconsciousness, and anesthesia. Target and effect-site concentrations of propofol, end-tidal concentration of sevoflurane, and BIS and AEP were recorded at each stage. Results. We obtained good EC50 with both monitors, at which there is a 50% chance that the patient has reached the end point, but the index variation was affected by the anesthetic technique. Propofol had higher correlations with stage of anesthesia, BIS, and AEP than sevoflurane. BIS had higher correlations with depth of anesthesia than AEP, but we did not find an anesthetic depth monitor that had high sensitivity and specificity and is not affected by the anesthetic technique. Conclusions. The prediction powers of BIS and AEP do not seem as good as some papers mentioned.

Download Full-text

Effects of circadian rhythm on Narcotrend index and target-controlled infusion concentration of propofol anesthesia

BMC Anesthesiology ◽

10.1186/s12871-021-01445-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jiang-hua Shen ◽

Min Ye ◽

Qian Chen ◽

Yan Chen ◽

Hai-lin Zhao ◽

...

Keyword(s):

Circadian Rhythms ◽

General Anesthesia ◽

Closed Loop ◽

Depth Of Anesthesia ◽

Drug Infusion ◽

Anesthetic Depth ◽

Time Points ◽

Target Controlled Infusion ◽

Medical University ◽

Narcotrend Index

Abstract Background The effects of circadian rhythms on drug metabolism and efficacy are being increasingly recognized. However, the extent to which they affect general anesthesia remains unclear. This study aims to investigate the effects of circadian rhythms on anesthetic depth and the concentrations of propofol target-controlled infusion (TCI). Methods Sixty patients undergoing laparoscopic surgeries were sequentially assigned to four groups. Group ND (n = 15): Propofol TCI with Narcotrend monitor during the day (8:00–18:00), Group NN (n = 15): Propofol TCI with Narcotrend monitor during the night (22:00–5:00), Group CLTD (n = 15): Propofol closed-loop TCI guided by bispectral index (BIS) during the day (8:00–18:00), Group CLTN (n = 15): Propofol closed-loop TCI guided by BIS during the night (22:00–5:00). The Narcotrend index, mean arterial pressure (MAP) and heart rate (HR) were compared between group ND and NN at 7 time points, from 5 min before induction to the end of operation. The propofol TCI concentrations, MAP and HR were compared between group CLTD and CLTN at 7 time points, from 5 min after induction to the end of operation. Results The Narcotrend index, MAP, and HR in group NN were lower than those in group ND from the beginning of mechanical ventilation to the end of operation (p < 0.05). The propofol TCI concentrations in group CLTN were lower than those in group CLTD from the beginning of operation to the end of operation (p < 0.05). Conclusion Circadian rhythms have a significant effect on the depth of anesthesia and drug infusion concentrations during propofol TCI. When using general anesthesia during night surgery, the propofol infusion concentration should be appropriately reduced compared to surgery during the day. Trial registration The present study was registered on the ClinicalTrials.gov website (NCT02440269) and approved by the Medical Ethics Committee of Southwest Hospital of Third Military Medical University (ethics lot number: 2016 Research No. 93). All patients provided informed written consent to participate in the study.

Download Full-text

Utilization of Pleth Index in Hysteroscopic Surgery: A Randomized Controlled Trial

10.21203/rs.3.rs-80596/v1 ◽

2020 ◽

Author(s):

Lifeng Yao ◽

Changshun Huang ◽

Jungang Zheng ◽

Yong Li

Keyword(s):

General Anesthesia ◽

Controlled Trial ◽

Depth Of Anesthesia ◽

Hysteroscopic Surgery ◽

Bodily Movement ◽

Anesthetic Drugs ◽

Recovery Times ◽

Monitoring Group ◽

Group B ◽

Intraoperative Movement

Abstract Background: When performing hysteroscopic surgery under general anesthesia in non-intubated patients, anesthesiologists and gynecologists face challenges including patient movement and respiratory depression due to variability in the depth of patient anesthesia. Intraoperative modulation of the depth of anesthesia is dictated by clinical practice. In recent years, the noninvasive surgical pleth index (SPI) has been purported to objectively reflect the depth of anesthesia. In the present study, we investigated the performance of SPI monitoring in hysteroscopic surgery.Methods: Eighty patients scheduled for hysteroscopic surgery under general anesthesia with a laryngeal mask airway (i.e., spontaneous ventilation without a muscle relaxant) were randomly divided into two groups (both n = 40): (1) bispectral index (BIS)- and SPI-monitoring group (BS Group); and (2) BIS-monitoring group (B group). Intraoperative analgesia was provided via target-controlled infusion (TCI) of remifentanil, which was modulated according to the SPI value (target interval, 20–50) in the BS Group or via the anesthesiologist's assessment in the B Group. In both groups, anesthesia was administered to maintain the BIS values between 40–60. Additionally, the incidences and degree of movement, consumption of anesthetic drugs, recovery times, complications, and satisfactory levels were compared between the two groups.Results: The incidence and degree of bodily movement in the BS Group were significantly lower than those in the B Group (P < 0.05). Furthermore, the remifentanil induction dose and recovery time in the BS group were significantly lower than those in the B group (P < 0.05). However, there were no significant differences between the two groups with regard to adverse events including nausea, vomiting, and dizziness. Finally, gynecologists had higher satisfactory levels in the BS Group (P < 0.05).Conclusion: SPI- and BIS-guided general anesthesia is clinically feasible in hysteroscopic surgery and leads to both inhibition of intraoperative movement and faster recovery.

Download Full-text

Epidural Lidocaine Decreases Sevoflurane Requirement for Adequate Depth of Anesthesia as Measured by the Bispectral Index ® Monitor

Anesthesiology ◽

10.1097/00000542-200105000-00018 ◽

2001 ◽

Vol 94 (5) ◽

pp. 799-803 ◽

Cited By ~ 109

Author(s):

Peter S. Hodgson ◽

Spencer S. Liu

Keyword(s):

General Anesthesia ◽

Epidural Anesthesia ◽

Bispectral Index ◽

Depth Of Anesthesia ◽

Intravenous Lidocaine ◽

Lidocaine Group ◽

Plasma Lidocaine ◽

Intravenous Saline ◽

End Tidal ◽

To Receive

Background Epidural anesthesia potentiates sedative drug effects and decreases minimum alveolar concentration (MAC). The authors hypothesized that epidural anesthesia also decreases the general anesthetic requirements for adequate depth of anesthesia as measured by Bispectral Index (BIS). Methods After premedication with 0.02 mg/kg midazolam and 1 microg/kg fentanyl, 30 patients aged 20-65 yr were randomized in a double-blinded fashion to receive general anesthesia with either intravenous saline placebo or intravenous lidocaine control (1-mg/kg bolus dose; 25 microg x kg(-1) x min(-1)). A matched group was prospectively assigned to receive epidural lidocaine (15 ml; 2%) with intravenous saline placebo. All patients received 4 mg/kg thiopental and 1 mg/kg rocuronium for tracheal intubation. After 10 min of a predetermined end-tidal sevoflurane concentration, BIS was measured. The ED50 of sevoflurane for each group was determined by up-down methodology based on BIS less than 50 (MAC(BIS50)). Plasma lidocaine concentrations were measured. Results The MAC(BIS50) of sevoflurane (0.59% end tidal) was significantly decreased with lidocaine epidural anesthesia compared with general anesthesia alone (0.92%) or with intravenous lidocaine (1%; P < 0.0001). Plasma lidocaine concentrations in the intravenous lidocaine group (1.9 microg/ml) were similar to those in the epidural lidocaine group (2.0 microg/ml). Conclusions Epidural anesthesia reduced by 34% the sevoflurane required for adequate depth of anesthesia. This effect was not a result of systemic lidocaine absorbtion, but may have been caused by deafferentation by epidural anesthesia or direct rostral spread of local anesthetic within the cerebrospinal fluid. Lower-than-expected concentrations of volatile agents may be sufficient during combined epidural-general anesthesia.

Download Full-text

Discrepant End-Tidal Concentrations of Sevoflurane at the Same A-Line Autoregressive Index Level during Induction of General Anesthesia: An Observational Study

Journal of Clinical Medicine ◽

10.3390/jcm10194526 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4526

Author(s):

Che-Hao Hsu ◽

Shung-Tai Ho ◽

Chih-Cherng Lu ◽

Ju-O Wang ◽

Te-Chun Yeh ◽

...

Keyword(s):

Mechanical Ventilation ◽

General Anesthesia ◽

Auditory Evoked Potentials ◽

Young Male ◽

Jugular Bulb ◽

Anesthesia Induction ◽

Index Level ◽

End Tidal ◽

To Receive ◽

Mean Time

Background: The A-Line Autoregressive Index (AAI), which is derived from auditory evoked potentials, has been used for determining anesthetic depth. This study verified the correlation between AAI values and the corresponding end-tidal concentrations of sevoflurane during general anesthesia induction. Methods: Thirty young male adults undergoing elective minor orthopedic surgery were sequentially allocated to receive inspiratory 3%, 5%, or 6% sevoflurane for mask induction, followed by mechanical ventilation after tracheal intubation. The inspiratory, end-tidal and estimated jugular bulb concentrations of sevoflurane were recorded at three target AAI values: below 20, below 10, and at the start of burst suppression. Results: The mean time to loss of consciousness in the 6% sevoflurane group was shorter than that in the 5% and 3% groups; however, the groups had comparable AAI values (range: 16–45). The 6% group had a higher end-tidal concentration (4.5% ± 0.2% vs. 3.8% ± 0.2%, p < 0.05) than did the 5% group, despite having the same target anesthetic levels by AAI score ≤10, whereas the estimated jugular bulb concentrations were comparable (1.9% vs. 1.9%) in both groups. Conclusions: Following mechanical ventilation with inspiratory 3%, 5%, or 6% sevoflurane, the end-tidal concentrations were discrepant at the same end points of AAI levels, despite similar estimated jugular bulb concentrations of sevoflurane. Thus, conventional alveolar concentration may overestimate anesthesia depth during rapid wash-in of sevoflurane.

Download Full-text

Detector-C: A Blood-based IVD with High Sensitivity and Specificity for Early Detection and Screening of Colorectal Cancer

Zeitschrift für Gastroenterologie ◽

10.1055/s-0030-1263628 ◽

2010 ◽

Vol 48 (08) ◽

Author(s):

A Rosenthal ◽

H Köppen ◽

R Musikowski ◽

R Schwanitz ◽

J Behrendt ◽

...

Keyword(s):

Colorectal Cancer ◽

Early Detection ◽

Sensitivity And Specificity ◽

High Sensitivity

Download Full-text

Faculty Opinions recommendation of The influence of inspired oxygen fraction and end-tidal carbon dioxide on post-cross-clamp cerebral oxygenation during carotid endarterectomy under general anesthesia.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.3232960.2917060 ◽

2010 ◽

Author(s):

Ian Herrick

Keyword(s):

Carbon Dioxide ◽

General Anesthesia ◽

Carotid Endarterectomy ◽

Cerebral Oxygenation ◽

Oxygen Fraction ◽

End Tidal Carbon Dioxide ◽

End Tidal ◽

Inspired Oxygen

Download Full-text

Trends in Diagnosis for Active Tuberculosis Using Nanomaterials

Current Medicinal Chemistry ◽

10.2174/0929867325666180912105617 ◽

2019 ◽

Vol 26 (11) ◽

pp. 1946-1959 ◽

Cited By ~ 3

Author(s):

Le Minh Tu Phan ◽

Lemma Teshome Tufa ◽

Hwa-Jung Kim ◽

Jaebeom Lee ◽

Tae Jung Park

Keyword(s):

Sensitivity And Specificity ◽

High Efficiency ◽

Point Of Care ◽

High Sensitivity ◽

Signs And Symptoms ◽

Diagnostic Methods ◽

Advantages And Disadvantages ◽

Treatment And Prevention ◽

Clinical Tools ◽

Diagnostic Applications

Background:Tuberculosis (TB), one of the leading causes of death worldwide, is difficult to diagnose based only on signs and symptoms. Methods for TB detection are continuously being researched to design novel effective clinical tools for the diagnosis of TB.Objective:This article reviews the methods to diagnose TB at the latent and active stages and to recognize prospective TB diagnostic methods based on nanomaterials.Methods:The current methods for TB diagnosis were reviewed by evaluating their advantages and disadvantages. Furthermore, the trends in TB detection using nanomaterials were discussed regarding their performance capacity for clinical diagnostic applications.Results:Current methods such as microscopy, culture, and tuberculin skin test are still being employed to diagnose TB, however, a highly sensitive point of care tool without false results is still needed. The utilization of nanomaterials to detect the specific TB biomarkers with high sensitivity and specificity can provide a possible strategy to rapidly diagnose TB. Although it is challenging for nanodiagnostic platforms to be assessed in clinical trials, active TB diagnosis using nanomaterials is highly expected to achieve clinical significance for regular application. In addition, aspects and future directions in developing the high-efficiency tools to diagnose active TB using advanced nanomaterials are expounded.Conclusion:This review suggests that nanomaterials have high potential as rapid, costeffective tools to enhance the diagnostic sensitivity and specificity for the accurate diagnosis, treatment, and prevention of TB. Hence, portable nanobiosensors can be alternative effective tests to be exploited globally after clinical trial execution.

Download Full-text

Value of Coronary Calcium Scoring in Symptomatic and Asymptomatic Coronary Artery Disease Patients

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405616666201023142030 ◽

2020 ◽

Vol 16 ◽

Author(s):

Hala T. Salem ◽

Eman A.S. Sabek

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Sensitivity And Specificity ◽

High Sensitivity ◽

Coronary Calcium ◽

Risk Estimate ◽

Calcium Scoring ◽

Coronary Calcium Scoring ◽

Framingham Risk ◽

Artery Disease

Aim and Objective: To estimate the relationship between Coronary Calcium Scoring (CCS)and presence of different degrees of obstructive coronary artery disease (CAD) to avoid unnecessary examinations and hence unnecessary radiation exposure and contrast injection. Background: Coronary Calcium Scoring (CCS) is a test uses x-ray equipment to produce pictures of the coronary arteries to determine the degree of its narrowing by the build-up of calcified plaques. Despite the lack of definitive data linking ionizing radiation with cancer, the American Heart Association supports widely that practitioners of Computed tomography Coronary Angiography (CTCA) should keep “patient radiation doses as low as reasonably achievable but consistent with obtaining the desired medical information”. Methods: Data obtained from 275 CTCA examinations were reviewed. Radiation effective doses were estimated for both CCS and CTCA, measures to keep it as low as possible were presented, CCS and Framingham risk estimate were compared to the final results of CTCA to detect sensitivity and specificity of each one in detecting obstructive lesions. Results: CCS is a strong discriminator for obstructive CAD and can with high sensitivity and specificity and correlates well with the degree of obstruction even more than Framingham risk estimate which has high sensitivity and low specificity. Conclusion: CCS helps reducing the effective radiation dose if properly evaluated to skip unnecessary CTCA if obstructive lesions was unlikely, and as a test does not use contrast material, harmful effect on the kidney will be avoided as most of coronary atherosclerotic patients have renal problems.

Download Full-text

Blood-Based Detection of Colorectal Cancer Using Cancer-Specific DNA Methylation Markers

Diagnostics ◽

10.3390/diagnostics11010051 ◽

2020 ◽

Vol 11 (1) ◽

pp. 51

Author(s):

Nam-Yun Cho ◽

Ji-Won Park ◽

Xianyu Wen ◽

Yun-Joo Shin ◽

Jun-Kyu Kang ◽

...

Keyword(s):

Colorectal Cancer ◽

Dna Methylation ◽

Sensitivity And Specificity ◽

Stage Iv ◽

High Sensitivity ◽

Liquid Biopsies ◽

Blood Leukocytes ◽

Marker Panel ◽

A Genome ◽

Methylight Assay

Cancer tissues have characteristic DNA methylation profiles compared with their corresponding normal tissues that can be utilized for cancer diagnosis with liquid biopsy. Using a genome-scale DNA methylation approach, we sought to identify a panel of DNA methylation markers specific for cell-free DNA (cfDNA) from patients with colorectal cancer (CRC). By comparing DNA methylomes between CRC and normal mucosal tissues or blood leukocytes, we identified eight cancer-specific methylated loci (ADGRB1, ANKRD13, FAM123A, GLI3, PCDHG, PPP1R16B, SLIT3, and TMEM90B) and developed a five-marker panel (FAM123A, GLI3, PPP1R16B, SLIT3, and TMEM90B) that detected CRC in liquid biopsies with a high sensitivity and specificity with a droplet digital MethyLight assay. In a set of cfDNA samples from CRC patients (n = 117) and healthy volunteers (n = 60), a panel of five markers on the platform of the droplet digital MethyLight assay detected stages I–III and stage IV CRCs with sensitivities of 45.9% and 95.7%, respectively, and a specificity of 95.0%. The number of detected markers was correlated with the cancer stage, perineural invasion, lymphatic emboli, and venous invasion. Our five-marker panel with the droplet digital MethyLight assay showed a high sensitivity and specificity for the detection of CRC with cfDNA samples from patients with metastatic CRC.

Download Full-text