Increased Minimum Alveolar Concentration-Awake of Sevoflurane in Women of Breast Surgery with Sleep Disorders

Abstract Background. Sleep disorders are commonly encountered in clinic. Evidences showed that sleep deprivation may modulate the effectiveness of general anesthetics in rats. However, this phenomenon has not been explored in humans. The study aimed to investigate whether the hypnotic potency of sevoflurane in patients with sleep disorders differ from patients with normal sleep habits. Methods. We recruited 44 patients scheduled for elective breast surgery and eventually analyzed 38 patients, including 19 subjects with normal sleep habits and 19 subjects with sleep disorders. According to the Dixon ‘up-and-down’ design, patients received sevoflurane at preselected concentrations starting at 1.0 vol%. After a steady-state period, a verbal command for testing awakening was performed. Based on the negative or positive response to the verbal command, we decreased or increased the concentration of sevoflurane by 0.2 vol% in the next patient accordingly. Plasma orexin-A was also measured before observation. Results. The MACawake of sevoflurane was 0.80% [95% confidence interval (CI), 0.683–0.926%] in the sleep disordered group vs 0.60% [95% CI, 0.493–0.689%] in the control group. The relative median potency between groups was 0.750 (95% CI, 0.236–0.969). Patients with sleep disorders had significantly higher orexin-A levels than control (72.17 ± 18.24 vs. 36.16 ± 14.18 pg/mL). A significant, positive relationship was detected between orexin-A level and probability of awakening (OR = 1.081, 95% CI is 1.020–1.146, P = 0.008). Conclusions. MACawake of sevoflurane is higher in mild-aged women of breast surgery with sleep disorders compared to those with normal sleep habits. The increased anesthetic requirement may be related to changes of orexin-A levels. These findings suggest that sleep may have a potential impact on clinical anesthesia, including changes of sensitivity to anesthetics or postoperative complications. Further research is needed to confirm this hypothesis.Clinical Trial Registration Chinese Clinical Trial Registry (ChiCTR1800016022), date of registration 07 May 2018 Keywords: Sevoflurane; MACawake (minimum alveolar concentration of awake); orexin-A; sleep disorders

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Minimum alveolar concentration-awake of sevoflurane in women of breast surgery with sleep disorders

10.21203/rs.2.285/v1 ◽

2019 ◽

Author(s):

Yuanyuan Cao ◽

Lei Zhang ◽

Xiaohui Peng ◽

Yun Wu ◽

Qunlin Zhang ◽

...

Keyword(s):

Clinical Trial ◽

Sleep Disorders ◽

Minimum Alveolar Concentration ◽

Breast Surgery ◽

Control Group ◽

General Anesthetics ◽

Sleep Habits ◽

Orexin A ◽

Verbal Command ◽

Normal Sleep

Abstract Background: Sleep disorders are commonly encountered in clinic. Evidences showed that sleep deprivation may modulate the effectiveness of general anesthetics in rats. However, this phenomenon has not been explored in humans. The study aimed to investigate whether the hypnotic potency of sevoflurane in patients with sleep disorders differ from patients with normal sleep habits. Methods: We recruited 44 patients scheduled for elective breast surgery and eventually analyzed 38 patients, including 19 subjects with normal sleep habits and 19 subjects with sleep disorders. According to the Dixon ‘up-and-down’ design, patients received sevoflurane at preselected concentrations starting at 1.0 vol%. After a steady-state period, a verbal command for testing awakening was performed. Based on the negative or positive response to the verbal command, we decreased or increased the concentration of sevoflurane by 0.2 vol% in the next patient accordingly. Plasma orexin-A was also measured before observation. Results: The MACawake of sevoflurane was 0.80% [95% confidence interval (CI), 0.683–0.926%] in the sleep disordered group vs 0.60% [95% CI, 0.493–0.689%] in the control group. The relative median potency between groups was 0.750 (95% CI, 0.236–0.969). Patients with sleep disorders had significantly higher orexin-A levels than control (72.17 ± 18.24 vs. 36.16 ± 14.18 pg/mL). A significant, positive relationship was detected between orexin-A level and probability of awakening (OR = 1.081, 95% CI is 1.020–1.146, P = 0.008). Conclusions: MACawake of sevoflurane is higher in patients with sleep disorders compared to those with normal sleep habits. The increased anesthetic requirement may be related to changes of orexin-A levels. These findings suggest that sleep may have a potential impact on clinical anesthesia, including changes of sensitivity to anesthetics or postoperative complications. Further research is needed to confirm this hypothesis. Clinical Trial Registration: Chinese Clinical Trial Registry (ChiCTR1800016022), date of registration 07 May 2017. Keywords: Sevoflurane; MACawake (minimum alveolar concentration of awake); orexin-A; sleep disorders.

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Validação Clínica da Versão Portuguesa do Questionário de Hábitos de Sono das Crianças (CSHQ-PT) em Crianças com Perturbações do Sono e PHDA

Acta Médica Portuguesa ◽

10.20344/amp.10906 ◽

2019 ◽

Vol 32 (3) ◽

pp. 195

Author(s):

Ana Filipa Parreira ◽

António Martins ◽

Filipa Ribeiro ◽

Filipe Glória Silva

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Sleep Disturbance ◽

Sleep Disorders ◽

Attention Deficit ◽

Control Group ◽

Sleep Habits ◽

Disturbance Index ◽

Hyperactivity Disorder ◽

Children’S Sleep Habits Questionnaire ◽

Children’S Sleep

Introduction: The Portuguese version of the Children’s Sleep Habits Questionnaire showed adequate psychometric properties in a community sample but the American cut-off seemed inadequate. This study aimed to validate this questionnaire in clinical populations of children with sleep disorders and with attention deficit/ hyperactivity disorder.Material and Methods: The study sample included 148 Portuguese children aged 2 to 10 years old that where divided in 3 groups: 1. Clinical group with sleep disorders (behavioral insomnias, parasomnias or sleep-related breathing disorders); 2. Clinical group with attention deficit/ hyperactivity disorder; 3. Control group. The sleep habits and sleep problems were evaluated using the Children’s Sleep Habits Questionnaire. Sleep-related disorders were confirmed by polysomnography.Results: The questionnaire’s internal consistency (Cronbach α) in the clinical sample (sleep disorders and attention deficit/ hyperactivity disorder) was 0.75 and ranged from 0.55 to 0.85 for the subscales. Children with sleep disorders and attention deficit/ hyperactivity disorder had a higher sleep disturbance index (full scale score) compared to the control group. The subscales presented significant differences between the subgroups with different sleep disorders showing discriminative validity. The receiver operating characteristic analysis of the sleep disturbance index comparing the sleep disorder and control sample determined a cut-off of 48 (sensibility 0.83;specificity 0.69).Discussion: Children with sleep disorders and attention deficit/ hyperactivity disorder evidenced higher Sleep Disturbance Index (full scale score) comparing to the control group. The subscales presented significative differences between the subgroups with different sleep disorders showing discriminative validityConclusion: The Portuguese version of the Children’s Sleep Habits Questionnaire showed adequate psychometric properties for children with sleep disorders and/or attention deficit/ hyperactivity disorder. The cut-off value 48 is better adjusted for the Portuguese population.

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Increased minimum alveolar concentration-awake of Sevoflurane in women of breast surgery with sleep disorders

BMC Anesthesiology ◽

10.1186/s12871-020-0931-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Yuanyuan Cao ◽

Lei Zhang ◽

Xiaohui Peng ◽

Yun Wu ◽

Qunlin Zhang ◽

...

Keyword(s):

Sleep Disorders ◽

Minimum Alveolar Concentration ◽

Breast Surgery

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Effect of epidural administration of lidocaine, fentanyl and their combination on the minimum alveolar concentration of halothane in dogs

Veterinární Medicína ◽

10.17221/5732-vetmed ◽

2012 ◽

Vol 49 (No. 11) ◽

pp. 421-426

Author(s):

P. Rauser ◽

L. Lexmaulova ◽

M. Vlasin ◽

T. Fichtel ◽

J. Lorenzova

Keyword(s):

Minimum Alveolar Concentration ◽

Control Group ◽

Epidural Administration ◽

General Anesthetics ◽

Mutual Relationship ◽

Significant Difference ◽

Basic Parameters ◽

Healthy Dogs ◽

End Tidal ◽

Vital Parameters

The efficacy of lidocaine, fentanyl, combination of both (2 mg/kg of lidocaine, along with fentanyl in the dose of 0.005 mg/kg) and saline (as a control) administered epidurally to 40 healthy dogs was under investigation, regarding their influence on minimum alveolar concentration (MAC) of halothane. Basic vital parameters, such as heart rate, respiratory rate, saturation of hemoglobin with oxygen and end-tidal partial pressure of CO<sub>2</sub> were recorded. Minimum alveolar concentration of halothane after administration of lidocaine (0.75 ± 0.24%), or the lidocaine/fentanyl combination (0.43 ± 0.08%) was found to be significantly lower (p < 0.05) compare to control group (1.15 ± 0.20%). However, we have not found significant difference in the group given fentanyl alone (0.95 ± 0.35%) compare to control group. Mutual relationship between epidurally given lidocaine and fentanyl (same route of administration) can be called as simply additive. There were no significant deviations in basic parameters within groups. We conclude that epidural administration of combination of these drugs we are able to reduce the dose of general anesthetics, which is important in management of critically ill patients.

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Cerebral oxygenation in 45-degree trendelenburg position for robot-assisted radical prostatectomy: a single-center, open, controlled pilot study

BMC Urology ◽

10.1186/s12894-020-00774-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Clemens Wiesinger ◽

Dominik Stefan Schoeb ◽

Mathias Stockhammer ◽

Emir Mirtezani ◽

Lukas Mitterschiffthaler ◽

...

Keyword(s):

Pilot Study ◽

Cerebral Oxygenation ◽

Preoperative Assessment ◽

Patient Characteristics ◽

Rank Test ◽

Control Group ◽

Robot Assisted ◽

Clinical Trial Registry ◽

Trendelenburg Position ◽

Signed Rank Test

Abstract Background Within the last decade, robotically-assisted laparoscopic prostatectomy (RALP) has become the standard for treating localized prostate cancer, causing a revival of the 45° Trendelenburg position. In this pilot study we investigated effects of Trendelenburg position on hemodynamics and cerebral oxygenation in patients undergoing RALP. Methods We enrolled 58 patients undergoing RALP and 22 patients undergoing robot-assisted partial nephrectomy (RAPN) (control group) in our study. Demographic patient data and intraoperative parameters including cerebral oxygenation and cerebral hemodynamics were recorded for all patients. Cerebral function was also assessed pre- and postoperatively via the Mini Mental Status (MMS) exam. Changes in parameters during surgery were modelled by a mixed effects model; changes in the MMS result were evaluated using the Wilcoxon signed rank test. Results Preoperative assessment of patient characteristics, standard blood values and vital parameters revealed no difference between the two groups. Conclusions Applying a 45° Trendelenburg position causes no difference in postoperative brain function, and does not alter cerebral oxygenation during a surgical procedure lasting up to 5 h. Further studies in larger patient cohorts will have to confirm these findings. Trial registration German Clinical Trial Registry; DRKS00005094; Registered 12th December 2013—Retrospectively registered; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00005094.

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Mental health and sleep habits/problems in children aged 3–4 years: a population study

BioPsychoSocial Medicine ◽

10.1186/s13030-021-00213-2 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Fumie Horiuchi ◽

Kentaro Kawabe ◽

Yasunori Oka ◽

Kiwamu Nakachi ◽

Rie Hosokawa ◽

...

Keyword(s):

Mental Health ◽

Health Status ◽

Healthcare Providers ◽

Poor Mental Health ◽

Mental Health Status ◽

Control Group ◽

Sleep Habits ◽

Psychological Burden ◽

Wake Time ◽

Health Group

Abstract Background Sleep is essential for mental health at all ages, but few studies have investigated the importance of sleep for mental health in early childhood. Therefore, this study examined the association between mental health and sleep habits/problems in children aged 3–4 years. Methods Children aged 3 to 4 years who were living in the community (n = 415; 211/204 boys/girls) were recruited for this study. Their mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ), and their sleep habits/problems were evaluated using the Child and Adolescent Sleep Checklist. Results Based on the total difficulties score of the SDQ, the children were divided into two groups: a poor mental health group (n = 76) and a control group (n = 339). In terms of sleep habits, which included total sleep time, bedtime, wake time, and nap conditions, there were no differences between the two groups. Regarding sleep-related problems, however, anxiety before going to sleep (p = 0.026), circadian rhythm abnormalities (p = 0.014), and sleepiness during classes outside of naptimes (p = 0.031) were significantly higher in the poor mental health group than in the control group. Multiple regression analysis showed that poor mental health status was significantly associated with sleepiness and snoring (p = 0.017 and p = 0.018, respectively). Conclusions The mental health status of 3–4-year-old children was associated with sleep-related problems, namely sleepiness and snoring. Healthcare providers should pay attention to children’s irregular sleep-wake patterns; moreover, interventions for appropriate sleep hygiene will reduce the psychological burden on both children and their families.

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NORMAL SLEEP AND SLEEP DISORDERS

Oral and Maxillofacial Surgery Clinics of North America ◽

10.1016/s1042-3699(20)30817-7 ◽

1995 ◽

Vol 7 (2) ◽

pp. 181-194

Author(s):

G. Vernon Pegram ◽

Ed Lucas

Keyword(s):

Sleep Disorders ◽

Normal Sleep

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Sleep habits and their association with daytime sleepiness among medical students of Tanta University, Egypt

Epidemiologic Methods ◽

10.1515/em-2019-0034 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Salwa A. Atlam ◽

Hala M. Elsabagh

Keyword(s):

Medical Students ◽

Sleep Disorders ◽

Sleep Duration ◽

Daytime Sleepiness ◽

Sleep Habits ◽

Restless Legs ◽

Sleeping Pills ◽

Life Pattern ◽

Waking Up ◽

Malaysian Students

AbstractObjectivesThis study aimed to assess the sleep quality (habits and disorders) and the daytime sleepiness among medical students.MethodsA cross-sectional questionnaire-based study was conducted during September 2018, through November 2018 at the Faculty of Medicine, Tanta University, Egypt. The study recruited undergraduate Egyptian and Malaysian students and applied a modified form of two questionnaires, namely the Sleep Habits and Life Style and the Epworth Sleepiness Scale (ESS)”. Statistical analysis was done using SPSS. The results were expressed as frequency, percentage, and mean ± standard deviation (SD). Chi-square test was used to explore associations between categorical variables. An independent sample t-test was used to detect the mean differences between groups. Ordinal regression analyses were done on the ESS findings in relation to demographics and sleep habits. p-values<0.05 were accepted as statistically significant.ResultsThe study included 899 medical students. Most of the participants were Egyptians (67%), rural residents (57.4%), and in the preclinical stage (79.5%). Males represented 66.0% of the study participants and participants average age (SD) was 21.98 (1.13) years. The average durations (SD) of night sleep were 7.3 (1.6) hours in work days and 8.7 (2.1) hours during the weekends. Both were significantly longer among young (<21 years-old) and preclinical students (p<0.05). Students had on average (SD) 1.33 (0.29) hours duration of napping, but 60% of the participants never or rarely scheduled for napping. Larger proportion of male and Malaysian students sometimes scheduled for napping more significantly than their peers (p<0.05). Only 16.24% of students reported that the cause of daytime napping was no enough sleep at night. The students reported sleep disorders of insomnia in the form of waking up too early, trouble falling asleep, or waking up at night with failure to re-sleep (31, 30, and 26%, respectively). Snoring (22.2%) and restless legs (22.0%) were also reported by the students. High chances of dozing off was reported by 22.02% of the participants, of which 10% used sleeping pills, 41.4% suffered psychological affection, and 34.8% reported life pattern affection. We found an increased chance of daytime sleepiness among males (0.430 times) and Egyptian (2.018 times) students. There was a decreased chance of daytime sleepiness in students from rural areas and those below 21-years-old (0.262 and 0.343 times, respectively). Absence of chronic diseases suffering was significantly associated with 5.573 more chance of daytime sleepiness or dozing off. In addition, enough and average sleep at night significantly decreased the chance of daytime sleepiness by 6.292 and 6.578, respectively, whereas daytime consumption of caffeinated beverages significantly decreased the chance of daytime sleepiness by 0.341.ConclusionThere was unbalanced sleep duration in work days and weekends as well as lack of scheduling for napping among the students. Sleep disorders as insomnia, snoring, and restless legs were associated with excessive daytime sleepiness. Some students who suffered daytime sleepiness also underwent psychological and life pattern affection including taking sleeping pills. Enough and average sleep duration at night as well as daytime consumption of caffeinated beverages decreased the chance of daytime sleepiness.

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Effect of intravenous oxycodone on the physiologic responses to extubation following general anesthesia

BMC Anesthesiology ◽

10.1186/s12871-021-01350-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Menglu Jiang ◽

Jiawei Ji ◽

Xin Li ◽

Zhenqing Liu

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

General Anesthesia ◽

Control Group ◽

Study Group ◽

Clinical Trial Registry ◽

Blood Oxygen Saturation ◽

Blood Concentrations ◽

Number Of Patients ◽

Blood Hormones

Abstract Background Endotracheal intubation and extubation may cause undesirable hemodynamic changes. Intravenous oxycodone has recently been introduced and used for relieving hemodynamic alterations in response to intubation, but there is insufficient information regarding its application in stabilizing hemodynamics during extubation in the patients emerging from general anesthesia. Methods One hundred patients, who had undergone assorted laparoscopic surgeries under general anesthesia, were randomly assigned to Control group (saline injection, 50 cases) and Study group (intravenous injection of 0.08 mg/kg oxycodone immediately after completion of the surgical procedure, 50 cases). Blood pressure, heart rate, blood oxygen saturation (SpO2) as well as blood concentrations of epinephrine, norepinephrine, and cortisol were recorded or measured immediately before extubation (T0), during extubation (T1), as well as one minute (T2), 5 min (T3), and 10 min after extubation (T4). In addition, coughing and restlessness, time of eye-opening, and duration from completing surgery to extubation as well as Ramsay Sedation Scale were analyzed. Results Blood pressure and heart rate as well as blood concentrations of epinephrine, norepinephrine, and cortisol were significantly higher in the Control group compared with the Study group at the time of extubation as well as 1, 5, and 10 min after extubation (P < 0.05). When the patients emerged from general anesthesia, 70 % of the Control group had cough, which was significantly higher than that of Study group (40 %, P < 0.05). Significantly higher number of patients manifested restlessness in the Control group before (40 %) and after extubation (20 %) compared with that in the Study group (20 and 2 %, respectively, P < 0.05). In addition, patients of Control group had lower Ramsay score at extubation (1.7 ± 0.7) as well as 30 min after extubation (2.4 ± 0.9) compared to that of the patients of Study group (2.2 ± 0.9, and 3.0 ± 0.8, respectively, P = 0.003 and 0.001). Conclusions Intravenous oxycodone attenuated alterations of hemodynamics and blood hormones associated with extubation during emergence from general anesthesia. Trial registration Chinese Clinical Trial Registry: ChiCTR2000040370 (registration date: 11-28-2020) “‘retrospectively registered”.

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Effect of Nudge-Based Intervention on Adherence to Physician Visit Recommendations and Early Health Outcomes among Individuals Identified with Chronic Kidney Disease in Screens

Journal of the American Society of Nephrology ◽

10.1681/asn.2021050664 ◽

2021 ◽

pp. ASN.2021050664

Author(s):

Shingo Fukuma ◽

Shusaku Sasaki ◽

Masataka Taguri ◽

Rei Goto ◽

Toshihiro Misumi ◽

...

Keyword(s):

Clinical Trial ◽

Health Outcomes ◽

Behavioral Economics ◽

Physician Visit ◽

Group Versus ◽

Control Group ◽

Trial Registry ◽

Clinical Trial Registry ◽

Screening Programs ◽

Early Health

BackgroundAlthough CKD screening programs have been provided in many settings, little is known as to how we can effectively translate those screening programs into improved health.MethodsWe conducted a randomized clinical trial on national health screening for CKD in Japan between April 2018 and March 2019. A total of 4011 participants in CKD screening programs aged 40–63 years were randomly assigned to two interventions or the control, with a ratio of 2:2:1, respectively: (1) the nudge-based letter that contained a message on the basis of behavioral economics, (2) the clinical letter including general information about CKD risks, and (3) the control (informed only of the screening results). The main outcome was adherence to a recommended physician visit within 6 months of the intervention. The secondary outcomes were eGFR, proteinuria, and BP 1 year after the intervention.ResultsCompared with the control group, the probability of undergoing a recommended physician visit was higher among participants who received the nudge-based letter (19.7% for the intervention group versus 15.8% for the control; difference, +3.9 percentage points [pp]; 95% CI, +0.8 to +7.0; P=0.02) and the clinical letter (19.7% versus 15.8%; difference, +3.9 pp; 95% CI, +0.8 to +7.0; P=0.02). We found no evidence that interventions were associated with improved early health outcomes.ConclusionsThe behavioral economics intervention tested in this large RCT had limited effect on changing behavior or improving health outcomes. Although the approach has promise, this study demonstrates the challenge of developing behavioral interventions that improve the effectiveness of CKD screening programs.Clinical Trial registry name and registration number: University Hospital Medical Information Network Clinical Trial Registry, UMIN000035230

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