The Response of EEG Signal on Brain Relaxation Meditation Using Different Type of Zikr

Depression and stress are increasingly prevalent in today’s society, owing to people’s hectic, competitive, and demanding lifestyles. These illnesses had become very common, particularly among young and middle-aged people, and suicidal ideation had been identified as one of the leading causes of death by the World Health Organization (WHO). Nature sound (sound of downpours or beach) has been linked to depression and anxiety in neurology research, and it has been shown to be an alternative to alleviate anxiety. The electroencephalogram (EEG) waveform has been discovered to possess the potential in identifying information from the brain signal as well as data from the past via Bluetooth communication. The waveform use in the study are the result of a few experiments. In this study, EEG data were collected from eight subjects, four males and four females, in between the age of 20 to 30 years old and in good health, using the BrainLink device. The participants were asked to listen to two playlists of zikr, Allah, Ya Allah, and SubhanAllah, during the experiments. To smooth the signal, the Butterworth filter was used. Later, the extracted features were Alpha, Beta, and Delta waves, which were segmented based on the filtered signal. To complete the decision-making stage, the average value of amplitude differences and the p-value test were performed in the final phase. Based on the results of the experiments, it is clear that zikr is dominant in Delta wave. In terms of data hypothesis analysis, the results of both experiment were differentiated to determine which brain signal was dominant, and p-value testing was performed. Furthermore, this research is an alternative to current methods because it suggest that zikr has the tendency to alter a person’s brain state to be either in a relaxed or calm mode regardless of the type of zikr recitation. As an outcome, the study recommends the relationship of the reaction of EEG signal on brain relaxation with different types of zikr in order to facilitate stress and anxiety patients to achieve relax or calm condition.

Comparison of 1.0 g/kg of 20% mannitol initiated at different time points and effects on brain relaxation in patients with midline shift undergoing supratentorial tumor resection: a randomized controlled trial

OBJECTIVE Previous studies have suggested the use of 1.0 g/kg of 20% mannitol at the time of skin incision during neurosurgery in order to improve brain relaxation. However, the incidence of brain swelling upon dural opening is still high with this dose. In the present study, the authors sought to determine a better timing for mannitol infusion. METHODS One hundred patients with midline shift who were undergoing elective supratentorial tumor resection were randomly assigned to receive early (immediately after anesthesia induction) or routine (at the time of skin incision) administration of 1.0 g/kg body weight of 20% mannitol. The primary outcome was the 4-point brain relaxation score (BRS) immediately after dural opening (1, perfectly relaxed; 2, satisfactorily relaxed; 3, firm brain; and 4, bulging brain). The secondary outcomes included subdural intracranial pressure (ICP) measured immediately before dural opening; serum osmolality and osmole gap (OG) measured immediately before mannitol infusion (T0) and at the time of dural opening (TD); changes in serum electrolytes, lactate, and hemodynamic parameters at T0 and 30, 60, 90, and 120 minutes thereafter; and fluid balance at TD. RESULTS The time from the start of mannitol administration to dural opening was significantly longer in the early administration group than in the routine administration group (median 66 [IQR 55–75] vs 40 [IQR 38–45] minutes, p < 0.001). The BRS (score 1/2/3/4, n = 14/26/9/1 vs 3/25/18/4, p = 0.001) was better and the subdural ICP (median 5 [IQR 3–6] vs 7 [IQR 5–10] mm Hg, p < 0.001) was significantly lower in the early administration group than in the routine administration group. Serum osmolality and OG increased significantly at TD compared to levels at T0 in both groups (all p < 0.001). Intergroup comparison showed that serum osmolality and OG at TD were significantly higher in the routine administration group (p < 0.001 and = 0.002, respectively). Patients who had received early administration of mannitol had more urine output (p = 0.001) and less positive fluid balance (p < 0.001) at TD. Hemodynamic parameters, serum lactate concentrations, and incidences of electrolyte disturbances were comparable between the two groups. CONCLUSIONS Prolonging the time interval between the start of mannitol infusion and dural incision from approximately 40 to 66 minutes can improve brain relaxation and decrease subdural ICP in elective supratentorial tumor resection.

\"Balanced hyperosmolar therapy\" using 3% hypertonic saline - 20% mannitol versus an equiosmolar volume of either 3% hypertonic saline or mannitol 20% in supratentorial tumor resection: A new approach to achieve hemodynamic stability

Both 3% hypertonic saline (3% HTS) and 20% mannitol were proven to be effective in relaxing the brain during supratentorial surgeries. This work aimed to study the effect of consecutive use of both drugs on the brain relaxation score and hemodynamic status during such surgeries.Ninety patients scheduled for supratentorial brain surgeries included in this prospective, randomized and double-blind study. Patients were allocated in three groups; HTS group (n=30) received 3 ml/kg 3% NaCl infusion over 30 minutes, HTS/M group (n=30) received mannitol 20% (1.4 ml/kg) as an infusion over 15 minute followed by 1.5 ml/kg 3% NaCl infused over 15 minutes and M group (n=30) received 3.2 ml/kg mannitol 20% infusion over 30 minutes. Brain relaxation was estimated. MAP and serum Na level were recorded at baseline and then at 30, 90 and 150 min. Total fluid intake, total urine output and operative time were recorded. Fluid intake and urine output were the highest with 20% mannitol (p ˂ 0.001). HTS/M and HTS groups showed no significance when satisfactory and fairly brain relaxation scores were added (p=0.862). MAP and CVP were near to baseline in HTS/M group at 30 and 90 min, while at 150 min no significant difference between groups. Serum hyperosmolarity was noticed in all groups at all check points but maximally with HTS group at 30 min (321.1 mOsm/L). Balanced hyperosmolar therapy using 3% HTS and 20% mannitol consecutively resulted in a satisfactory brain relaxation and allowed more hemodynamic stability.

CEREBRALANEURYSM SURGERY IN A PATIENT WITH CHRONIC RENAL FAILURE: PERIOPERATIVE CONCERNS AND CONFLICTS

Chronic renal failure (CRF) and associated multi-system abnormalities can adversely impact the outcome in patients undergoing high-risk aneurysm surgeries by causing hemodynamic instability, uid-electrolyte imbalance, bleeding and coagulation abnormalities, decreased anesthetic drug excretion, and dialysis-related complications. Conicts between the standard perioperative practices in aneurysm surgery and those in CRF further contribute to the management challenges. These include, using low anesthetic drug doses but achieving good brain relaxation, using a restrictive uid therapy but preventing postoperative vasospasm, and avoiding diuretics causing nephrotoxicity but reducing intracranial pressure. Ayoung male with dialysis-dependent CRF and hypertension underwent emergency craniotomy and clipping of a cerebral aneurysm. He was managed with a modied protocol of reduced heparin hemodialysis, BIS-guided use of minimum anesthetic drugs, goal-directed optimum uid therapy, maintaining hemodynamic stability, and management of post-aneurysm clipping vasospasm with hypertension. His perioperative management and related conicts are discussed

A COMPARISON OF 3% HYPERTONIC SALINE AND MANNITOL FOR BRAIN RELAXATION DURING ELECTIVE SUPRATENTORIAL BRAIN TUMOUR SURGERY

Brain tumours may cause disturbances of cerebral auto-regulation & the blood brain barrier (BBB). These effects could possibly have an unfavourable influence on brain condition. To compare the effects of the application of a bolus hypertonic saline with those of mannitol on intraoperative brain relaxation. Ninety patients of ASA grade II and III in the age group >18 years with supratentorial brain tumours posted for elective brain tumour surgery were studied in the current study. They were randomly allocated into two groups. Each group enrolled with 45 patients- Group HTS : receiving 160 ml of 3% hypertonic saline. Group M : receiving 150 ml of 20% mannitol. Patients from both groups were induced with injection fentanyl, propofol & rocuronium. Maintained with N2O: O2 in a ratio of 2:1 combined with isoflurane, fentanyl and vecuronium. End tidal Co2 pressure were maintained between 35-40 mm Hg. Arterial blood pressure were kept within baseline value ± 20. Hence application of hypertonic saline is a more effective method for brain relaxation in patients posted for elective supratentorial brain tumours surgery and can be a great value in routine practice.

Risk of Brain Herniation After Craniotomy With Preoperative Lumbar Spinal Drainage: A Single-Surgeon Experience of 365 Patients Among 3000 Major Cranial Cases

BACKGROUND Lumbar spinal drainage (LSD) can significantly facilitate brain relaxation and improve ease of surgical goals for a variety of neurosurgical indications. Although rapid drainage of large volumes of spinal fluid can theoretically produce shifts in brain compartments and herniation syndromes, the clinical significance of this phenomenon when LSD is used immediately before craniotomy is unclear. OBJECTIVE To report a large single-surgeon consecutive experience with symptomatic brain herniation after lumbar drainage before craniotomy. METHODS Included were 365 patients who underwent LSD with either lumbar drain or lumbar puncture for a variety of different neurosurgical pathologies between 2008 and 2018 immediately before craniotomy. We reviewed the surgical indications, craniotomy location, approach, type of LSD, presence of postoperative brain herniation on imaging, type of herniation, clinical symptoms, lesion pathology, and 30-d modified Rankin Scale score for each patient. RESULTS There was no patient who suffered from the development of new or worsening symptomatic or radiological brain herniation directly related to use of immediate preoperative LSD. This included 204 supratentorial and 161 infratentorial procedures. Surgical indications included 188 tumors, 5 aneurysms, 37 arteriovenous malformations, 2 revascularization procedures, 97 microvascular decompressions, 10 optic nerve decompressions requiring extradural clinoidectomy for tumor removal, and 26 “other” pathologies. CONCLUSION Brain herniation did not occur postoperatively with the use of immediate preoperative LSD in our series, regardless of craniotomy location, pathology, extent of mass effect, or approach. Our experience suggests that LSD is a potentially safe preoperative adjunct that can be used to facilitate surgical objectives.