Case report: Spinal anesthesia for cesarean section in a parturient with Potocki-Lupski syndrome

Background Potocki -Lupski syndrome is an uncommon disorder caused by a micro-duplication in chromosome 17p11.2. Variable clinical manifestations bring troubles to the general and neuraxial anesthesia, including mental retardation, facial dysmorphisms, structural cardiovascular anomalies, scoliosis, and malignant hyperthermia. Until now, the anesthesia management for cesarean section in these patients has not been reported yet. Case presentation Here we present a 23-year-old Chinese parturient with Potocki -Lupski syndrome who underwent elective cesarean section under spinal anesthesia. She was transferred to our hospital in her 40th week of gestation. She had a history of IgA nephropathy for more than three years and was diagnosed with Potocki -Lupski syndrome (17p12p11.2 segment 3.1 Mb repeat) in the 29th week of pregnancy. Amniocentesis showed the fetus had no abnormal autosomes. Preoperative multidisciplinary consultation suggested that she should terminate the pregnancy as soon as possible. She was ASA II. Her BMI was 26.43 kg/m2. Her airway evaluation was normal. Her spine could bend well and her spinal interspace could be touched clearly. We did the single spinal anesthesia at L2-3 interspace and gave 0.5% bupivacaine 1.7 ml. The absolute anesthesia level reached T8. The Apgar score for the newborn infant was 10 for 1st minute, 5th minute, and 10th minute. The vital signs were steady without using any vasoactive drugs. The patient had a good prognosis, and was subsequently discharged from hospital. Conclusion To date, the case may be the first reported spinal anesthesia for the parturient with Potocki -Lupski syndrome. Although its manifestations are variable, the spinal anesthesia is feasible under careful and comprehensive preoperative evaluation.

Slow waves form expanding, memory-rich mesostates steered by local excitability in fading anesthesia

During sleep and anesthesia, large groups of neurons throughout the entire cortex activate rhythmically producing wavefronts of activity referred to as slow-wave activity (SWA). In the arousal process, the brain restores its integrative and complex activity. The network mechanisms underlying this global state transition remain however to be elucidated. Here we investigated the network features shaping the SWA under fading anesthesia. Using electrocorticographical recordings of wide cortical areas of the mouse brain, we developed a quantitative measure of the anesthesia level based on slow-wave frequency and complexity. At deep anesthesia, we document a stringent alternation of posterior-anterior-posterior modes of propagation. With fading anesthesia, SWA evolves to produce a plethora of metastable spatiotemporal patterns. A network model of spiking neurons reproduced the data using short-range connectivity, subcortical input and a local activity-dependent adaptation. The emergence from deep anesthesia does not require modifying the connectivity, but small changes in the local excitability of cortical cell assemblies, further supporting the hypothesis of a tight bound between scales in the brain.

A systematic study of injectable anesthetic agents in the brown anole lizard (Anolis sagrei )

Anolis lizards have served as important research models in fields ranging from evolution and ecology to physiology and biomechanics. However, anoles are also emerging as important models for studies of embryo development and tissue regeneration. The increased use of anoles in the laboratory has produced a need to establish effective methods of anesthesia, both for routine veterinary procedures and for research procedures. Therefore, we tested the efficacy of different anesthetic treatments in adult female Anolis sagrei. Alfaxalone, dexmedetomidine, hydromorphone, ketamine and tribromoethanol were administered subcutaneously (SC), either alone or combined at varying doses in a total of 64 female anoles. Drug induction time, duration, anesthesia level and adverse effects were assessed. Differences in anesthesia level were observed depending on injection site and drug combination. Alfaxalone/dexmedetomidine and tribromoethanol/dexmedetomidine were the most effective drug combinations for inducing a surgical plane of anesthesia in anoles. Brown anoles injected SC with alfaxalone (30 mg/kg) plus dexmedetomidine (0.1 mg/kg) or with tribromoethanol (400 mg/kg) plus dexmedetomidine (0.1 mg/kg) experienced mean durations of surgical anesthesia levels of 31.2 ± 5.3 and 87.5 ± 19.8 min with full recovery after another 10.9 ± 2.9 and 46.2 ± 41.8 min, respectively. Hydromorphone given with alfaxalone/dexmedetomidine resulted in deep anesthesia with respiratory depression, while ketamine/hydromorphone/dexmedetomidine produced only light to moderate sedation. We determined that alfaxalone/dexmedetomidine or tribromoethanol/dexmedetomidine combinations were sufficient to maintain a lizard under general anesthesia for coeliotomy. This study represents a significant step towards understanding the effects of anesthetic agents in anole lizards and will benefit both veterinary care and research on these animals.

INVESTIGATION OF EEG SIGNAL LENGTH INFLUENCE ON ACCURACY OF ANESTHESIA LEVELS CLASSIFICATION

This paper considers one of the challenging tasks during surgical procedure, i.e. depth of anasthesia estimate. The purpose of this paper is to investigate the effect of the analyzed EEG signal fragment duration on the accuracy of anesthesia level estimate using the linear discriminant analysis algorithm and determining the EEG signal length, which yields acceptable accuracy of anesthesia level separation using these parameters.A new method for classifying EEG anesthesia levels is proposed. The possibility of classifying levels of anesthesia is demonstrated by means of sharing the EEG parameters under consideration (SE, BSR, SEF95, RBR). The method can be used in anesthesia monitors that are used to monitor the depth of anesthesia in order to select the appropriate dose of anesthetic drugs during operations, thus avoiding both cases of intraoperative arousal and excessively deep anesthesia.

Automatic anesthesia regularization system (AARS) with patient monitoring modules

The administration of high/low dose of anesthesia during surgery may cause lethal effect to the patient. To avoid such situation, the anesthetist administers few milliliters of anesthesia at regular intervals to the patient. To overcome such tedi-ous problems, this project aims to design an effective microcontroller based automatically operated anesthesia machine. In the proposed Automatic Anesthesia Regularization System, anesthesia level is controlled by multi-task feedback and microcontroller system, based on patient’s condition. The Automatic Anesthesia Controller designed using microcontroller aids to control anesthesia levels during the course of surgery. Mechanical syringe infusion pump is provided to deliver an-esthesia to the patient. The anesthetist can set the keypad to administer the dose of anesthesia in terms of milliliters per hour. The keypad transmits the analog signal to the microcontroller to control the required dose of anesthesia to be fed into DC motor to operate injection pump. The anesthesia was administered based on patient’s body condition and move-ment of syringe in the forward or backward direction based on the rotation of DC motor. This module will play a major role in the field of medicine and useful to the physicians during major surgery to provide the desire amount of anesthesia.

Effect of anesthesia level on murine cardiac function

Background: Echocardiography allows for sensitive and non-invasive assessment of cardiac function in mice, but requires sedation and immobility, which influences cardiac performance. Minimizing the hemodynamic effects of anesthesia is extremely important for improving the applicability of animal models to the clinical setting. We sought to evaluate the effects of isoflurane dose on myocardial function in a murine model.Methods: Twelve healthy C57BL/6 mice were studied with three different isoflurane anesthesia regimens: deep anesthesia with an objective of heart rate (HR) between 350 and 400 beats per minute (bpm), light anesthesia with an objective of HR between 475 and 525 bpm and just before the mice woke up (>575 bpm). Using a high-resolution ultrasound system, stroke volume, cardiac output, left ventricle dimension and fractional shortening were recorded.Results: Fractional shortening was not statistically different in the awake group and the light anesthesia group (49±5% in awake mice vs. 48±5%; p=0.62), whereas it was different compared to the deep anesthesia group (31±5%, p<0.0001 compared to both groups). Similar results were found for stroke volume (41.4±5.8 ml vs. 41.6±6.9 ml; p=0.81 and 35±8.3 ml; p<0.05 compared to both groups). Cardiac output was slightly lower in the light anesthesia group compared to the awake group (21.9±3.6 ml/min vs. 25.6±3.3; p=0.02) due to HR significant difference (522±17 bpm vs. 608±23 bpm; p<0.0001).Conclusions: Doppler echocardiography can be performed under very light anesthesia using small doses of isoflurane without influencing cardiac inotropic function. This technique allows for accurate and reproducible assessment of cardiac function while minimizing hemodynamic perturbations.