Penanganan Trigeminocardiac Reflex (TCR) selama Anestesi untuk Bedah Saraf

Trigeminocardiac reflex (TCR) is a unique brain stem reflex that manifests as negative cardio-respiratory perturbations. The trigeminocardiac reflex (TCR) is defined as the sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, apnea, or gastric hypermotility during stimulation of any of the sensory branches of the trigeminal nerve. Clinically, the TCR has been reported in all the surgical procedures in which a structure innervated by the trigeminal nerve is involved. This reflex is largely reported in skull base surgeries/interventions; however, in recent times, it has been also linked with many neurosurgical, neurointerventional procedures, non-neurosurgical and non-surgical conditions. This reflex presents with many cardiovascular changes that can create catastrophic complications, worse outcome as well as diagnostic dilemmas. Although, there is an abundant literature with reports of incidences and risk factors of the TCR; the physiological significance and function of this brainstem reflex has not yet been fully elucidated. In addition, there are complexities within the TCR that requires examination and clarification. If a CTR occurs, it can risk factor identification and modification, depth of anesthesia assessment, prophylactic treatment with either vagolytic agents or peripheral nerve block in case of peripheral manipulations of the nerve, careful cardiovascular monitoring during anesthesia, especially in those with a risk factor for TCR, treatment of the condition when it occurs: cessation of the manipulation, and administration of vagolytic agents and adrenaline. Therefore, this narrative review intends to elaborate on its mechanisms, definition, pathophysiology, manifestations, diagnosis and management.

‘Seeing’ music from manga: visualizing music with embodied mechanisms of musical experience

This study investigates how music is represented in musical-themed manga by visual components referred to as ‘visualized music’, and how embodied mechanisms of musical experience conceive these visual manifestations. Using Šorm and Steen’s (2018) Visual Metaphor Identification Procedure (VISMIP), the authors discovered four metaphors, and seven metonymies and ‘manpu’ (i.e. iconic signs used in manga) that are widely applied in visualizing music. In addition, they incorporated Juslin and Västfjäll’s (2008) framework and further proposed five major embodied mechanisms of musical experience: (1) brain stem reflex, (2) emotional contagion, (3) visual imagery, (4) emotional memory related to music, and (5) musical expectancy. Their results showed that these embodied mechanisms are the foundations of visualized music. The brain stem reflex, the underlying structure of most metonymies and manpu, triggers us to represent some acoustic characteristics by using sound symbolic components. These include emotional contagion-inducing metaphors representing emotional responses, such as ‘ MUSIC/EMOTION IS WEATHER’, which further entails their acoustic characteristics and visual imagery, the most important mechanism, basing our overall comprehension of music and metaphorical mapping between music and image-schemata. Readers also use emotional simulations to understand the visual imagery that further constructs their impressions toward music, emotional memory grounding manifestations related to music used to build background stories and intensify reader empathy, and lastly, musical expectancy, involving the ability of prediction and consciousness, usually associated with ‘ MUSIC IS LIGHT’. In this way, this study sheds light on our overall understanding of audio-visual cross-modality, musical experience, metaphor and embodied experience.

Role of expectancy in physiological responses to sound recognition of musical dissonance and timbral change

Recently, it has been suggested that tonal violations produce greater skin conductance response (SCR) than timbral violations in music listening. However, it is unknown how people focus their attention during musical excerpts. The aim of this study is to replicate previous research considering two psychophysiological mechanisms: prediction error and brain stem reflex. Twenty-seven nonmusicians were instructed to listen six melodies and detect three altered conditions in one note: a dissonance (note out-of-key), a timbral change, and dissonance which changes in timbre and tone ( timdis). Amplitudes of SCR, heart rate (HR), and respiration rate (RSPR) were analyzed. In addition, the frequency of SCR and the percentage of musical events detection were measured. Results showed no significant differences either on amplitude of SCR or on respiratory rate. However, perception of timdis produced an increase in HR higher than dissonance ( p < .05) and the timbre condition had a higher frequency of SCR than dissonance ( p < .05). In addition, participants only detected 59.3% of dissonances but they were aware of 90% of notes in-key ( original melody). Finally, there was no significant correlation between percentage of detection and frequency of SCR. Results are discussed based on the prediction error mechanism, a theoretical model of expectation.

The effects of emotionally congruent sad music listening in young adults high in rumination

There is debate as to whether sad music is harmful or helpful when used to regulate emotions. Listeners’ trait level of rumination may influence their responses to sad music during sadness. This study used an online community sample of young adults ( N = 386, 56% female, Mage = 21.89) in an induced sad state to understand the roles of listener rumination and the eight BRECVEMA musical emotion mechanisms (Brain Stem Reflex, Rhythmic Entrainment, Evaluative Conditioning, Contagion, Visual Imagery, Episodic Memory, Musical Expectancy, and Aesthetic Judgment) in determining changes in sadness during listening. Participants increased in sadness after listening to a self-nominated sad song. The increase in sadness observed was additionally moderated by rumination such that higher rumination predicted greater increases in sadness. People high in rumination were additionally more likely to experience musical entrainment, select a song with conditioned responses and associated memories, as well as experience emotional contagion while listening. Importantly, the effect of rumination was not significant when these BRECVEMA variables were added to the model. Results suggested that BRECVEMA mechanisms were more predictive of increases in sadness from pre- to post-listening than trait rumination levels. The findings suggest that attention should be given to individuals’ song choices and associated active BRECVEMA mechanisms in addition to their trait rumination.

Emotional Reactions to Music in Dementia Patients and Healthy Controls: Differential Responding Depends on the Mechanism

Music is frequently regarded as a unique way to connect with dementia patients. Yet little is known about how persons with dementia respond emotionally to music. Are their responses different from those of healthy listeners? If so, why? The present study makes a first attempt to tackle these issues in a Portuguese context, with a focus on psychological mechanisms. In Experiment 1, featuring 20 young and healthy adults, we found that musical excerpts which have previously been shown to activate specific emotion induction mechanisms (brain stem reflex, contagion, episodic memory, musical expectancy) in Sweden were valid and yielded predicted emotions also in Portugal, as indexed by self-reported feelings, psychophysiology, and post hoc mechanism indices. In Experiment 2, we used the same stimuli to compare the responses of 20 elderly listeners diagnosed with Alzheimer’s disease (AD) with those of 20 healthy listeners. We controlled for cognitive functioning (Mini-Mental State Examination) and depression (Geriatric Depression Scale). Our predictions about how mechanisms would be differentially affected by decline in brain regions associated with AD received support in that AD patients reported significantly lower levels of (a) sadness in the contagion condition, (b) happiness and nostalgia in the episodic memory condition, and (c) anxiety in the musical expectancy condition. By contrast, no significant difference in reported surprise was found in the brain stem reflex condition. Implications for musical interventions aimed at dementia are discussed, highlighting the key role that basic research may play in developing applications.

Jumping at Shadows

This chapter introduces a psychological mechanism that involves a close link between perception and motor behaviour. It focuses on a mechanism called the brain stem reflex, which refers to a process whereby an emotion is aroused in a listener because an acoustic feature — such as sound intensity or roughness of timbre — exceeds a certain cut-off value for which the auditory system has been designed by natural selection to quickly alert the brain. It is a kind of ‘override’ system, which is activated when an event seems to require first-priority attention. Brain stem reflexes are said to be ‘hard-wired’: they are quick, automatic, and unlearned.

PENGKAJIAN PASIEN MENGGUNAKAN FOUR SCORE COMA SCALE DI RUANG PERAWATAN INTENSIVE CARE UNIT (ICU)

Patients with poor conditions or decreased awareness need appropriate assessment to determine the management to be given. Awareness assessments can be done using FOUR (Full Outline of Response) scores with a range of scores from 0 to 16, consisting of eye response, motor response, brain stem reflex and respiration pattern FOUR score is used by nurses in the intensive care unit (Intensive Care Unit). ICU). The method of this study was descriptive analytical and numerator testing between oberserver prospectively to evaluate FOUR score to 100 patients in the ICU from October to December 2017. This study compared FOUR score with the GCS (Glasgow Coma Scale). Each patient was assessed using FOUR score and GCS by nurses. The average score is calculated based on the results obtained in both scoring. The results showed that the numerator test for FOUR score was very good (eye response 0.94, motor response 0.95, brain stem reflex 0.96 and respiratory pattern 1.00) and for GCS it was also very good (eye response 0.94, motoric response 0.95, verbal response 0.97). In predictive terms, GCS is better than FOUR score (characteristic curve value 0.01 difference; GCS 0.76 and FOUR score 0.75). The mortality rate of patients with FOUR scale was the lowest 0 (87%) compared with the lowest GCS score of 3 (70%). FOUR score has an excellent interpersonal and intensivisional level. In contrast to GCS, all components in FOUR score can be assessed even when the patient is installed intubation.

Emotional reactions to music in depressed individuals

Music is often used to alleviate depression, an affective disorder. Yet, little is known about how listeners suffering from depression respond emotionally to music. The goal of this study was to investigate whether listeners show different patterns of emotional reactions to music depending on level of depression. In previous research, depression has been linked with negative biases in cognitive processes such as memory and attention. Here we indirectly investigated whether such biases may also influence psychological mechanisms involved in the arousal of emotions during musical experiences. Seventy-seven listeners (19–65 years old) took part in an experiment which compared depressed individuals with non-depressed controls. The participants listened to music stimuli designed to target specific induction mechanisms (brain stem reflex, contagion, episodic memory), and were asked to rate felt emotions. Based on previous studies on cognitive bias, we made predictions about how depression would affect reactions to each stimulus. The predictions received partial support: depressed listeners reported significantly lower levels of happiness in the memory condition and non-significantly higher levels of anxiety in the brain stem condition, than did controls. Conversely, no difference in reported sadness was found in the contagion condition. Observed differences were mainly attributable to the severely depressed listeners.

What makes music emotionally significant? Exploring the underlying mechanisms

A common approach to study emotional reactions to music is to attempt to obtain direct links between musical surface features such as tempo and a listener’s response. However, such an analysis ultimately fails to explain why emotions are aroused in the listener. In this article, we propose an alternative approach, which seeks to explain musical emotions in terms of a set of underlying mechanisms that are activated by different types of information in musical events. We illustrate this approach by reporting a listening experiment, which manipulated a piece of music to activate four mechanisms: brain stem reflex; emotional contagion; episodic memory; and musical expectancy. The musical excerpts were played to 20 listeners, who were asked to rate their felt emotions on 12 scales. Pulse rate, skin conductance, and facial expressions were also measured. Results indicated that target mechanisms were activated and aroused emotions largely as predicted by a multi-mechanism framework.