Anesthesia Depth Monitoring Based on Anesthesia Monitor with the Help of Artificial Intelligence / 中国医疗器械杂志

OBJECTIVE@#To use the low-cost anesthesia monitor for realizing anesthesia depth monitoring, effectively assist anesthesiologists in diagnosis and reduce the cost of anesthesia operation.@*METHODS@#Propose a monitoring method of anesthesia depth based on artificial intelligence. The monitoring method is designed based on convolutional neural network (CNN) and long and short-term memory (LSTM) network. The input data of the model include electrocardiogram (ECG) and pulse wave photoplethysmography (PPG) recorded in the anesthesia monitor, as well as heart rate variability (HRV) calculated from ECG, The output of the model is in three states of anesthesia induction, anesthesia maintenance and anesthesia awakening.@*RESULTS@#The accuracy of anesthesia depth monitoring model under transfer learning is 94.1%, which is better than all comparison methods.@*CONCLUSIONS@#The accuracy of this study meets the needs of perioperative anesthesia depth monitoring and the study reduces the operation cost.

Application of propofol closed-loop target-controlled infusion for different anesthesia depth combined with nerve block in elderly artificial hip replacement / 中国医师杂志

Objective:To investigate the effect of propofol closed-loop target-controlled infusion system in controlling the bispectral index (BIS) at different levels during artificial hip replacement in the elderly under general anesthesia combined with nerve block on postoperative delirium, postoperative pain and intraoperative circulation control.Methods:From October 2017 to May 2019, 95 elderly patients with elective unilateral artificial hip replacement were selected from Xiangya Hospital of Central South University. They were randomly divided into light anesthesia group (48 cases) and deep anesthesia group (47 cases). Under general anesthesia combined with nerve block, the target BIS value of propofol closed-loop target-controlled infusion in the light anesthesia group was set to 55±5, and the target BIS value of the deep anesthesia group was 45±5. The incidence of postoperative delirium and postoperative pain visual analogue scale (VAS) score were observed. The changes of hemodynamics, intraoperative vasoactive drug use, propofol dosage and intraoperative BIS value at different time points were compared between the two groups.Results:There was no significant difference in the incidence of postoperative delirium and the VAS score of postoperative pain between the two groups ( P>0.05). The average intraoperative BIS and the ratio of intraoperative BIS>50 in the light anesthesia group were higher than those in the deep anesthesia group ( P<0.001), and the intraoperative propofol consumption was lower than the deep anesthesia group ( P<0.001); In the light anesthesia group, the arterial systolic blood pressure level after laryngeal mask implantation and skin incision during the induction period of general anesthesia was higher than that in the deep anesthesia group ( P<0.05), and the number of cases of phenylephrine use in the light anesthesia group was lower than that of the deep anesthesia group ( P<0.05). Conclusions:When using general anesthesia combined with nerve block for the elderly artificial hip replacement, the different control levels of BIS in the closed-loop target-controlled infusion of propofol have no effect on postoperative pain and postoperative delirium, but the intraoperative BIS value controlled at a lower level is related to the suppression of the patient′s hemodynamics and brings more propofol consumption.

Effects of different depth of total intravenous anesthesia on postoperative hyperalgesia in patients undergoing lower abdominal operation / 临床麻醉学杂志

Objective By observing the incidence of postoperative hyperalgesia in patients with total intravenous anesthesia,to study the effects of different anesthesia depth on postoperative hyperalgesia.Methods Forty gynecologic patients undergoing open lower abdominal operation were randomized into two groups (n=20): group B1 with BIS 40-49 and the group B2 with BIS 50-59.Anaesthesia was induced and maintained with intravenous anesthetics.The threshold of haphalgesia and the range of mechanical hyperalgesia were measured before operation.The consumption of the intravenous anesthetics,the emergence time and the extubation time were recorded.The vital signs were recorded at eight time points: pre-aneasthesia (T0),abdominal exploration (T1),the end of operation (T2)and 1 h (T3),4 h (T4),12 h (T5),24 h (T6),48 h (T7) after extubation.The VAS scores at T3-T7 were recorded.The PCA dosage of analgesic and superaddition in postoperative 24 h and 48 h were recored.The Von Frey Hairs were used to assessed the threshold of haphalgesia and the range of mechanical hyperalgesia at T6 and T7.Results The MAP at T6 and T7 and the VAS scores at T6 of the group B1 were lower than those of the group B2 (P<0.05).The range of mechanical hyperalgesia at T7 of the group B1 was narrower than that of the group B2 (P<0.05).Conclusion Maintaining the anesthesia depth within BIS 40-49 can reduce the body′s stress reaction,decrease the incidence of postoperative hyperalgesia and accelerate the recovery time of mechanical hyperalgesia in postoperative 48 h.

The protective effects of sevoflurane at different anesthesia depths on periperative myocardial ischemia in coronary heart disease patients undergoing noncardiac surgery / 实用医学杂志

Objective To study the protective effects of sevoflurane at different anesthesia depths on periperative myocardial ischemia in coronary heart disease patients undergoing noncardiac surgery.Methods 96 patients with coronary undergoing noncardiac surgery were randomly divided into three groups:control group (Group C),high-concentration sevoflurane group (Group S 1) and low-concentration sevoflurane group (Group S2).Etomidate,Propofol,Cisatracurium Besilate and Fentanyl were used for intravenous anesthetic induction and maintenance of anesthesia.In addition,B ispectralindex (BIS) remained between 35 ～ 45 and 45 ～ 55 in groups S1 and S2,re spectively.BIS remained between 40 ～ 50 in group C.Perioperative hemodynamic changes,ECG ST-segment before induction of anesthesia,endotracheal immediate intubation and extubation were recorded.Plasma concentrations of cTnT,high sensitive cardiac troponin (hs-cTnT) and high sensitive ereaetive protein (hs-CRP) were detected with central venous blood before anesthesia induction and immediate extubation.Results Compared with group C,the incidences of hypertension,tachycardia,myocardial ischemia,proiosystole and atrial fibrillation were significantly reduced in groups S1 and S2 (P ＜ 0.05);The incidences of bradycardia and hypotension groups were significantly higher in group S1 (P ＜ 0.05).Compared with group S1,the incidences of hypotension,bradycardia,myocardial ischemia were significantly reduced in group S2 (P ＜ 0.05).Compared with group C,plasma concentrations of cTnT,hs-cTnT and hs-CRP were significantly reduced after endotracheal extubation in group S1 and S2 (P ＜ 0.05).Conclusion Myocardial protective effect is better and less risky for patients with coronary artery disease undergoing noncardiac surgery by inhalation of 1.0％ to 2.5％ sevoflurane to maintain BIS between 45 to 55.

Use of ADMS™ during sedation for dental treatment of an intellectually disabled patient: a case report

Dental treatment is often performed under general anesthesia or sedation when an intellectually disabled patient has a heightened fear of treatment or has difficulty cooperating. When it is impossible to control the patient due to the severity of intellectual disability, conscious sedation is not a viable option, and only deep sedation should be performed. Deep sedation is usually achieved by propofol infusion using the target controlled infusion (TCI) system, with deep sedation being achieved at a slightly lower concentration of propofol in disabled patients. In such cases, anesthesia depth monitoring using EEG, as with a Bispectral Index (BIS) monitor, can enable dental treatment under appropriate sedation depth. In the present case, we performed deep sedation for dental treatment on a 27-year-old female patient with mental retardation and severe dental phobia. During sedation, we used BIS and a newly developed Anesthetic Depth Monitor for Sedation (ADMS™), in addition to electrocardiography, pulse oximetry, blood pressure monitoring, and capnometry for patient safety. Oxygen was administered via nasal prong to prevent hypoxemia during sedation. The BIS and ADMS™ values were maintained at approximately 70, and dental treatment was successfully performed in approximately 30 min..

Effect of different sedation anesthesia depth toperioperative hemodynamic in closed-loop target controlled infusion / 实用医学杂志

Objective To investigate the effect of different sedation depth of anesthesia the BIS settings (BISis 45 and 55) to perioperative hemodynamic. Methods Thirty-two patients were randomly divided into two groups. Through closed-loop target controlled infusion technology, depth of sedation anesthesia in A:the BIS=45, and in B: the BIS=55.12 time points(i.e. before operation, tracheal intubation instant, operation beginning, 20, 40,60,80,100 and 120 minutes after operation beginning, operation accomplishment point, tracheal catheter pulling out point, before patient′s carried out of operation room)perioperativenoninvasivemean arterial blood pressureandheart rate wererecorded. Results Themean arterial blood pressurebetween the two groups at time point T2,T11 was significantly different. Within group B,compared with T1, there wassignificantdifferenceat T2,T11. Heart ratein group B at T5and T10increasedsignificantly compared with A.Within group B,heart rate at T5,T6 increased significantly compared with that at T1. Conclusion Compared with BIS 55, the sedation anesthesia depth of BIS 45 can better keep stable of blood pressureandheart rate.

Relación entre monitorización del índice de estado cerebral y predictores clínicos de profundidad anestésica / Relation between the monitoring of cerebral status rate and the prediction levels

INTRODUCCIÓN: Las cardiopatías valvulares adquiridas presentan una notable mejoría con tratamiento quirúrgico; sin embargo, se atribuye una alta incidencia de despertar intraoperatorio, por lo que resulta necesario monitorizar el estado de profundidad anestésica, mediante la valoración de signos clínicos o registros electroencefalográficos simples o computarizados. OBJETIVOS: Comparar el grado de profundidad anestésica mediante monitorización del índice de estado cerebral y la valoración clínica intraoperatoria en pacientes propuestos para tratamiento quirúrgico. MÉTODO: Se realizó un estudio descriptivo transversal en 40 pacientes a los cuales se les administró anestesia general. Se comparó la relación existente entre el valor del índice de estado cerebral y la valoración clínica utilizándose diferentes pruebas estadísticas. RESULTADOS: La media de los valores del CSI se comportó entre 48.5 y 50 durante el intraoperatorio y en 95.5 al extubar. Se evidenció que la evaluación clínica de profundidad anestésica mediante la TAM y la FC tienen una alta sensibilidad y valor predictivo positivo corroborada según mediciones del CSI. No se registraron recuerdos intraoperatorios. La recuperación anestésica fue valorada como buena. CONCLUSIONES: La evaluación del estado de profundidad anestésica según los predictores clínicos, muestran una fiabilidad similar a la obtenida mediante la monitorización del índice de Estado Cerebral.

Introduction: The acquired valvular heart diseases have a marked improvement with the surgical treatment; however, may to have a high incidence of intraoperative wake being necessary to monitor the deep anesthesia status by clinical signs assessment or single or computarized electroencephalographic registries. Objectives: To compare the anesthesia depth level by the monitoring of cerebral status and the intraoperative clinical assessment in patients candidates to surgical treatment. Method: A cross-sectional and descriptive study was conducted in 40 patients under general anesthesia. The existing relationship between the value of cerebral status rate and the clinical assessment were compared using different statistic tests. Results: The mean of CSI values was between 48.5 and 50 during the intraoperative period and in 95.5 at extubation. It was evidenced that the clinical assessment of anesthetic depth by the mean arterial tension (MAT) and the heart rate (HR) has a high sensitivity level and positive prediction value corroborated by CSI measurements. There weren't intraoperative recalls. The recovery from anesthesia was assessed as good. Conclusions: The assessment of the anesthesia depth status according to the clinical predictors shows a similar reliability to that obtained by the monitoring of cerebral status rate.

Monitoring on Depth of Anesthesia Basing on ? Rhythm Autocorrelation of EEG Signals / 航天医学与医学工程

Objective To explore the relationship between the depth of anesthesia and the autocorrelation of spontaneous EEG signals,and to find a new indicator which is easily calculated and involves fewer channels of ECG.Methods Eighteen patients with a surgical operation on chest or abdomen under general anesthesia served as the subjects.EEG signals of the patients were recorded.Change of ? rhythm of the EEG signal during general anesthesia was investigated by autocorrelation.Results The changes of autocorrelation indicator in channels Fp1-Cz and Fp2-Cz were obvious and consistent with the process of anesthesia;The changes of autocorrelation kcr in the two observed channels were almost synchronous.Conclusion The autocorrelation indicator kcr may be a new idea and a new tool for monitoring depth of anesthesia with fewer channels and the method will find wide prospect of application in clinic and in related scientific research work.

Correlation between Epidural Depth and Physical Measurements / 대한마취과학회지

BACKGROUND: This study was performed to accurately discover the correlation between the epidural depth and physical measurements. METHODS: We measured the L2-3, L3-4 epidural depth pre-marked on the needle shaft only when the block was successful. Correction of the depth was made by the angulation of the needle from the perpendicular line (with regard to both the x- and y-axis) to the skin. Height and weight from the medical record was noted and neck, waist, and hip circumferences of each subject was measured. Physical parameters such as waist/neck (waist circumference-to-neck circumference ratio), waist/height (waist circumference-to-height ratio), waist/hip (waist circumference-to-hip circumference ratio), weight/neck (weight- to-neck circumference ratio), weight/height (weight-to-height ratio) and body mass index (BMI) were calculated. Peason's correlation and a regression test between the epidural depth and the physical mea surements were performed. RESULTS: Significant correlation with epidural depth was found in weight, waist, hip, neck, BMI, waist/height, waist/hip, weight/neck, and weight/height. With the regression test, we found weight to be the most important for predicting epidural depth (R square = 0.330, P < 0.05). CONCLUSIONS: Weight has the highest predictive value for lumbar epidural depth.

The Effect of Increased Minute Ventilation on the Changes of End-Tidal Isoflurane Concentration and Bispectral Index / 대한마취과학회지

BACKGROUND: An increase in ventilation is known to accelerate the rate of the rise of alveolar concentration of inhalation anesthetics and increase the rate of anesthetic induction. However, it is still debatable whether or not a rise of alveolar isoflurane concentrations by increased minute ventilation (MV) actually increases the depth of anesthesia. METHODS: After anesthetic induction by intravenous thiopental and succinylcholine, and after the bispectral index (BIS) had recovered to 75 after intubation, isoflurane anesthesia was begun (inspired concentration:2 vol.%, respiratory rate:12/min, tidal volume: group I; 8 ml/kg, group II; 12 ml/kg). BIS, spectral edge frequency (SEF), blood pressure, pulse rate were recorded 1 minute before induction, and 1, 2, 3, 4, 5, 7 and 10 minutes after isoflurane anesthesia. End-tidal concentrations of isoflurane and CO2 (ET-iso and -CO2) were recorded at 1, 2, 3, 4, 5, 7 and 10 minutes after isoflurane anesthesia. RESULTS: The increase of ET-iso and the decrease of ET-CO2 were significantly fast in group II. There was no difference in BIS and SEF between the two groups. CONCLUSIONS: Increasing MV induced a rapid rise of alveolar isoflurane concentrations, but changes of BIS and SEF were not affected by increased MV.