Intraoperative Electroencephalography Alpha-Band Power Is a Better Proxy for Preoperative Low MoCA Under Propofol Compared With Sevoflurane.

BACKGROUND: Preoperative abnormal cognitive status is a risk factor for postoperative complications yet remains underdiagnosed. During propofol general anesthesia, intraoperative electroencephalography (EEG) variables, such as alpha band power (α-BP), correlate with cognitive status. This relationship under sevoflurane is unclear. We investigated whether EEG biomarkers of poor cognitive status found under propofol could be extended to sevoflurane. METHODS: In this monocentric prospective observational study, 106 patients with intraoperative EEG monitoring were included (propofol/sevoflurane = 55/51). We administered the Montreal Cognitive Assessment (MoCA) scale to identify abnormal cognition (low MoCA) 1 day before intervention. EEG variables included delta to beta frequency band powers. Results were adjusted to age and drug dosage. We assessed depth of anesthesia (DoA) using the spectral edge frequency (SEF 95 ) and maintained it within (8-13) Hz. RESULTS: The difference in α-BP between low and normal MoCA patients was significantly larger among propofol patients (propofol: 4.3 ± 4.8 dB versus sevoflurane: 1.5 ± 3.4 dB, P = .022). SEF 95 and age were not statistically different between sevoflurane and propofol groups. After adjusting to age and dose, low α-BP was significantly associated with low MoCA under propofol (odds ratio [OR] [confidence interval {CI}] = 0.39 [0.16-0.94], P = .034), but not under sevoflurane, where theta-band power was significantly associated with low MoCA (OR [CI] = 0.31 [0.13-0.73], P = .007). CONCLUSIONS: We suggest that intraoperative EEG biomarkers of abnormal cognition differ between propofol and sevoflurane under general anesthesia.

[Failure factors in X-ray computed tomography-guided biopsy of pulmonary lesions: analysis of 103 consecutive biopsies]. / Facteurs d'échec de la biopsie guidée par tomodensitométrie des lésions pulmonaires: analyse de 103 biopsies consécutives.

OBJECTIVE: Percutaneous biopsy of pulmonary lesions with use of CT-guidance is well established and relatively safe. Reported accuracy rates are 64%-90% and major complications are rare. To determine the failure factors of CT-guided biopsy of lung lesions, we retrospectively analyzed 103 consecutive procedures. MATERIALS AND METHODS: Fourteen characteristics of the biopsy procedure were analyzed, including size, location, skin-lesion and chest wall-lesion distances, operator experience, procedure type (histology and/or cytology), histologic definite diagnosis, and other. RESULTS: Overall success rate was 88%. Success rate was correlated with the size of the lesion 4.3 +/- 2.9 cm for the positive results versus 2 +/- 1.2 cm for the negative results (p < 0.01). Skin- and chest wall-lesion distances were 5.8 +/- 2.2 and 1.5 +/- 1.8 respectively for positive results and 8.3 +/- 2.9 and 3.7 +/- 2.5 for negative results (p < 0.001). The overall complication rate for pneumothorax was 17%. Chest wall-lesion distances were 3.3 +/- 1.8 cm for complicated procedures and 1.5 +/- 1.9 cm for uncomplicated procedures (p < 0.001). No other factor was significantly correlated with the risk of pneumothorax. CONCLUSION: Small lesion size, long skin- and chest wall-lesion distances are significant predictive failure factors. Long chest wall-lesion distance is significantly correlated with the complication rate for pneumothorax.