Journal articles on the topic 'Anesthesia Data processing'
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Junger, A., L. Quinzio, A. Michel, G. Sciuk, C. Fuchs, K. Marquardt, G. Hempelmann, and M. Benson. "Data Processing at the Anesthesia Workstation: from Data Entry to Data Presentation." Methods of Information in Medicine 39, no. 04/05 (2000): 319–24. http://dx.doi.org/10.1055/s-0038-1634450.
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Abstract:Main requirements for an Anesthesia Information Management System (AIMS) are the supply of additional information for the anesthesiologist at his workstation and complete documentation of the anesthetic procedure. With the implementation of an AIMS (NarkoData) and effective user support, the quality of documentation and the information flow at the anesthesia workstation could be increased. Today, more than 20,000 anesthesia procedures are annually recorded with the AIMS at 112 decentralized workstations. The network for data entry and the presentation and evaluation of data, statistics and results directly available at the clinical workstation was made operational.
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MORI, T. "Data-processing for Quality Assurance of Anesthesia Care." JAPANES JOURNAL OF MEDICAL INSTRUMENTATION 63, no. 8 (August 1, 1993): 357–63. http://dx.doi.org/10.4286/ikakikaigaku.63.8_357.
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J. Brown, Michael, Arun Subramanian, Timothy B. Curry, Daryl J. Kor, Steven L. Moran, and Thomas R. Rohleder. "Improving operating room productivity via parallel anesthesia processing." International Journal of Health Care Quality Assurance 27, no. 8 (October 7, 2014): 697–706. http://dx.doi.org/10.1108/ijhcqa-11-2013-0129.
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Purpose – Parallel processing of regional anesthesia may improve operating room (OR) efficiency in patients undergoes upper extremity surgical procedures. The purpose of this paper is to evaluate whether performing regional anesthesia outside the OR in parallel increases total cases per day, improve efficiency and productivity. Design/methodology/approach – Data from all adult patients who underwent regional anesthesia as their primary anesthetic for upper extremity surgery over a one-year period were used to develop a simulation model. The model evaluated pure operating modes of regional anesthesia performed within and outside the OR in a parallel manner. The scenarios were used to evaluate how many surgeries could be completed in a standard work day (555 minutes) and assuming a standard three cases per day, what was the predicted end-of-day time overtime. Findings – Modeling results show that parallel processing of regional anesthesia increases the average cases per day for all surgeons included in the study. The average increase was 0.42 surgeries per day. Where it was assumed that three cases per day would be performed by all surgeons, the days going to overtime was reduced by 43 percent with parallel block. The overtime with parallel anesthesia was also projected to be 40 minutes less per day per surgeon. Research limitations/implications – Key limitations include the assumption that all cases used regional anesthesia in the comparisons. Many days may have both regional and general anesthesia. Also, as a case study, single-center research may limit generalizability. Practical implications – Perioperative care providers should consider parallel administration of regional anesthesia where there is a desire to increase daily upper extremity surgical case capacity. Where there are sufficient resources to do parallel anesthesia processing, efficiency and productivity can be significantly improved. Originality/value – Simulation modeling can be an effective tool to show practice change effects at a system-wide level.
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Fontanini, Alfredo, and James M. Bower. "Variable Coupling Between Olfactory System Activity and Respiration in Ketamine/Xylazine Anesthetized Rats." Journal of Neurophysiology 93, no. 6 (June 2005): 3573–81. http://dx.doi.org/10.1152/jn.01320.2004.
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In this study, we have characterized slow and fast oscillations at several stages of olfactory processing under light and deep ketamine/xylazine anesthesia in the albino rat. While monitoring the animal's respiration, we also obtained field potentials from the olfactory bulb and piriform (olfactory) cortex and simultaneously recorded membrane potentials in piriform cortex pyramidal cells. Our results demonstrate that oscillations are generally found at higher frequencies under lighter and lower frequencies under deeper anesthesia. In previous studies of cerebral cortex, similar results in ketamine/xylazine anesthetized animals have been interpreted to correspond with the higher frequencies found during waking and lower frequencies found in the sleep state. Correlation and coherence analysis between data obtained in the bulb and cortex reveals a clear difference in coupling depending on the anesthetic state of the animal. Specifically, activity recorded in the whole system is highly correlated with respiration during deep anesthesia, whereas only the olfactory bulb, and not the cortex, is correlated with respiration during light anesthesia. These data suggest that global activity in the piriform cortex is actually more directly tied to peripheral slow respiratory input during slow wave than fast wave states and that the coupling between olfactory structures can be dynamically modulated by the level of anesthesia and therefore presumably by different brain states as well.
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Lee, UnCheol, and George A. Mashour. "Role of Network Science in the Study of Anesthetic State Transitions." Anesthesiology 129, no. 5 (November 1, 2018): 1029–44. http://dx.doi.org/10.1097/aln.0000000000002228.
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Abstract The heterogeneity of molecular mechanisms, target neural circuits, and neurophysiologic effects of general anesthetics makes it difficult to develop a reliable and drug-invariant index of general anesthesia. No single brain region or mechanism has been identified as the neural correlate of consciousness, suggesting that consciousness might emerge through complex interactions of spatially and temporally distributed brain functions. The goal of this review article is to introduce the basic concepts of networks and explain why the application of network science to general anesthesia could be a pathway to discover a fundamental mechanism of anesthetic-induced unconsciousness. This article reviews data suggesting that reduced network efficiency, constrained network repertoires, and changes in cortical dynamics create inhospitable conditions for information processing and transfer, which lead to unconsciousness. This review proposes that network science is not just a useful tool but a necessary theoretical framework and method to uncover common principles of anesthetic-induced unconsciousness.
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Plourde, Gilles, Pascal Belin, Daniel Chartrand, Pierre Fiset, Steven B. Backman, Guoming Xie, and Robert J. Zatorre. "Cortical Processing of Complex Auditory Stimuli during Alterations of Consciousness with the General Anesthetic Propofol." Anesthesiology 104, no. 3 (March 1, 2006): 448–57. http://dx.doi.org/10.1097/00000542-200603000-00011.
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Background The extent to which complex auditory stimuli are processed and differentiated during general anesthesia is unknown. The authors used blood oxygenation level-dependent functional magnetic resonance imaging to examine the processing words (10 per period; compared with scrambled words) and nonspeech human vocal sounds (10 per period; compared with environmental sounds) during propofol anesthesia. Methods Seven healthy subjects were tested. Propofol was given by a computer-controlled pump to obtain stable plasma concentrations. Data were acquired during awake baseline, sedation (propofol concentration in arterial plasma: 0.64 +/- 0.13 microg/ml; mean +/- SD), general anesthesia (4.62 +/- 0.57 microg/ml), and recovery. Subjects were asked to memorize the words. Results During all periods including anesthesia, the sounds conditions combined elicited significantly greater activations than silence bilaterally in primary auditory cortices (Heschl gyrus) and adjacent regions within the planum temporale. During sedation and anesthesia, however, the magnitude of the activations was reduced by 40-50% (P < 0.05). Furthermore, anesthesia abolished voice-specific activations seen bilaterally in the superior temporal sulcus during the other periods as well as word-specific activations bilaterally in the Heschl gyrus, planum temporale, and superior temporal gyrus. However, scrambled words paradoxically elicited significantly more activation than normal words bilaterally in planum temporale during anesthesia. Recognition the next day occurred only for words presented during baseline plus recovery and was correlated (P < 0.01) with activity in right and left planum temporale. Conclusions The authors conclude that during anesthesia, the primary and association auditory cortices remain responsive to complex auditory stimuli, but in a nonspecific way such that the ability for higher-level analysis is lost.
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Ranft, Andreas, Daniel Golkowski, Tobias Kiel, Valentin Riedl, Philipp Kohl, Guido Rohrer, Joachim Pientka, et al. "Neural Correlates of Sevoflurane-induced Unconsciousness Identified by Simultaneous Functional Magnetic Resonance Imaging and Electroencephalography." Anesthesiology 125, no. 5 (November 1, 2016): 861–72. http://dx.doi.org/10.1097/aln.0000000000001322.
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Abstract Background The neural correlates of anesthetic-induced unconsciousness have yet to be fully elucidated. Sedative and anesthetic states induced by propofol have been studied extensively, consistently revealing a decrease of frontoparietal and thalamocortical connectivity. There is, however, less understanding of the effects of halogenated ethers on functional brain networks. Methods The authors recorded simultaneous resting-state functional magnetic resonance imaging and electroencephalography in 16 artificially ventilated volunteers during sevoflurane anesthesia at burst suppression and 3 and 2 vol% steady-state concentrations for 700 s each to assess functional connectivity changes compared to wakefulness. Electroencephalographic data were analyzed using symbolic transfer entropy (surrogate of information transfer) and permutation entropy (surrogate of cortical information processing). Functional magnetic resonance imaging data were analyzed by an independent component analysis and a region-of-interest–based analysis. Results Electroencephalographic analysis showed a significant reduction of anterior-to-posterior symbolic transfer entropy and global permutation entropy. At 2 vol% sevoflurane concentrations, frontal and thalamic networks identified by independent component analysis showed significantly reduced within-network connectivity. Primary sensory networks did not show a significant change. At burst suppression, all cortical networks showed significantly reduced functional connectivity. Region-of-interest–based thalamic connectivity at 2 vol% was significantly reduced to frontoparietal and posterior cingulate cortices but not to sensory areas. Conclusions Sevoflurane decreased frontal and thalamocortical connectivity. The changes in blood oxygenation level dependent connectivity were consistent with reduced anterior-to-posterior directed connectivity and reduced cortical information processing. These data advance the understanding of sevoflurane-induced unconsciousness and contribute to a neural basis of electroencephalographic measures that hold promise for intraoperative anesthesia monitoring.
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Pasma, Wietze, Linda M. Peelen, Stef van Buuren, Wilton A. van Klei, and Jurgen C. de Graaff. "Artifact Processing Methods Influence on Intraoperative Hypotension Quantification and Outcome Effect Estimates." Anesthesiology 132, no. 4 (April 1, 2020): 723–37. http://dx.doi.org/10.1097/aln.0000000000003131.
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Abstract Background Physiologic data that is automatically collected during anesthesia is widely used for medical record keeping and clinical research. These data contain artifacts, which are not relevant in clinical care, but may influence research results. The aim of this study was to explore the effect of different methods of filtering and processing artifacts in anesthesiology data on study findings in order to demonstrate the importance of proper artifact filtering. Methods The authors performed a systematic literature search to identify artifact filtering methods. Subsequently, these methods were applied to the data of anesthesia procedures with invasive blood pressure monitoring. Different hypotension measures were calculated (i.e., presence, duration, maximum deviation below threshold, and area under threshold) across different definitions (i.e., thresholds for mean arterial pressure of 50, 60, 65, 70 mmHg). These were then used to estimate the association with postoperative myocardial injury. Results After screening 3,585 papers, the authors included 38 papers that reported artifact filtering methods. The authors applied eight of these methods to the data of 2,988 anesthesia procedures. The occurrence of hypotension (defined with a threshold of 50 mmHg) varied from 24% with a median filter of seven measurements to 55% without an artifact filtering method, and between 76 and 90% with a threshold of 65 mmHg. Standardized odds ratios for presence of hypotension ranged from 1.16 (95% CI, 1.07 to 1.26) to 1.24 (1.14 to 1.34) when hypotension was defined with a threshold of 50 mmHg. Similar variations in standardized odds ratios were found when applying methods to other hypotension measures and definitions. Conclusions The method of artifact filtering can have substantial effects on estimates of hypotension prevalence. The effect on the association between intraoperative hypotension and postoperative myocardial injury was relatively small. Nevertheless, the authors recommend that researchers carefully consider artifacts handling and report the methodology used. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
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Darmayanti, Anita, Oka Yughana, and Bun Yurizali. "The Relationship of Risk Factors With The Incidence Of Postoperative Nausea And Vomiting In Patients who underwent surgery with General Anesthesia at Rsi Siti Rahmah." Science Midwifery 10, no. 4 (October 5, 2022): 3001–10. http://dx.doi.org/10.35335/midwifery.v10i4.739.
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General anesthesia is a medical procedure that aims to relieve pain, lose consciousness, and be predictable. General anesthesia has side effects in the form of PONV which cancause dehydration, electrolyte imbalance, re-open wounds, pulmonary aspiration and delay in discharge from the hospital. To know the characteristics of general anesthesia patients, to know the degree of PONV, and to know the relationship between patient, intraoperative, and postoperative risk factors who experience PONV in patients undergoing surgery under anesthesia general.The type of this research used is analytic observational with a cross-sectional approach. The affordable population in this study were all general anesthesia patients at Siti Rahmah Hospital Padang with 65 samples using a consecutive sampling technique. Analysis of univariate and bivariate data presented in the form of frequency and percentage distributions, data processing using the Kolgomorov Smirnov test statistical test. General anesthesia patients aged 26-35 years (24.6%), female (56.9%), no smoking history (89.2%), surgical oncology (47.7%), 60 minutes duration (67.7%), mild pain (38.5%), opioid use (92.3%). Grade 0 PONV (87.6%). The relationship of risk factors for patients experiencing PONV with age p = 0.288, gender p = 0.997, motion sickness p = 0.443, smoking history p = 0.958. Relationship of intraoperative risk factors for PONV with type of surgery p = 1,000, duration of surgery p = 0,978. The relationship between postoperative risk factors for experiencing PONV with opioid use p = 1,000, pain degree p = 1,000. Most general anesthesia patients were aged 26-35 years, most gender was female, most motion history was no history, most smoking history ie no history, the most type of surgery is oncology, the most duration is 60 minutes, the most opioid use is using, the highest degree of pain is mild.
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Mena Camejo, Dr Reynaldo, Yacnira Martínez Bazán, Dr C. Yurisnel Ortiz Sánchez, and Kenya Dalia Leon Paz. "Determination and calibration in the airway of the Mallampati, Patil-Aldreti tests, sternomentonian distance, interincisive distance." Journal of Anesthesia & Critical Care: Open Access 13, no. 1 (February 15, 2021): 47–53. http://dx.doi.org/10.15406/jaccoa.2021.13.00468.
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An analytical, cross-sectional study was carried out in patients undergoing major elective surgery under general orotracheal anesthesia, at the "Carlos Manuel de Céspedes" University Provincial Hospital of Bayamo, in the period from January to December 2018, with the objective of evaluating the effectiveness of predictive tests of difficult intubation: Mallampati, Patil-Aldreti test, sternomentonian distance, and interincisive distance. For the calculation of the sample, the professional statistical program Epidemiological Analysis of Tabulated Data was applied, resulting in 269 patients, who were selected in the anesthesia office and applied the tests, after signing the informed consent. For the information processing, descriptive and inferential statistics were used. According to the Youden index, the interincisive distance was unsurpassed in effectiveness in all the tests performed, following the sternomentonian distance; The Mallampati test was the one with the lowest predictive value. Combinations of tests can increase the diagnostic value compared to the value of each test alone.
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Kim, Dae Sung, Young Suk Shon, Rim Kyung Hong, Mi Kyung Oh, and Hee Yoon Cho. "Microvascular Changes of the Non-surgical Eye after General Anesthesia in Optical Coherence Tomography Angiography." Journal of the Korean Ophthalmological Society 63, no. 8 (August 15, 2022): 669–81. http://dx.doi.org/10.3341/jkos.2022.63.8.669.
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Purpose: To investigate chorioretinal vascular changes in the non-surgical eyes of patients who underwent vitreoretinal surgery under general anesthesia using optical coherence tomography angiography (OCTA).Methods: Data from 40 patients who underwent retinal surgery were retrospectively analyzed. Ophthalmologic examinations (including OCTA) were performed in the morning before and after surgery. The presence of intraoperative hypotension (IOH; mean arterial pressure <70 mmHg) was determined based on medical records. The vessel density of superficial and deep retinal capillary plexus layers, choriocapillaris void features, and thickness of the choroid and retina were quantified after image processing. Associations between retinal OCTA parameters and anesthesia profiles were also assessed.Results: DCP vessel density was increased after general anesthesia (<i>p</i> < 0.05). Among the patients who experienced IOH, there was no statistical difference in chorioretinal vessel parameters before and after general anesthesia. Also, we did not observe a difference in chorioretinal vessel parameters after general anesthesia between healthy patients and patients with chronic disease, including hypertension and diabetes (<i>p</i> > 0.05). The duration of anesthesia and average size of the choriocapillaris void (<i>p</i> < 0.05, r = -0.32), and the intraoperative mean arterial pressure (MAP) fluctuation and DCP, showed statistically significant negative linear correlations (<i>p</i> < 0.05, r = -0.38). The choriocapillaris void size and intraoperative MAP fluctuation also displayed a significant negative correlation (<i>p</i> < 0.05, r = -0.37), while the average size signal void showed a weak positive linear correlation (<i>p</i> < 0.01, r = 0.41; and <i>p</i> < 0.01, r = 0.44, respectively).Conclusions: This is the first study to assess the effects of general anesthesia on chorioretinal vessels using OCTA. The Vessel density of the DCP was significantly increased in the non-surgical eye after total vitrectomy under general anesthesia. Furthermore, we found a correlation between MAP fluctuation and choriocapillaris void features. More studies are needed to confirm and expand on these observations.
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Burns, Michael L., Michael R. Mathis, John Vandervest, Xinyu Tan, Bo Lu, Douglas A. Colquhoun, Nirav Shah, Sachin Kheterpal, and Leif Saager. "Classification of Current Procedural Terminology Codes from Electronic Health Record Data Using Machine Learning." Anesthesiology 132, no. 4 (April 1, 2020): 738–49. http://dx.doi.org/10.1097/aln.0000000000003150.
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Abstract Background Accurate anesthesiology procedure code data are essential to quality improvement, research, and reimbursement tasks within anesthesiology practices. Advanced data science techniques, including machine learning and natural language processing, offer opportunities to develop classification tools for Current Procedural Terminology codes across anesthesia procedures. Methods Models were created using a Train/Test dataset including 1,164,343 procedures from 16 academic and private hospitals. Five supervised machine learning models were created to classify anesthesiology Current Procedural Terminology codes, with accuracy defined as first choice classification matching the institutional-assigned code existing in the perioperative database. The two best performing models were further refined and tested on a Holdout dataset from a single institution distinct from Train/Test. A tunable confidence parameter was created to identify cases for which models were highly accurate, with the goal of at least 95% accuracy, above the reported 2018 Centers for Medicare and Medicaid Services (Baltimore, Maryland) fee-for-service accuracy. Actual submitted claim data from billing specialists were used as a reference standard. Results Support vector machine and neural network label-embedding attentive models were the best performing models, respectively, demonstrating overall accuracies of 87.9% and 84.2% (single best code), and 96.8% and 94.0% (within top three). Classification accuracy was 96.4% in 47.0% of cases using support vector machine and 94.4% in 62.2% of cases using label-embedding attentive model within the Train/Test dataset. In the Holdout dataset, respective classification accuracies were 93.1% in 58.0% of cases and 95.0% among 62.0%. The most important feature in model training was procedure text. Conclusions Through application of machine learning and natural language processing techniques, highly accurate real-time models were created for anesthesiology Current Procedural Terminology code classification. The increased processing speed and a priori targeted accuracy of this classification approach may provide performance optimization and cost reduction for quality improvement, research, and reimbursement tasks reliant on anesthesiology procedure codes. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
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Yin, Qiang, Dai Shen, and Qian Ding. "Influence of Sliding Time Window Size Selection Based on Heart Rate Variability Signal Analysis on Intelligent Monitoring of Noxious Stimulation under Anesthesia." Neural Plasticity 2021 (June 5, 2021): 1–8. http://dx.doi.org/10.1155/2021/6675052.
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In recent decades, little progress of objective evaluation of pain and noxious stimulation has been achieved under anesthesia. Some researches based on medical signals have failed to provide a general understanding of this problem. This paper presents a feature extraction method for heart rate variability signals, aiming at further improving the evaluation of noxious stimulation. In the process of data processing, the empirical mode decomposition is used to decompose and recombine heart rate variability signals, and the sliding time window approach is used to extract the signal features of noxious stimulation, respectively. The influence of window size on feature extraction is studied by changing the window size. By comparing the results, the feature extraction in the process of data processing is valuable, and the selection of window size has a significant impact. With the increase of selected window sizes, we can get better detection results. But for the best choice of window size, to ensure the accuracy of the results and to make it easy to use, then, we need to get just a suitable window size.
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Pratama, Raditya Ery, and M. Ardian CL. "Correlation between response time and infant outcome in pregnant women with fetal distress undergoing caesarean section in two tertiary hospitals." Majalah Obstetri & Ginekologi 29, no. 1 (April 28, 2021): 1. http://dx.doi.org/10.20473/mog.v29i12021.1-6.
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Objectives: This study aimed to illustrate the response time of pregnant women with fetal distress undergoing caesarean section at dr. Soetomo Hospital and Universitas Airlangga Hospital during 2015-2017.Materials and Methods: This was a non-experimental descriptive observational study using medical records at dr. Soetomo Hospital and Universitas Airlangga Hospital during 2015-2017. Samples of the study were enrolled using total sampling.Results: Data at dr. Soetomo Hospital revealed 103 patients: the age characteristics of >30 year were 48 patients (38%), underlying diseases with hypertension 68 cases (66%), use of general anesthesia with 65 cases (63%). Caesarean section response time >30 minutes was in 85 cases (83%), from which 58 babies (56.3%) had severe asphyxia. At Universitas Airlangga Hospital there were 5 patients, from whom those of 20-30 years were 4 (80%), and those with underlying diseases of hypertension were 3 patients (60%), and those using general anesthesia were 4 (80%). caesarean section response time of >30 minutes were in 3 cases (60%) where all 5 babies (100%) had moderate asphyxia. Age data processing with Chi-square test revealed p = 0.534 (p>0.05), indicating no significant relationship between age group with fetal outcome. Response time of the caesarean section showed p = 0.027 (p<0.05), indicating significant relationship between caesarean section response time and fetal outcome.Conclusion: Response time of pregnant women with fetal distress performed caesarean section at dr. Soetomo Hospital and Universitas Airlangga Hospital period 2015-2017 was still more than 30 minutes and the baby's was found to have moderate-severe asphyxia. These were due to delayed informed consent, patient stabilization, as well as anesthesia, operating room and pediatrics preparation.
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Görges, Matthias, Nicholas C. West, Christian L. Petersen, and J. Mark Ansermino. "Development and Implementation of the Portable Operating Room Tracker App With Vital Signs Streaming Infrastructure: Operational Feasibility Study." JMIR Perioperative Medicine 2, no. 2 (August 5, 2019): e13559. http://dx.doi.org/10.2196/13559.
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Background In the perioperative environment, a multidisciplinary clinical team continually observes and evaluates patient information. However, data availability may be restricted to certain locations, cognitive workload may be high, and team communication may be constrained by availability and priorities. We developed the remote Portable Operating Room Tracker app (the telePORT app) to improve information exchange and communication between anesthesia team members. The telePORT app combines a real-time feed of waveforms and vital signs from the operating rooms with messaging, help request, and reminder features. Objective The aim of this paper is to describe the development of the app and the back-end infrastructure required to extract monitoring data, facilitate data exchange and ensure privacy and safety, which includes results from clinical feasibility testing. Methods telePORT’s client user interface was developed using user-centered design principles and workflow observations. The server architecture involves network-based data extraction and data processing. Baseline user workload was assessed using step counters and communication logs. Clinical feasibility testing analyzed device usage over 11 months. Results telePORT was more commonly used for help requests (approximately 4.5/day) than messaging between team members (approximately 1/day). Passive operating room monitoring was frequently utilized (34% of screen visits). Intermittent loss of wireless connectivity was a major barrier to adoption (decline of 0.3%/day). Conclusions The underlying server infrastructure was repurposed for real-time streaming of vital signs and their collection for research and quality improvement. Day-to-day activities of the anesthesia team can be supported by a mobile app that integrates real-time data from all operating rooms.
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Fontanini, Alfredo, and Donald B. Katz. "Behavioral States, Network States, and Sensory Response Variability." Journal of Neurophysiology 100, no. 3 (September 2008): 1160–68. http://dx.doi.org/10.1152/jn.90592.2008.
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We review data demonstrating that single-neuron sensory responses change with the states of the neural networks (indexed in terms of spectral properties of local field potentials) in which those neurons are embedded. We start with broad network changes—different levels of anesthesia and sleep—and then move to studies demonstrating that the sensory response plasticity associated with attention and experience can also be conceptualized as functions of network state changes. This leads naturally to the recent data that can be interpreted to suggest that even brief experience can change sensory responses via changes in network states and that trial-to-trial variability in sensory responses is a nonrandom function of network fluctuations, as well. We suggest that the CNS may have evolved specifically to deal with stimulus variability and that the coupling with network states may be central to sensory processing.
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Chui, Charles K., Yu-Ting Lin, and Hau-Tieng Wu. "Real-time dynamics acquisition from irregular samples — With application to anesthesia evaluation." Analysis and Applications 14, no. 04 (April 27, 2016): 537–90. http://dx.doi.org/10.1142/s0219530515500165.
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Although most digital representations of information sources are obtained by uniform sampling of some continuous function representations, there are many important events for which only irregular data samples are available, including trading data of the financial market and various clinical data, such as the respiration signals hidden in ECG measurements. For such digital information sources, the only available effective smooth function interpolation scheme for digital-to-analog (D/A) conversion algorithms are mainly for offline applications. Hence, in order to adapt the powerful continuous-function mathematical approaches for real-time applications, it is necessary to introduce an effective D/A conversion scheme as well as to modify the desired continuous-function mathematical method for online implementation. The powerful signal processing tool to be discussed in this paper is the synchrosqueezed continuous wavelet transform (SST), which requires computation of the continuous wavelet transform (CWT), as well as its derivative, of the analog signal of interest. An important application of this transform is to extract information, such as the underlying dynamics, hidden in the signal representation. The first objective of this paper is to introduce a unified approach to remove the two main obstacles for adapting the SST approach to irregular data samples in order to allow online computation. Firstly, for D/A conversion, a real-time algorithm, based on spline functions of arbitrarily desired order, is proposed to interpolate the irregular data samples, while preserving all polynomials of the same spline order, with assured maximum order of approximation. Secondly, for real-time dynamic information extraction from an oscillatory signal via SST, a family of vanishing-moment and minimum-supported spline-wavelets (to be called VM wavelets) are introduced for online computation of the CWT and its derivative. The second objective of this paper is to apply the proposed real-time algorithm and VM wavelets to clinical applications, particularly to the study of the “anesthetic depth” of a patient during surgery, with emphasis on analyzing two dynamic quantities: the “instantaneous frequencies” and the “non-rhythmic to rhythmic ratios” of the patient’s respiration, based on a one-lead electrocardiogram (ECG) signal. Indeed, the “R-peaks” of the ECG signal, which constitute a waveform landmark for clinical evaluation, are non-uniform samples of the respiratory signal. It is envisioned that the proposed algorithm and VM wavelets should enable real-time monitoring of “anesthetic depth”, during surgery, from the respiration signal via ECG measurement.
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Chen, Pei-Fu, Lichin Chen, Yow-Kuan Lin, Guo-Hung Li, Feipei Lai, Cheng-Wei Lu, Chi-Yu Yang, Kuan-Chih Chen, and Tzu-Yu Lin. "Predicting Postoperative Mortality With Deep Neural Networks and Natural Language Processing: Model Development and Validation." JMIR Medical Informatics 10, no. 5 (May 10, 2022): e38241. http://dx.doi.org/10.2196/38241.
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Background Machine learning (ML) achieves better predictions of postoperative mortality than previous prediction tools. Free-text descriptions of the preoperative diagnosis and the planned procedure are available preoperatively. Because reading these descriptions helps anesthesiologists evaluate the risk of the surgery, we hypothesized that deep learning (DL) models with unstructured text could improve postoperative mortality prediction. However, it is challenging to extract meaningful concept embeddings from this unstructured clinical text. Objective This study aims to develop a fusion DL model containing structured and unstructured features to predict the in-hospital 30-day postoperative mortality before surgery. ML models for predicting postoperative mortality using preoperative data with or without free clinical text were assessed. Methods We retrospectively collected preoperative anesthesia assessments, surgical information, and discharge summaries of patients undergoing general and neuraxial anesthesia from electronic health records (EHRs) from 2016 to 2020. We first compared the deep neural network (DNN) with other models using the same input features to demonstrate effectiveness. Then, we combined the DNN model with bidirectional encoder representations from transformers (BERT) to extract information from clinical texts. The effects of adding text information on the model performance were compared using the area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC). Statistical significance was evaluated using P<.05. Results The final cohort contained 121,313 patients who underwent surgeries. A total of 1562 (1.29%) patients died within 30 days of surgery. Our BERT-DNN model achieved the highest AUROC (0.964, 95% CI 0.961-0.967) and AUPRC (0.336, 95% CI 0.276-0.402). The AUROC of the BERT-DNN was significantly higher compared to logistic regression (AUROC=0.952, 95% CI 0.949-0.955) and the American Society of Anesthesiologist Physical Status (ASAPS AUROC=0.892, 95% CI 0.887-0.896) but not significantly higher compared to the DNN (AUROC=0.959, 95% CI 0.956-0.962) and the random forest (AUROC=0.961, 95% CI 0.958-0.964). The AUPRC of the BERT-DNN was significantly higher compared to the DNN (AUPRC=0.319, 95% CI 0.260-0.384), the random forest (AUPRC=0.296, 95% CI 0.239-0.360), logistic regression (AUPRC=0.276, 95% CI 0.220-0.339), and the ASAPS (AUPRC=0.149, 95% CI 0.107-0.203). Conclusions Our BERT-DNN model has an AUPRC significantly higher compared to previously proposed models using no text and an AUROC significantly higher compared to logistic regression and the ASAPS. This technique helps identify patients with higher risk from the surgical description text in EHRs.
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Liu, Xinyue, Jing Ji, and Guo-Qing Zhao. "General anesthesia affecting on developing brain: evidence from animal to clinical research." Journal of Anesthesia 34, no. 5 (June 29, 2020): 765–72. http://dx.doi.org/10.1007/s00540-020-02812-9.
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Abstract As the recent update of General anaesthesia compared to spinal anaesthesia (GAS) studies has been published in 2019, together with other clinical evidence, the human studies provided an overwhelming mixed evidence of an association between anaesthesia exposure in early childhood and later neurodevelopment changes in children. Pre-clinical studies in animals provided strong evidence on how anaesthetic and sedative agents (ASAs) causing neurotoxicity in developing brain and deficits in long-term cognitive functions. However pre-clinical results cannot translate to clinical practice directly. Three well designed large population-based human studies strongly indicated that a single brief exposure to general anesthesia (GAs) is not associated with any long-term neurodevelopment deficits in children’s brain. Multiple exposure might cause decrease in processing speed and motor skills of children. However, the association between GAs and neurodevelopment in children is still inconclusive. More clinical studies with larger scale observations, randomized trials with longer duration exposure of GAs and follow-ups, more sensitive outcome measurements, and strict confounder controls are needed in the future to provide more conclusive and informative data. New research area has been developed to contribute in finding solutions for clinical practice as attenuating the neurotoxic effect of ASAs. Xenon and Dexmedetomidine are already used in clinical setting as neuroprotection and anaesthetic sparing-effect, but more research is still needed.
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Godbersen, Godber S., Johannes Schneider-Littfeld, Jochen A. Werner, Sönke Wolters, and Axel Pellner. "Soft Palate Reflex: Technical Requirements and First Results." Cleft Palate-Craniofacial Journal 29, no. 4 (July 1992): 340–45. http://dx.doi.org/10.1597/1545-1569_1992_029_0340_sprtra_2.3.co_2.
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The present study describes technical prerequisites for soft palate reflex measurements and first results. Reflex measurements can be done using standard electromyographic methods. The data-processing system that records and processes the electromyographic signals was activated when the soft palate was stimulated by a newly developed device. The first results of objective soft palate reflex measurements in 15 healthy subjects show that the musculus levator veli palatini reacts to a mechanical stimulation of the soft palate with a contraction that can be measured electromyographicslly. The response latencies were constant in the individual subjects. In 12 subjects a minimum of 30 ms and a maximum of 61 ms was recorded. In one healthy subject, the reflex was activated only after 167 ms. No reflex could be evoked in two subjects. The stimulus was always supraliminal. Reaction time was longer following surface anesthesia of the oral mucosa.
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Turovets, M. I., P. V. Mozgovoy, A. V. Ekstrem, S. M. Slakhter, and A. V. Lopushkov. "PREVENTION OF SHORT-TERM COMPLICATIONS FOR OFF-PUMP CORONARY ARTERY BYPASS GRAFTING IN PATIENTS WITH DIABETES MELLITUS." Journal of Volgograd State Medical University 75, no. 3 (September 30, 2020): 39–45. http://dx.doi.org/10.19163/1994-9480-2020-3(75)-39-45.
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Diabetes mellitus is an independent risk factor for the development of early postoperative complications in coronary artery bypass grafting without cardiopulmonary bypass (off-pump CABG). A comparative analysis of early postoperative complications for off-pump CABG in patients with diabetes mellitus was made. A randomized study of the results of surgical treatment of patients with coronary heart disease who underwent coronary artery bypass grafting of 2 or more branches of the coronary arteries without the use of cardiopulmonary bypass included 191 patients. In patients of the main group (n = 32), the comorbid background was complicated by diabetes; in patients in the control group (n = 159), this disease was not detected. For statistical processing of the obtained data, nonparametric criteria were used (Fisher test and relative risk (RR) with a 95% confidence interval (CI)). It is proved that in patients of the main group (with diabetes) the relative risk of developing postoperative complications (acute myocardial infarction, pneumonia, acute renal failure, multiple organ failure syndrome, etc.) is significantly higher than in patients in the control group (RR = 1.36–4.97). The use of combined anesthesia (with prolonged thoracic epidural analgesia) allowed patients of both groups to significantly reduce the risk of developing clinically significant complications (RR = 0.26–0.78). Performing off-pump CABG in patients with diabetes is associated with a significant increase in the risk of postoperative complications, and the use of combined anesthesia effectively reduces the risk of their development in patients of this category.
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Chery, Romain, Hirac Gurden, and Claire Martin. "Anesthetic regimes modulate the temporal dynamics of local field potential in the mouse olfactory bulb." Journal of Neurophysiology 111, no. 5 (March 1, 2014): 908–17. http://dx.doi.org/10.1152/jn.00261.2013.
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Anesthetized preparations have been widely used to study odor-induced temporal dynamics in the olfactory bulb. Although numerous recent data of single-cell recording or imaging in the olfactory bulb have employed ketamine cocktails, their effects on networks activities are still poorly understood, and odor-induced oscillations of the local field potential have not been characterized under these anesthetics. Our study aimed at describing the impact of two ketamine cocktails on oscillations and comparing them to awake condition. Anesthesia was induced by injection of a cocktail of ketamine, an antagonist of the N-methyl-d-aspartate receptors, combined with one agonist of α2-adrenergic receptors, xylazine (low affinity) or medetomidine (high affinity). Spontaneous and odor-induced activities were examined in anesthetized and awake conditions, in the same mice chronically implanted with an electrode in the main olfactory bulb. The overall dynamic pattern of oscillations under the two ketamine cocktails resembles that of the awake state. Ongoing activity is characterized by gamma bursts (>60 Hz) locked on respiration and beta (15–40 Hz) power increases during odor stimulation. However, anesthesia decreases local field potential power and leads to a strong frequency shift of gamma oscillations from 60–90 Hz to 100–130 Hz. We conclude that similarities between oscillations in anesthetized and awake states make cocktails of ketamine with one α2-agonist suitable for the recordings of local field potential to study processing in the early stages of the olfactory system.
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Suslin, Sergei A., Aleksandr V. Vavilov, Rufiya I. Ginnyatulina, Vasilii V. Pavlov, and Pavel V. Timyashev. "Medical and sociological characteristics of planned hospitalization." Science and Innovations in Medicine 5, no. 2 (June 15, 2020): 119–23. http://dx.doi.org/10.35693/2500-1388-2020-5-2-119-123.
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Objectives - to study the patients' opinions on the organization of planned admission to the city multidisciplinary hospital. Materials and methods. An anonymous survey of 320 inpatients hospitalized on the scheduled basis to Samara City Hospital No. 1 was carried out according to a specially developed program. Statistical, analytical and sociological research methods were used in data collection and processing. Results. The vast majority of patients (96.0%) expected the inpatient care for two weeks. On average, 55-60% of respondents were fully informed and 25-30% were partially informed about various aspects of their state of health at different stages of planned hospitalization. Conclusion. The majority of patients (76.3%) were completely satisfied with the inpatient treatment, 21.8% were partially satisfied and less than 2% were not satisfied with the treatment. From the point of view of the respondents, the important parameters of the provision of inpatient care were: staff qualification, anesthesia, absence of complications, recovery, diagnosis accuracy, etc.
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Ota, Kouichi, Tadao Yanagidani, Kazuhiro Kishikawa, Yuji Yamamori, and J. G. Collins. "Cutaneous Responsiveness of Lumbar Spinal Dorsal Horn Neurons Is Reduced by General Anesthesia, An Effect Dependent in Part on GABAA Mechanisms." Journal of Neurophysiology 80, no. 3 (September 1, 1998): 1383–90. http://dx.doi.org/10.1152/jn.1998.80.3.1383.
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Ota, Kouichi, Tadao Yanagidani, Kazuhiro Kishikawa, Yuji Yamamori, and J. G. Collins. Cutaneous responsiveness of lumbar spinal dorsal horn neurons is reduced by general anesthesia, an effect dependent in part on GABAA mechanisms. J. Neurophysiol. 80: 1383–1390, 1998. Extracellular activity was recorded from single spinal dorsal horn neurons in both chronic cat and acute rat models. This was done to define the effects of anesthesia on the processing of sensory information elicited by nonnoxious tactile stimulation of peripheral receptive fields (RFs). In the chronic cat model, baseline data were obtained in physiologically intact, awake, drug-free animals before anesthetic administration (halothane 1.0–2.0%). This made it possible to compare and contrast activity of each cell in the drug-free and anesthetized state. Halothane effects were confirmed in the acute rat model (anesthetized, spinally transected, and in some cases decerebrate). In addition, the γ-aminobutyic acid-A (GABAA)-receptor antagonist picrotoxin (2 mg/kg) was administered intravenously to verify that the observed halothane effect on spinal dorsal horn neurons was mediated by an interaction with GABAA-receptor systems. Halothane effects on three separate measures of response to nonnoxious tactile stimuli were observed in the chronic cat model. Halothane produced a significant, dose-dependent reduction in the low-threshold RF area of the neurons studied. Halothane also caused a significant reduction in neuronal response to RF brushing (dynamic stimulus) and to maintained contact with the RF (static stimulus). A dose dependency was not observed with these latter two effects. Neurons with a predominant rapidly adapting response seemed to be less susceptible to halothane suppression than slowly adapting cells. In the acute rat model an increase in halothane caused a reduction in neuronal response similar to that seen in the cat. The intravenous administration of 2 mg/kg of picrotoxin by itself caused no significant change in RF size or response to brushing. However, the same amount of picrotoxin did cause a 50% reversal of the halothane-induced reduction in RF size without causing a significant change in the halothane effect on response to RF brushing. In contrast to work recently reported in a chronic sheep model, halothane causes a significant reduction in spinal dorsal horn neuronal response to tactile stimulation of peripheral RFs. This effect is caused by, in part, but not exclusively, to GABAA-neurotransmitter systems. However, the relative influence of GABAA systems may vary with the nature of the stimulus.
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Slavkovic, Nemanja, Zoran Vukasinovic, and Slobodan Slavkovic. "Factors influencing the development of avascular necrosis in non-operative treatment of the acute slipped capital femoral epiphysis." Srpski arhiv za celokupno lekarstvo 135, no. 1-2 (2007): 54–60. http://dx.doi.org/10.2298/sarh0702054s.
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Introduction: The acute slipped capital femoral epiphysis can result in development of avascular necrosis of the femoral head which is very difficult condition to treat. Orthopedic surgeon can influence the development of avascular necrosis. Objective The main objective in our study was to identify factors influencing the development of avascular necrosis in nonoperative treated patients for the acute slipped capital femoral epiphysis. Method A total of 53 patients and 59 hips treated for the acute slipped capital femoral epiphysis at the Institute for Orthopedic Surgery "Banjica" between 1968-2004 were studied. Necessary data were obtained from the accurate medical records. Results Avascular necrosis of the femoral head was diagnosed in 8 patients (13.56%). Six of them (75%) were treated by manipulative reduction in general anesthesia and spica cast immobilization. Fischer test, used for statistical data processing, found significant difference between two non-operative methods of treatment (p=0.0008). Conclusion Higher-degree epihyseal displacement as well as complete separation of the physis and metaphysis were found to be the risk factors of avascular necrosis. Every manipulation with the affected hip was also associated with higher percentage of avascular necrosis of the femoral head.
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Smith, Michael P., Warren S. Sandberg, Joseph Foss, Kathleen Massoli, Mona Kanda, Wael Barsoum, and Armin Schubert. "High-throughput Operating Room System for Joint Arthroplasties Durably Outperforms Routine Processes." Anesthesiology 109, no. 1 (July 1, 2008): 25–35. http://dx.doi.org/10.1097/aln.0b013e31817881c7.
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Background Recent publications have focused on increased operating room (OR) throughput without increasing total OR time. The authors hypothesized that a system of parallel processing for lower extremity joint arthroplasties sustainably reduces nonoperative time and increases throughput. Methods The high-throughput parallel processing strategy included neuraxial anesthesia performed in an "induction room" adjacent to the OR, patient selection, an additional circulating nurse, and end-of-case transfer of care to a recovery room nurse who transported the patient from the OR to recovery. Instruments and supplies were prepared in a dedicated sterile setup area. Data were extracted from administrative databases. Group comparisons used standard statistical methods; statistical process control was used to evaluate performance over time. Results There were 688 historic control cases from 299 days over 16 months, and 905 high-throughput cases from 304 days spanning 24 consecutive months starting September 1, 2004. Throughput increased from 2.6 +/- 0.7 (mean +/- SD) to 3.4 +/- 0.8 arthroplasties per day per room. Nonoperative time decreased by 36 min (or 50%) per case. Operative time also decreased by 14 min (12%) per case. The end time for the high-throughput OR day was only 16 min later than control. Nonoperative time, operative time, and throughput remained significantly improved after 2 yr of operation. Contribution margin increased 19.6%. Conclusion Reorganizing the perioperative work process for total joint replacements sustainably increased OR throughput. Because joint arthroplasties generated a positive margin greater than the incremental cost, the high-throughput system improved financial performance.
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Tao, Feng, Qiang Chen, Yuko Sato, John Skinner, Pei Tang, and Roger A. Johns. "Inhalational Anesthetics Disrupt Postsynaptic Density Protein-95, Drosophila Disc Large Tumor Suppressor, and Zonula Occludens-1 Domain Protein Interactions Critical to Action of Several Excitatory Receptor Channels Related to Anesthesia." Anesthesiology 122, no. 4 (April 1, 2015): 776–86. http://dx.doi.org/10.1097/aln.0000000000000609.
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Abstract Background: The authors have shown previously that inhaled anesthetics disrupt the interaction between the second postsynaptic density protein-95, Drosophila disc large tumor suppressor, and zonula occludens-1 (PDZ) domain of postsynaptic density protein-95 (PSD-95) and the C-terminus of N-methyl-d-aspartate receptor subunits NR2A and NR2B. The study data indicate that PDZ domains may serve as a molecular target for inhaled anesthetics. However, the underlying molecular mechanisms remain to be illustrated. Methods: Glutathione S-transferase pull-down assay, coimmunoprecipitation, and yeast two-hybrid analysis were used to assess PDZ domain–mediated protein–protein interactions in different conditions. Nuclear magnetic resonance spectroscopy was used to investigate isoflurane-induced chemical shift changes in the PDZ1–3 domains of PSD-95. A surface plasmon resonance–based BIAcore (Sweden) assay was used to examine the ability of isoflurane to inhibit the PDZ domain–mediated protein–protein interactions in real time. Results: Halothane and isoflurane dose-dependently inhibited PDZ domain–mediated interactions between PSD-95 and Shaker-type potassium channel Kv1.4 and between α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor subunit GluA2 and its interacting proteins—glutamate receptor–interacting protein or protein interacting with c kinase 1. However, halothane and isoflurane had no effect on PDZ domain–mediated interactions between γ-aminobutyric acid type B receptor and its interacting proteins. The inhaled anesthetic isoflurane mostly affected the residues close to or in the peptide-binding groove of PSD-95 PDZ1 and PDZ2 (especially PDZ2), while barely affecting the peptide-binding groove of PSD-95 PDZ3. Conclusion: These results suggest that inhaled anesthetics interfere with PDZ domain–mediated protein–protein interactions at several receptors important to neuronal excitation, anesthesia, and pain processing.
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Choi, Byung-Moon, Ji Yeon Yim, Hangsik Shin, and Gyujeong Noh. "Novel Analgesic Index for Postoperative Pain Assessment Based on a Photoplethysmographic Spectrogram and Convolutional Neural Network: Observational Study." Journal of Medical Internet Research 23, no. 2 (February 3, 2021): e23920. http://dx.doi.org/10.2196/23920.
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Background Although commercially available analgesic indices based on biosignal processing have been used to quantify nociception during general anesthesia, their performance is low in conscious patients. Therefore, there is a need to develop a new analgesic index with improved performance to quantify postoperative pain in conscious patients. Objective This study aimed to develop a new analgesic index using photoplethysmogram (PPG) spectrograms and a convolutional neural network (CNN) to objectively assess pain in conscious patients. Methods PPGs were obtained from a group of surgical patients for 6 minutes both in the absence (preoperatively) and in the presence (postoperatively) of pain. Then, the PPG data of the latter 5 minutes were used for analysis. Based on the PPGs and a CNN, we developed a spectrogram–CNN index for pain assessment. The area under the curve (AUC) of the receiver-operating characteristic curve was measured to evaluate the performance of the 2 indices. Results PPGs from 100 patients were used to develop the spectrogram–CNN index. When there was pain, the mean (95% CI) spectrogram–CNN index value increased significantly—baseline: 28.5 (24.2-30.7) versus recovery area: 65.7 (60.5-68.3); P<.01. The AUC and balanced accuracy were 0.76 and 71.4%, respectively. The spectrogram–CNN index cutoff value for detecting pain was 48, with a sensitivity of 68.3% and specificity of 73.8%. Conclusions Although there were limitations to the study design, we confirmed that the spectrogram–CNN index can efficiently detect postoperative pain in conscious patients. Further studies are required to assess the spectrogram–CNN index’s feasibility and prevent overfitting to various populations, including patients under general anesthesia. Trial Registration Clinical Research Information Service KCT0002080; https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=6638
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Usenko, A. Yu, A. V. Skums, and A. A. Skums. "Implementation of an accelerated recovery program for pancreatoduodenectomy." Reports of Vinnytsia National Medical University 24, no. 2 (December 13, 2020): 286–91. http://dx.doi.org/10.31393/reports-vnmedical-2020-24(2)-15.
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Annotation. A number of issues concerning the practical application of the program of accelerated recovery of patients after surgery without compromising their safety remain debatable. The purpose of this study was to assess the feasibility of ERAS program for patients who undergo pancreatoduodenectomy (PD) and its impact on postoperative results. The study included 60 patients from 28 to 75 years old with benign and malignant pathologies of the pancreas and ampullary region, in which PD was performed between January 2015 and December 2018. The preoperative components of ERAS program were fulfilled in all patients. Mathematical data processing was performed using the software Statistica 64 ver. 10.0.1011.0 (StatSoft Inc.). All intraoperative components were implemented (100%) (except for epidural anesthesia – 85%). Postoperative components of ERAS program were implemented in the range from 56.7% to 100%. There was no postoperative mortality. Complications were observed in 16 (26.7%) patients in whom total number of complications was 22. The average duration of hospital stay after surgery was 13.1±4.1 days. The most of components of ERAS program for PD patients can be successfully implemented, decreasing the lengths of hospital stay without increase in number of postoperative complications.
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Owen, Medge D., Sibel Gürün, Gary P. Zaloga, and William R. Millington. "Glycyl-l-glutamine [β-endorphin-(30—31)] attenuates hemorrhagic hypotension in conscious rats." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 273, no. 5 (November 1, 1997): R1598—R1606. http://dx.doi.org/10.1152/ajpregu.1997.273.5.r1598.
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The profound hypotension caused by acute hemorrhage is thought to involve opioid peptide neurons. In this study, we tested whether glycyl-l-glutamine [Gly-Gln; β-endorphin-(30—31)], a nonopioid peptide derived from β-endorphin processing, prevents the cardiovascular depression induced by hemorrhage in conscious and anesthetized rats. Previously, we found that Gly-Gln inhibits the hypotension and respiratory depression produced by β-endorphin and morphine but does not affect opioid antinociception. Hemorrhage (2.5 ml/100 g body wt over 20 min) lowered arterial pressure in conscious rats (from 120.1 ± 2.9 to 56.2 ± 4.7 mmHg) but did not change heart rate significantly. Intracerebroventricular Gly-Gln (3, 10, or 30 nmol) pretreatment inhibited the fall in arterial pressure and increased heart rate significantly. The response was dose related and was sustained during the 35-min posthemorrhage interval. Pentobarbital sodium anesthesia potentiated the hemodynamic response to hemorrhage and attenuated the effect of Gly-Gln. Gly-Gln (10 or 100 nmol icv) did not influence arterial pressure or heart rate in normotensive rats. These data indicate that Gly-Gln is an effective antagonist of hemorrhagic hypotension.
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Smolin, N. S., K. N. Khrapov, and V. M. Miroshkina. "Epidural Analgesia as a Part of Combined Anesthesia during Abdominal Oncological Surgeries (Results of the Survey among the Russian Anesthesiologists and Resuscitators)." Messenger of ANESTHESIOLOGY AND RESUSCITATION 19, no. 4 (August 31, 2022): 61–68. http://dx.doi.org/10.21292/2078-5658-2022-19-4-61-68.
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The objective: to analyze the contemporary specific parameters of intraoperative management of epidural analgesia (EA) in combined anesthesia in abdominal oncological surgeries in different medical organizations of Russia.Subjects and Methods. The data necessary for analysis and statistical processing were obtained by developing a formalized questionnaire (21 questions, some of which with the possibility of choosing several answers at the same time – multiple choice), published on the official website of the Association of Anesthesiologists-Resuscitators (https://association-ar.ru/). The survey lasted for 16 days (from May 23, 2022 to June 7, 2022). The survey results were collected using the Google Forms online service and processed using the Google Spreadsheets. Multiple choice responses were processed as absolute numbers and presented as a percentage of the total number of responses to a particular question.Results. The total number of respondents who took part in the survey was 217 specialists from various medical organizations, mostly from the North-Western Federal District of the Russian Federation (34.1%) with more than 15 years of expertise in the specialty (44.7%). According to the survey results, the following specific features of EA during combined anesthesia practice in Russia have been identified: most participants perform EA in the sitting position (63.6%); ropivacaine is the drug of choice among local anesthetics (LA) (84.2%); as a rule, EA is initiated prior to incision (69.6%). During open surgical interventions, 44.7% use a combined EA method (continuous infusion and bolus injection – bolus-based mode), while during laparoscopic surgeries there is no preferred method (combined method – 33.1%; continuous infusion only – 35.5%; bolus injection only – 31.4%). Low concentrations of LA (0.2 ‒ 0.375%) combined with a low volume of administration (4‒10 ml for bolus, 4‒8 ml/h for infusion) are used more often both in open and laparoscopic surgeries. In most cases, achievement of effective EA is supported by lower doses of systemic opioid analgesics (65.4%). Insufficient degree of intraoperative analgesia is managed in different ways, such as using systemic opioids (68.7%), enhancing epidural analgesia (17.5%), and administration of non-opioid analgesics (13.8%).Conclusion. At present, there is no unified approach to the method of EA in combined anesthesia. The results of the survey showed the uncertainty of experts' opinions regarding the choice of LA concentrations for EA, the rate and volume of its administration into the epidural space. Finding the optimal method of intraoperative EA in abdominal oncological surgery is the most important clinical objective in terms of reducing perioperative complications.
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Imanniarti, Yuni. "Design of Post Operation Recovery Room Control System Based on Wireless Sensor Network." Jurnal Jartel: Jurnal Jaringan Telekomunikasi 8, no. 1 (March 1, 2019): 32–40. http://dx.doi.org/10.33795/jartel.v8i1.157.
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The recovery room is a room in hospital, where patients are treated after they have undergone surgical operations and recovered from the effects of anesthesia. In recovery room, patients really need a comfort so that they don't experience physical and psychological stress too much. Comfort for everyone is different, but there are several factors that can make the room more comfortable. Therefore, it will take parameters for this research, namely temperature, humidity and lighting.In this study, we will discuss how to design a wireless sensor network system for controlling the recovery room after cesarean operation and how to test sensors on this system and how to display processing result data to a smartphone.This research will explain about the system description of room temperature and humidity, UV light and room light intensity based on wireless sensor network using 2 types of nodes, namely sink nodes and control sensor nodes and using the HC-12 wireless module as data sender and receiver between nodes. The data taken is related to the measurement result information data that will be accessed and displayed via Android application in realtime.From the system designed, the error value is obtained with an average temperature value on R1 of 1.16%, R2 is 2.64% and R3 is 5.36%, while for the humidity value on R1 is 3.70%, R2 is 9, 32% and R3 10.54%. For testing the communication distance of 10m, the delay value without barrier is 60 seconds, while with barrier, the delay value is 97 seconds.
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McCormick, Patrick J., Michael J. Schoene, Matthew A. Dehmler, and Gerald McDonnell. "Moist Heat Disinfection and Revisiting the A0 Concept." Biomedical Instrumentation & Technology 50, s3 (April 1, 2016): 19–26. http://dx.doi.org/10.2345/0899-8205-50.s3.19.
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Moist heat is employed in the medical device, pharmaceutical, and food processing industries to render products and goods safe for use and human consumption. Applications include its use to pasteurize a broad range of foods and beverages, the control of microbial contamination of blood products, and treatment of bone tissue transplants and vaccines. In the pharmaceutical industry, water heated to 65°C to 80°C is used to sanitize high-purity water systems. In healthcare, it has been employed for decades to disinfect patient care items ranging from bedpans to anesthesia equipment. There is a good understanding of the conditions necessary to achieve disinfection of microorganisms at temperatures ranging from 65°C to 100°C. Based on this information, the efficacy of moist heat processes at a range of exposure times and temperatures can be quantified based on mathematical models such as the A0 calculation. While the A0 concept is recognized within the European healthcare community, it has yet to be widely adopted within the United States. This article provides information regarding the A0 concept, a brief overview of the classification of thermal disinfection for use with healthcare applications within the United States, and recent data on reinvestigating the thermal disinfection of a selected panel of microorganisms and a mixed culture biofilm.
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Mykhailevych, M. Yu, and V. F. Makeev. "INTEGRATED EVALUATION OF ANAMNESTIC DATA IN THE DIFFERENTIAL DIAGNOSIS OF TEMPOROMANDIBULAR DISORDERS AND DISEASES THAT AFFECT THEM." Ukrainian Dental Almanac, no. 1 (March 23, 2021): 41–51. http://dx.doi.org/10.31718/2409-0255.1.2021.07.
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In modern dentistry, temporomandibular disorders (TMD) are the third most common dental disease after caries, its complications and periodontal pathology. Despite the fact that a significant amount of research has been devoted to this problem, the etiology and pathogenesis have still not fully derermined.
The aim is to carry out an integrated assessment of anamnestic data in the differential diagnosis of temporomandibular disorders and diseases that affect them and to determine their clinical significance in the diagnosis.
Material and methods. 178 patients with suspected temporomandibular disorders were examined who were referred by other medical institutions in Lviv, Lviv region and other regions of Ukraine to the Department of Orthopedic Dentistry of Danylo Halytsky Lviv National Medical University aged 9 to 76 years. 142 female patients and 36 male ones were involved in this examination. During clinical examination and processing of the obtained material, it was identified a number of factors that could affect the occurrence of myogenic, arthrogenic, combined and affected disorders.
Results. During clinical examination and processing of the obtained material, a number of factors that could affect the appearance of arthrogenic disorders have been identified. During the method of logistic regression, 13 factors were singled out from among them, which, when combined, have a probable influence on the development of this disorder. Only two of them have a preventive effect (their presence reduces the patient’s risk of arthrogenic TMD): hypermobility of all joints and pain on palpation of the muscles. All other 11 factors have a provocative effect - if they are present, the patient has an increased risk of arthrogenic TMD. Similarly, 11 factors have been identified that, when combined, have a probable effect on the development of myogenic disorder. The values of their regression coefficients are given in table 3. From 11 ones, only three have a preventive effect (their presence reduces the patient’s risk of myogenic TMD): exercise, intubation anesthesia over the past year and a history of rheumatism. All other eight factors have a provocative effect - if they are present, the patient increases the risk of myogenic TMD. Similarly, 17 factors have been identified that, when combined, have a likely impact on the development of a combined disorder. From these 17 factors, only two have a preventive effect (their presence reduces the patient’s risk of combined TMD): exercise and a past history of rheumatism. Other 15 factors have a provocative effect - if they are present, the patient increases the risk of combined TMD. Similarly, 13 factors were identified that, when combined, have a likely impact on the development of this affected disorder. The values of their regression coefficients are given in table 5. From these 13 factors have been analyzed, five ones have a preventive effect (their presence reduces the patient’s risk of affected TMD): limited mouth opening; crunch, click or crepitation on auscultation of the joints; and pain on palpation of the muscles. All other eight factors have a provocative effect - during their presence, the patient increases the risk of affected TMD. Using the method of logistic regression, it has been identified a number of factors that, when they were combined, affect the development of these disorders. It will increase the efficiency of diagnosis of temporomandibular disorders by substantiating clinical and diagnostic criteria and the development of diagnostic complexes in the diagnosis of TMD.
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Belinskyi, A. V., L. V. Rasputina, Y. M. Mostovoy, O. P. Mostova, and T. D. Danilevych. "Cognitive disorders in patients after cardiac surgery." Biomedical and Biosocial Anthropology, no. 40 (November 27, 2021): 26–32. http://dx.doi.org/10.31393/bba40-2020-04.
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The occurrence of cognitive disorders is a common problem after surgery. The degree of worsening of cognitive functions after surgery and anesthesia has a significant impact on the patient's health and is significantly associated with prolonged recovery in the hospital, increased morbidity and delayed functional recovery. The aim of the study was to increase the effectiveness of the diagnosis of moderate cognitive impairment and to determine its gender and age characteristics in patients before and after cardiac surgery in the early postoperative period (3 and 7 days). We examined 56 patients who underwent cardiac surgery for coronary heart disease in 37 (66.1 %) and valvular heart defects in 19 (33.9 %) patients. Assessment of cognitive functions was performed before surgery, on the 3rd and 7th day of the postoperative period. Testing was performed using the Montreal Cognitive Test. Statistical processing of the obtained data was performed on a personal computer using the statistical software package SPSS 12.0 for Windows using parametric and non-parametric methods. It was found that presence of cognitive disorders before surgery was registered in 37 (66.1 %) patients, mostly among the age of group of 60-74 years and had no gender difference. It was found that in the early postoperative period there is a significant worsening of cognitive functions in patients after cardiac surgery on 3rd day – in 45 (80.4 %), on 7th day – in 44 (78.6 %) patients, respectively.
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Jouret, François, Stéphan Walrand, Kleber S. Parreira, Pierre J. Courtoy, Stanislas Pauwels, Olivier Devuyst, and François Jamar. "Single photon emission-computed tomography (SPECT) for functional investigation of the proximal tubule in conscious mice." American Journal of Physiology-Renal Physiology 298, no. 2 (February 2010): F454—F460. http://dx.doi.org/10.1152/ajprenal.00413.2009.
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Noninvasive analysis of renal function in conscious mice is necessary to optimize the use of mouse models. In this study, we evaluated whether single photon emission-computed tomography (SPECT) using specific radionuclear tracers can be used to analyze changes in renal proximal tubule functions. The tracers included 99mTC- dimercaptosuccinic acid (99mTc-DMSA), which is used for cortex imaging; 99mTc-mercaptoacetyltriglycine (99mTc-MAG3), used for dynamic renography; and 123I-β2-microglobulin, which monitors receptor-mediated endocytosis. 99mTc-DMSA SPECT imaging was shown to delineate the functional renal cortex with a ∼1-mm spatial resolution and accumulated in the cortex reaching a plateau 5 h after injection. The cortical uptake of 99mTc-DMSA was abolished in Clcn5 knockout mice, a model of proximal tubule dysfunction. Dynamic renography with 99mTc-MAG3 in conscious mice demonstrated rapid extraction from blood, renal accumulation, and subsequent tubular secretion. Anesthesia induced a significant delay in the 99mTc-MAG3 clearance. The tubular reabsorption of 123I-β2-microglobulin was strongly impaired in the Clcn5 knockout mice, with defective tubular processing and loss of the native tracer in urine, reflecting proximal tubule dysfunction. Longitudinal studies in a model of cisplatin-induced acute tubular injury revealed a correlation between tubular recovery and 123I-β2-microglobulin uptake. These data show that SPECT imaging with well-validated radiotracers allows in vivo investigations of specific proximal tubule functions in conscious mice.
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Bielohuby, Maximilian, Martin Bidlingmaier, and Uwe Schwahn. "Control of (pre)-analytical aspects in immunoassay measurements of metabolic hormones in rodents." Endocrine Connections 7, no. 4 (April 2018): R147—R159. http://dx.doi.org/10.1530/ec-18-0035.
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The measurement of circulating hormones by immunoassay remains a cornerstone in preclinical endocrine research. For scientists conducting and interpreting immunoassay measurements of rodent samples, the paramount aim usually is to obtain reliable and meaningful measurement data in order to draw conclusions on biological processes. However, the biological variability between samples is not the only variable affecting the readout of an immunoassay measurement and a considerable amount of unwanted or unintended variability can be quickly introduced during the pre-analytical and analytical phase. This review aims to increase the awareness for the factors ‘pre-analytical’ and ‘analytical’ variability particularly in the context of immunoassay measurement of circulating metabolic hormones in rodent samples. In addition, guidance is provided how to gain control over these variables and how to avoid common pitfalls associated with sample collection, processing, storage and measurement. Furthermore, recommendations are given on how to perform a basic validation of novel single and multiplex immunoassays for the measurement of metabolic hormones in rodents. Finally, practical examples from immunoassay measurements of plasma insulin in mice address the factors ‘sampling site and inhalation anesthesia’ as frequent sources of introducing an unwanted variability during the pre-analytical phase. The knowledge about the influence of both types of variability on the immunoassay measurement of circulating hormones as well as strategies to control these variables are crucial, on the one hand, for planning and realization of metabolic rodent studies and, on the other hand, for the generation and interpretation of meaningful immunoassay data from rodent samples.
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Lee, Hyung-Chul, Hyun-Kyu Yoon, Karam Nam, Youn Cho, Tae Kim, Won Kim, and Jae-Hyon Bahk. "Derivation and Validation of Machine Learning Approaches to Predict Acute Kidney Injury after Cardiac Surgery." Journal of Clinical Medicine 7, no. 10 (October 3, 2018): 322. http://dx.doi.org/10.3390/jcm7100322.
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Machine learning approaches were introduced for better or comparable predictive ability than statistical analysis to predict postoperative outcomes. We sought to compare the performance of machine learning approaches with that of logistic regression analysis to predict acute kidney injury after cardiac surgery. We retrospectively reviewed 2010 patients who underwent open heart surgery and thoracic aortic surgery. Baseline medical condition, intraoperative anesthesia, and surgery-related data were obtained. The primary outcome was postoperative acute kidney injury (AKI) defined according to the Kidney Disease Improving Global Outcomes criteria. The following machine learning techniques were used: decision tree, random forest, extreme gradient boosting, support vector machine, neural network classifier, and deep learning. The performance of these techniques was compared with that of logistic regression analysis regarding the area under the receiver-operating characteristic curve (AUC). During the first postoperative week, AKI occurred in 770 patients (38.3%). The best performance regarding AUC was achieved by the gradient boosting machine to predict the AKI of all stages (0.78, 95% confidence interval (CI) 0.75–0.80) or stage 2 or 3 AKI. The AUC of logistic regression analysis was 0.69 (95% CI 0.66–0.72). Decision tree, random forest, and support vector machine showed similar performance to logistic regression. In our comprehensive comparison of machine learning approaches with logistic regression analysis, gradient boosting technique showed the best performance with the highest AUC and lower error rate. We developed an Internet–based risk estimator which could be used for real-time processing of patient data to estimate the risk of AKI at the end of surgery.
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Ren, Yong, Liping Zhang, Ying Lu, Hong Yang, and Karin N. Westlund. "Central Lateral Thalamic Neurons Receive Noxious Visceral Mechanical and Chemical Input in Rats." Journal of Neurophysiology 102, no. 1 (July 2009): 244–58. http://dx.doi.org/10.1152/jn.90985.2008.
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Thalamic intralaminar and medial nuclei participate mainly in affective and motivational aspects of pain processing. Unique to the present study were identification and characterization of spontaneously active neurons in the central lateral nucleus (CL) of the intralaminar thalamus, which were found to respond only to viscerally evoked noxious stimuli in animals under pentobarbital anesthesia. Responses to noxious colorectal distention, intrapancreatic bradykinin, intraperitoneal dilute acetic acid, and greater splanchnic nerve electrical stimulation were characterized. Electrophysiological recordings revealed activity in most CL neurons (93%) was excited (69%) or inhibited (31%) in response to noxious visceral stimulation of visceral nerves. Expression of c-Fos observed in CL nucleus after intensive visceral stimulation confirmed the activation. However, excited CL neurons did not have somatic fields, except in 3 of 43 (7%) CL neurons tested for responses to somatic stimulation (innocuous brush and noxious pinch). Intrathecal administration of morphine significantly reduced the increased responses of CL neurons to colorectal and pancreatic stimuli and was naloxone reversible. High-level thoracic midline dorsal column (DC) myelotomy also dramatically reduced responses, identifying the DC as a major route of travel from the spinal cord for CL input, in addition to input traveling ventromedially in the spinothalamic tract identified anatomically in a previous study. Spinal cord and lower brain stem cells providing input to medial thalamus were mapped after stereotaxic injections of a retrograde dye. These data combined with our previous data suggest that the CL nucleus is an important component of a medial visceral nociceptive system that may mediate attentional, affective, endocrine, motor, and autonomic responses to noxious visceral stimuli.
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Gil-González, Julián, Andrés A. Álvarez-Meza, Julián D. Echeverry-Correa, Álvaro A. Orozco-Gutiérrez, and Mauricio A. Álvarez-López. "Enhancement of nerve structure segmentation by a correntropy-based pre-image approach." TecnoLógicas 20, no. 39 (May 2, 2017): 197–208. http://dx.doi.org/10.22430/22565337.717.
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Peripheral Nerve Blocking (PNB) is a commonly used technique for performing regional anesthesia and managing pain. PNB comprises the administration of anesthetics in the proximity of a nerve. In this sense, the success of PNB procedures depends on an accurate location of the target nerve. Recently, ultrasound images (UI) have been widely used to locate nerve structures for PNB, since they enable a non-invasive visualization of the target nerve and the anatomical structures around it. However, UI are affected by speckle noise, which makes it difficult to accurately locate a given nerve. Thus, it is necessary to perform a filtering step to attenuate the speckle noise without eliminating relevant anatomical details that are required for high-level tasks, such as segmentation of nerve structures. In this paper, we propose an UI improvement strategy with the use of a pre-image-based filter. In particular, we map the input images by a nonlinear function (kernel). Specifically, we employ a correntropy-based mapping as kernel functional to code higher-order statistics of the input data under both nonlinear and non-Gaussian conditions. We validate our approach against an UI dataset focused on nerve segmentation for PNB. Likewise, our Correntropy-based Pre-Image Filtering (CPIF) is applied as a pre-processing stage to segment nerve structures in a UI. The segmentation performance is measured in terms of the Dice coefficient. According to the results, we observe that CPIF finds a suitable approximation for UI by highlighting discriminative nerve patterns.
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Landis-Lewis, Zach, Allen Flynn, Allison Janda, and Nirav Shah. "A Scalable Service to Improve Health Care Quality Through Precision Audit and Feedback: Proposal for a Randomized Controlled Trial." JMIR Research Protocols 11, no. 5 (May 10, 2022): e34990. http://dx.doi.org/10.2196/34990.
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Background Health care delivery organizations lack evidence-based strategies for using quality measurement data to improve performance. Audit and feedback (A&F), the delivery of clinical performance summaries to providers, demonstrates the potential for large effects on clinical practice but is currently implemented as a blunt one size fits most intervention. Each provider in a care setting typically receives a performance summary of identical metrics in a common format despite the growing recognition that precisionizing interventions hold significant promise in improving their impact. A precision approach to A&F prioritizes the display of information in a single metric that, for each recipient, carries the highest value for performance improvement, such as when the metric’s level drops below a peer benchmark or minimum standard for the first time, thereby revealing an actionable performance gap. Furthermore, precision A&F uses an optimal message format (including framing and visual displays) based on what is known about the recipient and the intended gist meaning being communicated to improve message interpretation while reducing the cognitive processing burden. Well-established psychological principles, frameworks, and theories form a feedback intervention knowledge base to achieve precision A&F. From an informatics perspective, precision A&F requires a knowledge-based system that enables mass customization by representing knowledge configurable at the group and individual levels. Objective This study aims to implement and evaluate a demonstration system for precision A&F in anesthesia care and to assess the effect of precision feedback emails on care quality and outcomes in a national quality improvement consortium. Methods We propose to achieve our aims by conducting 3 studies: a requirements analysis and preferences elicitation study using human-centered design and conjoint analysis methods, a software service development and implementation study, and a cluster randomized controlled trial of a precision A&F service with a concurrent process evaluation. This study will be conducted with the Multicenter Perioperative Outcomes Group, a national anesthesia quality improvement consortium with >60 member hospitals in >20 US states. This study will extend the Multicenter Perioperative Outcomes Group quality improvement infrastructure by using existing data and performance measurement processes. Results The proposal was funded in September 2021 with a 4-year timeline. Data collection for Aim 1 began in March 2022. We plan for a 24-month trial timeline, with the intervention period of the trial beginning in March 2024. Conclusions The proposed aims will collectively demonstrate a precision feedback service developed using an open-source technical infrastructure for computable knowledge management. By implementing and evaluating a demonstration system for precision feedback, we create the potential to observe the conditions under which feedback interventions are effective. International Registered Report Identifier (IRRID) PRR1-10.2196/34990
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Simanjuntak, Esraida, and Mustamil Alwi Dasopang. "Tinjauan Pelaksanaan Review Berkas Rekam Medis Sesuai Standar Manajemen Informasi Dan Rekam Medik (MIRM 13.4) Di Rumah Sakit Imelda Pekerja Indonesia Tahun 2020." Jurnal Ilmiah Perekam dan Informasi Kesehatan Imelda (JIPIKI) 6, no. 1 (February 27, 2021): 7–13. http://dx.doi.org/10.52943/jipiki.v6i1.476.
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One of the parameters for determining the quality of health services in the hospital is data or information from good and complete medical records. Medical records are an important part of helping the implementation of service delivery to patients at the hospital. Standards relating to medical records in SNARS Edition 1 are in the group of hospital management standards, namely Medical Record Information Management (MIRM) regarding medical record document processing including provision, filling of medical records and reviewing medical records. This research method is descriptive with the method of observation. When this research was conducted in July 2020 at the Imelda Hospital Worker Indonesia Medan. The population taken was 705 medical record documents while the sample in this study was 87 medical record documents. Based on the results of the study, in the review the accuracy of returning medical record documents was 57.4% and 42.5% were incorrect. Readability review of ER assessment as much as 63.2%, assessment of Inpatient as much as 56.3%, CPPT as much as 60.9%, approval for action as much as 77%, reports of anesthesia as much as 68.9%. 3 forms of completeness review are complete, namely Education Assessment, rejection and education form (100%). Suggestions in this study are that review officers must be more assertive to remind every doctor or other medical personnel to pay attention to the accuracy of the restoration, the legibility of medical record files and the completeness of medical record documents. As well as regularly socializing the elements of the MIRM 13.4 assessment.
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Tkachenko, P. I., I. I. Starchenko, S. O. Bilokon, N. M. Lokhmatova, O. B. Dolenko, N. M. Korotych, Yu V. Popelo, and N. P. Bilokon. "THE FEATURES OF SURGICAL TREATMENT AND MORPHOLOGICAL ASPECTS OF EPULIS AND PAPILLOMA IN CHILDREN." Ukrainian Dental Almanac, no. 1 (March 23, 2021): 28–37. http://dx.doi.org/10.31718/2409-0255.1.2021.05.
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The paper presents the findings of the study on the features of surgical treatment and morphological structure of epulis and papillomas in children.
The clinical aspect of the paper concerns 123 children with epulis and 185 with papillomas, who were treated at the clinic of the Department of Pediatric Oral Surgery for the period of 10 years. Verification of the histological structure of neoplasms to determine the final diagnosis was performed by the faculty staff of the Department of Pathological Anatomy with Autopsy Course.
Statistical processing of the digital data and analysis of the findings of the study showed that epulis and papillomas are more common in girls than in boys (in 2.5 and 2.3 times higher, respectively). A clear pattern of their diagnosis by age was established. Thus, the peak incidence of epulis was recorded in young adolescents of lower and higher secondary school ages (60.3% and 36.6%, respectively). Papilloma was also found quite often in the same age groups (47.0% and 31.4%, respectively).
After comprehensive examination, the clinical diagnosis of the giant cell epulis was established in 21.1% of cases, and the share of its fibrous and angiomatous forms accounted for 35.0% and 43.9%, respectively. Neither patients with epulis of all its types nor their relatives could clearly determine the time periods of the appearance of the first clinical signs of the disease.
All patients with papillomas and their relatives complained of the presence of newly formed masses on the oral mucosa or skin, which caused some discomfort, growing slowly, rarely reaching large sizes. The exact time periods of their occurrence could not be specified.
Treatment of epulis, provided outpatiently for all patients under local anesthesia, was aimed at elimination of the etiological factor (if detected) and surgery.
No recurrences were noted after removal of fibrous epulis and in cases of treatment of angiomatous epulis recurrence occurred in 1 girl. Among patients with giant cell epulis, recurrence after surgical removal was observed in 4 patients, 3 of whom underwent repeated surgery with preservation of teeth. In 1 child recurrence occurred for the third time and tooth extraction and partial resection of the alveolar ridge was made as part of the inpatient treatment.
Treatment of papillomas involved surgical removal of neoplasms at the border of healthy tissue up to the submucosal layer using an electrocoagulator or radio knife.
Depending on the clinical situation and localization of the tumor, manipulations were performed under local (161 cases - 87.0%) anesthesia at the polyclinic, and in 24 children (13.0%) with labile mental health and localization of papilloma on the soft palate, uvula, palatal arches, anesthesia was performed at inpatient. No complications during surgery and in the postoperative period were observed.
The surgical material was always sent for histological examination, the results of which allowed determining one of the mentioned nosological forms.
Morphological study has established, that the clinical diagnosis did not coincide with the morphological one in 5 cases (4.1%) in fibrous epulis, in 8 - 6.5% in angiomatous and in 10 - 8.1% in giant cell forms, which together made their discrepancy in 23 observations (18.7%).
Thus, epulis and papillomas located in the oral cavity have a certain similarity in clinical symptoms and require careful differential diagnosis, and given their unique morphological structure, the final diagnosis must be established taking into account the findings of histopathological examination, as inconsistency of clinical and histopathological examinations, for example, in epulis, reaches 18.7%.
When planning the treatment, in an every single case the type, extent and site of surgery, as well as type of anesthesia should be carefully considered.
The presented material can serve as the basis for further in-depth scientific and practical research on comparison of clinical manifestations and immunohistochemical features of epulis and papillomas depending the age of patients.
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Hashmi, Javeria A., Marco L. Loggia, Sheraz Khan, Lei Gao, Jieun Kim, Vitaly Napadow, Emery N. Brown, and Oluwaseun Akeju. "Dexmedetomidine Disrupts the Local and Global Efficiencies of Large-scale Brain Networks." Anesthesiology 126, no. 3 (March 1, 2017): 419–30. http://dx.doi.org/10.1097/aln.0000000000001509.
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Abstract Background A clear understanding of the neural basis of consciousness is fundamental to research in clinical and basic neuroscience disciplines and anesthesia. Recently, decreased efficiency of information integration was suggested as a core network feature of propofol-induced unconsciousness. However, it is unclear whether this finding can be generalized to dexmedetomidine, which has a different molecular target. Methods Dexmedetomidine was administered as a 1-μg/kg bolus over 10 min, followed by a 0.7-μg · kg−1 · h−1 infusion to healthy human volunteers (age range, 18 to 36 yr; n = 15). Resting-state functional magnetic resonance imaging data were acquired during baseline, dexmedetomidine-induced altered arousal, and recovery states. Zero-lag correlations between resting-state functional magnetic resonance imaging signals extracted from 131 brain parcellations were used to construct weighted brain networks. Network efficiency, degree distribution, and node strength were computed using graph analysis. Parcellated brain regions were also mapped to known resting-state networks to study functional connectivity changes. Results Dexmedetomidine significantly reduced the local and global efficiencies of graph theory–derived networks. Dexmedetomidine also reduced the average brain connectivity strength without impairing the degree distribution. Functional connectivity within and between all resting-state networks was modulated by dexmedetomidine. Conclusions Dexmedetomidine is associated with a significant drop in the capacity for efficient information transmission at both the local and global levels. These changes result from reductions in the strength of connectivity and also manifest as reduced within and between resting-state network connectivity. These findings strengthen the hypothesis that conscious processing relies on an efficient system of information transfer in the brain.
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Tashiro, A., K. Okamoto, S. B. Milam, and D. A. Bereiter. "Differential Effects of Estradiol on Encoding Properties of TMJ Units in Laminae I and V at the Spinomedullary Junction in Female Rats." Journal of Neurophysiology 98, no. 6 (December 2007): 3242–53. http://dx.doi.org/10.1152/jn.00677.2007.
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To determine whether estrogen status modulated dorsal horn neural activity relevant to temporomandibular joint (TMJ) processing single units were recorded in superficial and deep laminae at the trigeminal subnucleus caudalis/upper cervical cord (Vc/C1–2) junction of ovariectomized (OvX) female rats under barbiturate anesthesia after 17β-estradiol (E2) treatment for 2 days. E2 dose-dependently enhanced the response to intra-TMJ stimulation by adenosine triphosphate (ATP) of neurons classified as nociceptive specific (NS), but not wide dynamic range (WDR), in superficial laminae. ATP caused similar responses among NS and WDR neurons from deep laminae in all groups. By contrast, the cutaneous receptive field areas of WDR, but not NS, units in superficial and deep laminae were enlarged in high E2-treated (HE2) compared with low E2-treated (LE2) females. Units from untreated or vehicle-treated male rats displayed responses similar to those of LE2 females. TMJ units in superficial laminae from females were more likely to receive convergent cutaneous input and respond to jaw movement than males, independent of E2 treatment. Western blot analysis revealed similar levels of P2X2 and P2X3 receptor protein in Vc/C1–2 or trigeminal ganglion samples in all groups. Immunohistochemistry revealed dense terminal labeling for P2X3 receptors in superficial laminae and moderate labeling in deep laminae at the Vc/C1–2 junction. These data indicated a significant linkage between estrogen status and the magnitude of articular input evoked by ATP from TMJ neurons in the superficial laminae at the Vc/C1–2 junction, whereas estrogenic modulation of TMJ neurons in deep laminae affected only the convergent input from overlying facial skin.
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Bondar, R. A. "Influence of different prevention options on cognitive dysfunction in the early and remote postoperative period in otolaryngological interventions with controlled hypotension." Reports of Vinnytsia National Medical University 26, no. 2 (June 14, 2022): 233–38. http://dx.doi.org/10.31393/reports-vnmedical-2022-26(2)-11.
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Annotation. Cognitive dysfunction complicates the course of the early postoperative period, and in the longer term worsens the quality of life of patients due to their professional, social and domestic maladaptation, so the prevention of cognitive disorders is an urgent problem of modern medicine. The aim of the study was to investigate the effect of drugs with antioxidant properties and effects on choline metabolism on the state of cognitive function of patients after otolaryngological surgery with controlled hypotension. The data of neurocognitive testing of 127 patients were analyzed, including: patients of group 1 (control, n=33) did not receive prevention of cognitive dysfunction, patients of group 2 (n=32) were prescribed ethylmethylhydroxypyridine succinate, patients of group 3 (n=30) – choline alfoscerate, patients of group 4 (n=32) – choline alfoscerate and ethylmethylhydroxypyridine succinate. The assessment of cognitive function of all patients was conducted before surgery, 7 days and 3 months after surgery using the Lurie test, the Toulouse-Pieron test, the Trial Making Test and the Stroop test. Statistical processing of the obtained data was performed in the statistical package “SPSS 20” (SPSS Inc.) using parametric and non-parametric methods of evaluation of the obtained results. The results of neurocognitive testing of otolaryngological patients who underwent surgery under general anesthesia using controlled arterial hypotension, showed that cognitive impairment, registered in the early postoperative period in 24.4% of patients, significantly decreased within 3 months after surgery and reached 11%. Perioperative use of choline alfoscerate reduces the incidence of postoperative cognitive dysfunction in the early postoperative period from 39.4% to 16.7%, while the combination of choline alfoscerate with ethylmethylhydroxypyridine succinate reduces the incidence to 12.5%. No significant effect of perioperative prophylactic medication on the frequency of cognitive dysfunction was found in the long postoperative period of otolaryngological interventions with controlled hypotension. The obtained results can serve as a justification for the subsequent purposeful determination of clinical predictors of postoperative cognitive impairment.
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Risnawati, Risnawati, and Masitah Handayani. "penerapan Jaringan Saraf Tiruan Untuk Proyeksi Logistik Berdasarkan Prediksi Pasien Menggunakan Algoritma Backpropagation." JURTEKSI 4, no. 1 (December 4, 2017): 21–28. http://dx.doi.org/10.33330/jurteksi.v4i1.20.
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Abstract: Enormous logistical needs on General Hospital Kartini range to facilitate treatment requires a system that can predict to meet those needs with the right so as not to result in advantages and disadvantages to the amount of usage that is always changing every year. At this time the calculations have been carried out with the help of software that is on a high-speed computer such as Neural Networks. Neural networks are used to predict the projection Backpropogation logistics patients based on the type of drugs Analgesics, antiemetics, vitamins, Antiepileptic, Anesthesia, Anti-Parkinson, Psychotherapeutic, Corticosteroids. This logistical projection data processing using software of Matlab 6.1. After using Backpropogation finally found the best architectural pattern is 8-3-3-1 of 5 aritektur architecture that has been tested. Of the pattern is then predicted projection logistics at General Hospital Kartini range in 2014 will increase to 91 290 from 65 422 in 2013 for an increase of 25 868 (28.33%). Keywords: neural networks, backpropagation algorithm, projection logistics, matlab Abstrak: Kebutuhan logistik yang sangat besar pada Rumah Sakit Umum Ibu Kartini Kisaran untuk memperlancar pengobatan membutuhkan suatu sistem yang bisa memprediksi untuk memenuhi kebutuhan tersebut dengan tepat agar tidak mengakibatkan kelebihan dan kekurangan terhadap jumlah pemakaian yang selalu berubah setiap tahunnya. Pada saat ini proses perhitungan telah banyak dilakukan dengan bantuan software-software yang ada pada komputer yang berkecepatan tinggi seperti Jaringan Saraf Tiruan. Jaringan Saraf Tiruan Backpropogation digunakan untuk memprediksi proyeksi logistik pasien berdasarkan jenis obat Analgetik, Antiemetik, Vitamin, Antiepilepsi, Anestesi, Anti Parkinson, Psikofarmaka, Kortikosteroid. Pengolahan data proyeksi logistik ini menggunakan software Matlab 6.1. Setelah menggunakan Backpropogation akhirnya ditemukan pola arsitektur yang terbaik yaitu arsitektur 8-3-3-1 dari 5 arsitektur yang telah diujikan. Dari pola tersebut kemudian diprediksi proyeksi logistik di Rumah Sakit Umum Ibu Kartini Kisaran pada tahun 2014 akan meningkat menjadi 91290 dari tahun 2013 sebesar 65422 atau meningkat sebesar 25868 (28,33%). Kata Kunci: jaringan saraf tiruan, algoritma backpropagation, proyeksi logistik, matlab
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Akcaalan, Yasemin, Mehmet Sahap, Handan Gulec, Eyup Horasanli, Mahmut Ugurlu, and Serhat Akcaalan. "Comparison of propofol and ketofol for sedation in patients undergoing shoulder surgery with interscalene and suprascapular nerve blocks." Anaesthesia, Pain & Intensive Care 26, no. 1 (February 7, 2022): 102–9. http://dx.doi.org/10.35975/apic.v26i1.1775.
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Introduction and Purpose: We compared propofol and ketofol for sedation in patients who underwent shoulder arthroscopy under anesthesia with interscalene and suprascapular blocks. We evaluated both of agents the intraoperative hemodynamic effects, sedation efficiency, postoperative recovery times and the time to discharge to the service. We aimed to achieve an effective sedation with stable hemodynamics, resulting in rapid recovery with early onset.
Methodology: The study was carried out prospectively in a double-blind randomized study on ASA I and II patients aged 18-65, total of 42 shoulder surgeries planned. Anesthesia was provided to the patients by performing interscalene and suprascapular nerve block with USG. Group 1 (Propofol group), 1 mg/kg propofol iv, in Group 2 (Ketofol group), a mixture of ketamine-propofol was prepared in a 1:1 ratio, 1 mg / kg ketofol iv was administered. Processing was started in both groups when Ramsey Sedation Scale (RSS) was 3. SBP, DBP, MBP, heart rate, O2 saturation, RSS, Faces scale were recorded throughout the case. The patients with an Aldrete score of 9 were discharged and sent to the service.
Results: A total of 42 patients undergoing planned shoulder surgeries were enrolled. No statistically significant was determined between the groups in respect of demographic data (age, gender, height, weight, ASA), operating time and postoperative length of stay in hospital. More patients required esmolol in the ketofol group compared to propofol group; 15 (71.4%) vs. 7 (33%) patients (p < 0.05). Significant higher mean values of hemodynamic findings in the ketofol group were noted; SBP at 55 min, DBP at 60 min, MBP at 60 min and MBP on discharge (p < 0.05). In the absence of esmolol, the pulse measurements at 0, 1, 3, 25, and 30 min were determined to be statistically significantly higher in the ketofol group than the propofol group (p < 0.05). The mean values of the SpO2 measurements were significantly lower in the ketofol group (p < 0.05). No statistically significant difference was determined in respect of the postoperative modified Aldrete Scores (MAS) at any of the time points (p > 0.05).
Conclusion: While a deeper and higher quality sedation was provided with ketofol, we achieved rapid onset and short-acting sedation with propofol. Both agents have different superior properties and can be used safely for sedation.
Key words: Brachial plexus block, ketofol, shoulder arthroscopy, propofol, sedation
Citation: Akcaalan Y, Sahap M, Gulec H, Horasanli E, Ugurlu M, Akcaalan S. Comparison of propofol and ketofol for sedation in patients undergoing shoulder surgery with interscalene and suprascapular nerve blocks. Anaesth. pain intensive care 2022;26(1):102-109.
DOI: 10.35975/apic.v26i1.1775
Received: September 24, 2021, Reviewed: October 18, 2021, Accepted: Nov 09, 2021
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Oelschlägel, Martin, Tobias Meyer, Ute Morgenstern, Hannes Wahl, Johannes Gerber, Gilfe Reiß, Edmund Koch, et al. "Mapping of language and motor function during awake neurosurgery with intraoperative optical imaging." Neurosurgical Focus 48, no. 2 (February 2020): E3. http://dx.doi.org/10.3171/2019.11.focus19759.
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Intraoperative optical imaging (IOI) is a marker-free, contactless, and noninvasive imaging technique that is able to visualize metabolic changes of the brain surface following neuronal activation. Although it has been used in the past mainly for the identification of functional brain areas under general anesthesia, the authors investigated the potential of the method during awake surgery. Measurements were performed in 10 patients who underwent resection of lesions within or adjacent to cortical language or motor sites. IOI was applied in 3 different scenarios: identification of motor areas by using finger-tapping tasks, identification of language areas by using speech tasks (overt and silent speech), and a novel approach—the application of IOI as a feedback tool during direct electrical stimulation (DES) mapping of language. The functional maps, which were calculated from the IOI data (activity maps), were qualitatively compared with the functional MRI (fMRI) and the electrophysiological testing results during the surgical procedure to assess their potential benefit for surgical decision-making.The results reveal that the intraoperative identification of motor sites with IOI in good agreement with the preoperatively acquired fMRI and the intraoperative electrophysiological measurements is possible. Because IOI provides spatially highly resolved maps with minimal additional hardware effort, the application of the technique for motor site identification seems to be beneficial in awake procedures. The identification of language processing sites with IOI was also possible, but in the majority of cases significant differences between fMRI, IOI, and DES were visible, and therefore according to the authors’ findings the IOI results are too unspecific to be useful for intraoperative decision-making with respect to exact language localization. For this purpose, DES mapping will remain the method of choice.Nevertheless, the IOI technique can provide additional value during the language mapping procedure with DES. Using a simple difference imaging approach, the authors were able to visualize and calculate the spatial extent of activation for each stimulation. This might enable surgeons in the future to optimize the mapping process. Additionally, differences between tumor and nontumor stimulation sites were observed with respect to the spatial extent of the changes in cortical optical properties. These findings provide further evidence that the method allows the assessment of the functional state of neurovascular coupling and is therefore suited for the delineation of pathologically altered tissue.
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Ivanov, A. V., V. A. Lipatov, S. V. Lazarenko, N. N. Zherdev, and D. A. Severinov. "Studying the response of tissues of laboratory animals to implantation of vascular endoprostheses." Patologiya krovoobrashcheniya i kardiokhirurgiya 20, no. 2 (August 17, 2016): 87. http://dx.doi.org/10.21688/1681-3472-2016-2-87-94.
Full textAbstract:
<p><strong>Aim:</strong> The paper looks at one of pressing problems of angiosurgery, the choice of plastic material to be used in reconstructive interventions and focuses on the response of biological tissues to implantation of vascular endoprostheses. <br /><strong>Methods:</strong> To do research on the study material, use was made of vascular dacron implant & a woven double velour vascular endoprosthesis of polyester fibers and impregnated with modified gelatin. 60 Vistar rats (males) weighing 200-250 g were chosen as study objects. The animals were assigned to 4 groups according to the number of firms-manufacturers and the time of removing from the experiment (at 15 and 30 days). Under general anesthesia in the operating room, the rats’ skin and subcutaneous fat were dissected along the paravertebral line. Two pouches 3.5 cm deep were formed in the subcutaneous fat by blunt dissection. A 2x2 cm sample of the vascular patch was introduced into each pouch. The surgical wound was closed completely and treated with antiseptics. Histological preparations were stained by using a hematoxylin-eosin/Mallory technique. The obtained microphotographs enabled us to evaluate the structure of the connective-tissue capsule, as well as the content of its cellular layer. A cellular index, the relationship between fibroblast cells and inflammatory infiltrate cells, was calculated in each group. The indicator exceeding 1 demonstrated the predominance of reparative tendencies, if it was below 1, inflammatory changes prevailed. Statistical processing of the data obtained was performed by means of descriptive and variation statistical methods. <br /><strong>Results:</strong> Changes of inflammatory reaction phases proceed faster in the zone of implantation of dacron patches, which manifest themselves by a reliable increase in the quantity of resident cells from 62.4% to 80.5% and a decrease in nonresident cells by 1.7 times on the same terms respectively. The reaction of fabrics is more expressed to a polyester implant, which is confirmed by an insignificant decrease from 53.5% to 43.7% of the quantity of inflammatory infiltrate cells and a growth of fibroblast cells from 46.5% (at 15 days) to 56.3% (at 30 days). <br /><strong>Conclusion:</strong> The reaction of tissues of laboratory animals is less expressed to a dacron implant.</p>