Articles: general-anesthesia.
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Curr Opin Anaesthesiol · Oct 2020
ReviewDouble standard: why electrocardiogram is standard care while electroencephalogram is not?
A compelling argument that the EEG and it's derivative monitors should be 'standard of care' during anaesthesia, contrasting this with the ECG, arguably a less useful, actionable or meaningful monitor, yet has been widely considered a routine monitor for three decades.
The authors' main thesis is that:
- Intraoperative EEG accurately monitors anaesthetic depth.
- Using EEG to guide intraoperative depth may reduce both anaesthetic use and postoperative delirium.
- Reducing drug exposure and depth of anaesthesia probably has significant patient and societal benefits.
- All anaesthetists and anesthesiologists should be familiar with interpreting the raw EEG in the context of anaesthesia.
However...
- While postoperative delirium is common in the over 65y age group (15-20%) and is associated with adverse outcomes, it is less clear that avoiding excessive depth reliably reduces postoperative delirium (some studies say yes, others...)
- Additionally, because post-op delirium is often used as (or at least inadvertently becomes) a surrogate marker for a range of adverse post-op events, then it follows that EEG monitoring should also be associated with reducing these events. This has not yet been shown.
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Journal of anesthesia · Oct 2020
ReviewGeneral anesthesia affecting on developing brain: evidence from animal to clinical research.
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. ⋯ 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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Anesthesia and analgesia · Sep 2020
Meta AnalysisElectroencephalography-Guided Anesthetic Delivery for Preventing Postoperative Delirium in Adults: An Updated Meta-analysis.
Postoperative delirium is a major debilitating complication for patients and is associated with poor outcomes. Previous studies have suggested that excessive general anesthesia may lead to postoperative delirium. Electroencephalography (EEG)-based monitors have been administered in clinical practice in an attempt to deliver appropriate anesthesia. The aim of this updated meta-analysis was to evaluate the current body of research concerning the effects of EEG-based monitor on postoperative delirium. ⋯ The current evidence is not sufficient to support the prevention effects of EEG monitor on postoperative delirium. More robustly designed and well-conducted studies with emphasis on this matter are warranted.
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Acta clinica Croatica · Sep 2020
ReviewEIGHTY YEARS OF ELECTROCONVULSIVE THERAPY IN CROATIA AND IN SESTRE MILOSRDNICE UNIVERSITY HOSPITAL CENTRE.
In 1937, Ugo Cerletti and Lucio Bini performed electroconvulsive treatment (ECT) in Rome for the first time. That was the time when different types of 'shock therapy' were performed; beside ECT, insulin therapies, cardiazol shock therapy, etc. were also performed. ⋯ As early as 1940, just two years after the results of the ECT had been published, it was also introduced in Croatia, at Sestre milosrdnice Hospital, for the first time in our hospital and in the then state of Yugoslavia. Since 1960, again the first in Croatia and the state, we performed ECT in general anesthesia and continued it down to the present, with a single time brake.