Monitoring level of sedation with bispectral EEG analysis: comparison between hypothermic and normothermic cardiopulmonary bypass

The level of sedation of 28 patients undergoing elective coronaryartery bypass grafting with fentanyl–propofol anaesthesiawas monitored with bispectral analysis (BIS), spectral edgefrequency, and band power of the electroencephalogram. Fourteenpatients underwent hypothermic cardiopulmonary bypass (CPB)(32°C, group H), and 14 normothermic CPB (group N). Thelevel of sedation was measured with Observer’s Assessmentof Alertness/Sedation Score and with Ramsay Sedation Score.BIS was the only EEG measurement that paralleled the clinicalcourse of the patients’ sedation level. Values (median,95% confidence intervals (CI)) changed significantly over timein both groups (P<0.0001). In group H, BIS decreased from97 (95, 99) the day before surgery to 48 (44, 52) after trachealintubation, to 46 (41, 52) before going off CPB, to 91 (85,97) immediately before extubation. In group N, values were 93(91, 97) the day before surgery, 53 (47, 59) after trachealintubation, 48 (43, 53) before going off CPB, and 90 (84, 96)before extubation. During CPB, BIS values were significantlydifferent between the two groups. Group H had a median of 41(95% CI, 39, 42), and group N had a median of 49 (95% CI, 48,51, P<0.0001). Peak values of all other processed EEG parametersduring anaesthesia and surgery overlapped with values from theday before, when patients had no sedating medication, and thesevalues did not correlate to the patients’ course of sedationduring the study. There was no explicit recall of the surgeryin either group. During the phases of anaesthesia and surgerywithout CPB, the progression of BIS levels was comparable withpreviously published data for non-cardiac surgery. During normothermicCPB, the highest BIS values were close to values representinginsufficient depth of sedation. It remains to be elucidatedwhether the much lower BIS values in the hypothermic group weresolely a result of brain cooling or if increased serum propofolconcentrations, because of slowed pharmacodynamics during hypothermia,also contributed. Br J Anaesth 2001; 86: 769–76     

Prevention of perinatal group B streptococcal infection: current controversies

Group B streptococcus (GBS) is the most frequent cause of neonatal sepsis in the United States. The Centers for Disease Control and Prevention (CDC) issued guidelines for its prevention in 1996. This article details areas of controversy with those guidelines and offers recommendations for resolution. We recommend that a prevention policy be adopted by all hospitals. If a screening-based policy is chosen, compliance is essential. Penicillin is the antibiotic of choice for GBS prevention. Increasing resistance to clindamycin and erythromycin might eliminate them as alternative choices in patients allergic to penicillin. Group B streptococcal prophylaxis might not be necessary in women who have repeat elective cesarean delivery. In asymptomatic women, a positive urine culture for GBS should be considered clinically equivalent to a positive vaginal or rectal sample for screening. Neonatal sepsis caused by organisms other than GBS must be monitored carefully by all hospitals providing obstetrics services.     

Use of transdermal amitriptyline gel in a patient with chronic pain and depression

A man with severe inflammatory bowel disease suffered from chronic abdominal pain and depression. A transdermal amitriptyline gel preparation was compounded since he was unable to take drugs orally Serum concentrations of amitriptyline and its active metabolite nortriptyline were measured over 24 hours. Symptoms of depression were monitored before starting transdermal therapy and at the end of 6 weeks. Pain symptoms and amitriptyline adverse drug events were monitored daily Steady-state serum concentrations of drug and metabolite were within the therapeutic range over 24 hours. The patient reported that his mood was improved but his abdominal pain remained unchanged. Transdermal amitriptyline gel was well tolerated and is an alternative delivery system in patients unable to take drugs orally.     

Alimentäre Leukocytenschwankungen und Aciditätsverhältnisse des Magens

Ohne Zusammenfassung     

Recall and reproduction of words: age-dependent activation of context information in recalling episodic memory contents

Older people tend to have more problems with the retrieval of episodic memory contents than younger people. One hypothesis to explain this phenomenon refers to age deficits in activating specific pieces of contextual information concerning the learning episode. This hypothesis was submitted to an experimental test for 60 old (about 70 years) and 60 young (about 25 years) adults using the recognition failure paradigm. In this paradigm memory performance is assessed by a cued recall test as well as by an unexpected recognition test. The amount of recognition failure served as the central dependent variable; the length of the retention interval and a strategy instruction (given vs not given) were manipulated as independent variables. Various predictions were derived from the central hypothesis and from typical findings in the literature. They are tested by means of statistical hypotheses on planned a priori contrasts. On the whole, the results confirm the hypothesis concerning age deficits in activating context information during retrieval. Implications for models of gerontological changes in episodic memory are discussed within the framework of Tulving's Synergistic Ecphory model.