EEG predicts movement response to surgical stimuli during general anesthesia with combinations of isoflurane, 70% N2O,and fentanyl

Objective. Our objective was to evaluate the performance of the EEG as an indicator of anesthetic depth by measuring EEG prediction of movement response to surgical stimuli.Methods. While using 5 different combinations of isoflurane, 70% N₂O, and fentanyl, we measured the EEG of 246 patients during pelvic laparoscopy and observed their movement responses to opening stimuli (defined as skin incision, CO₂ needle insertion, or trocar insertion) and also to closing stimuli (defined as sutures during incision closure). The EEG was expressed asF95, the frequency in hertz below which resides 95% of the power in the EEG frequency spectrum. The relations betweenF95 and movement response were expressed as logistic regression curves.F95-response logistic regression curves, which are analogous to dose-response curves, were calculated for each of the 2 stimuli administered during each of the 5 anesthetic techniques. The prediction of patient responsiveness byF95 was tested using (beta), a measure of the slope of anF95-response logistic curve. The presence of shifts among theF95-response logistic curves was tested using the differences inF95 values between curves. Hypothesis tests used a level of significance ofP = 0.05.Main Results. The slopes of theF95-response logistic regression curves showed a statistically significant ability to predict movement response to stimuli for 9 of the 10 combinations of stimuli and anesthetic techniques. We did not calculate anF95-response logistic curve for the tenth combination because it contained burst suppression, which our EEG analysis method was not designed to process. TheF95-response logistic curves were shifted relative to each other, and the shifts were affected by the type of stimulus and the combination of anesthetic agents. Referenced to opening curves, the mean shift of the closing curves was ± 4.2 ± 0.3 Hz (mean ± SD). With increasing doses of fentanyl, the use of 70% N₂O, or both, the curves shifted to higher values ofF95; the range in shifts was 0.2 to 8.1 Hz. The slope values of theF95-response logistic curves and the shifts among the curves were similar to the values and shifts that might be expected from changes in anesthetic agent doses.Conclusions. The EEG, expressed asF95, predicted movement response to surgical stimuli during combinations of isoflurane, 70% N₂O, and fentanyl. TheF95-response curves shifted upward on the frequency scale for the less intense stimuli and for anesthetic techniques using 70% N₂O, fentanyl, or both.F95 prediction of movement response appeared to be related to anesthetic agent doses. OurF95-response curves may provide helpful guidelines for usingF95 to titrate the administration of anesthetic agents and for assessing the depth of general anesthesia.     

The heaviest repeat users of an inner city emergency department are not general practice patients

Objective: To test the hypothesis that frequent attenders to the ED are suitable for diversion to general practice. Methods: A retrospective review of a computerized database for the top 500 frequent presenters to an inner city adult teaching hospital ED. Results: Five hundred patients presented 12 940 times, an average of 26 times per patient, accounting for (8.4%[8.3, 8.6]) of total ED presentations over 64 months. There were 7699 (59.5%[58.7, 60.4]) presentations deemed appropriate for ED. Of the remaining 5241 presentations, 1553 (29.6%[28.4, 30.9]) were between 22.00 and 07.00 hours, outside the hours of most actual or proposed primary care clinics. This left 3688 (28.5%[27.7, 29.3]) presentations by the heaviest users of the ED as potentially appropriate for general practice. Of these presentations 1507 (40.9%[39.3, 42.5]) were by people who were homeless. A total of 2574 (69.8%[68.3, 71.3]) had pre‐existing case management, either by the hospital or another service. Nine hundred and seventy‐eight (26.5%[25.1, 28.0]) had primary psychiatric or altered conscious states due to drugs and alcohol as the presenting problem. At least 90 of these 500 frequently presenting patients died during the study period. Conclusion: The majority of the presentations by the heaviest users of an ED in a city teaching hospital are not suitable for general practice. Attempting diversion of the heaviest repeat ED users to a general practice in this setting may not be successful due to the severity, acuity and nature of casemix of the presentations and would have minimal impact on crowding in similar emergency departments.     

Incidence and costs of herpes zoster and postherpetic neuralgia in German adults aged ≥50 years: A prospective study

Objectives

Herpes zoster (HZ) mainly affects elderly people and immunocompromised individuals. HZ is usually characterized by a unilateral painful skin rash. Its most common complication, postherpetic neuralgia (PHN), may cause chronic debilitating pain. This study aimed to estimate the HZ incidence in individuals aged ≥50 years in Germany, the proportion of PHN and the economic burden.

Prevalence of left ventricular hypertrophy in a hypertensive population

AIMS: This investigation was set up to study the prevalence of leftventricular hypertrophy in a hypertensive population with referenceto a normotensive control group. From the general population3498 men and women aged 35, 45, 55 and 65 years old were invitedto a health examination. Participants with blood pressure above160 mmHg systolic or 95 mmHg diastolic or those taking antihypertensivemedication or having done so during the previous 6 months wereasked to undergo an echocardiographic examination. Normotensivecontrols were randomly selected from the same population. Of552 participants in the final study population, 194 were normotensivecontrols and 358 were in the hypertensive group. Echocardiographicmeasurements were made according to the Penn conventions andindexed for body surface. Cut-off values for left ventricularhypertrophy were 134 g. m^{– 2} for males and 102 g. m^–2 for women. RESULTS: Overall, the prevalence of left ventricular hypertrophy wasl4%/20% (men/women) in normotensives and 25%/26% in hypertensives(P<0·01). After subdivision by age and sex, therewas a significant difference in the prevalence of left ventricularhypertrophy between normotensives and hypertensives only inthe 65-year-old group (P<0·02 for males and P<0·05for females). CONCLUSION: The association between blood pressure and left ventricularhypertrophy in the general population is weak. Left ventricularhypertrophy is only significantly more frequent among hypertensivesas compared to normotensives in older people.     

Evolution of Functional Exercise Capacity in Lung Transplant Patients With and Without Bronchiolitis Obliterans Syndrome: A Longitudinal Case–Control Study

Introduction

Bronchiolitis Obliterans Syndrome (BOS) is a debilitating disease with limited treatment options that threatens both the quality of life and long-term survival of lung transplant (LTx) recipients. This retrospective longitudinal case–control study was performed to compare the long-term functional evolution of LTx recipients with and without BOS.

急性脑外伤患者全麻手术期间及术后12导联心电图观察分析

目的：观察急性脑外伤患者全麻手术期间及术后心电图变化情况。方法186例成人急诊颅脑手术过程中及术后描记12导联电图,进行心电监护并记录。结果186例脑外伤患者麻醉手术期间有157例出现不同程度心电图异常改变（占84．4％）。窦性心动过缓、ST-T改变、心肌缺血最常见,其他异常主要有早搏、心律不齐、传导阻滞、异常 Q 波、Q-T 间期延长等改变。心电图的改变主要发生在脑部病变的急性期及开颅手术的一周内,且与病情严重程度密切相关。结论脑外伤患者急性期脑水肿颅内压增高、缺血缺氧、电解质紊乱等导致大多数患者有心电图异常,且变化复杂,一般为应激反应,是暂时的、可逆的,可随病情的减轻而好转或消失;麻醉及手术操作刺激对患者的心血管系统也造成一定的影响。通过监测分析心电图可发现潜在危险,特别是对有器质性心脏疾病者更应提高警惕。     

Into the pressure cooker: Student stress in college preparatory high schools

PurposeThe goals of this study were to (1) measure psychological, physiological, and behavioral indicators of stress, (2) assess the relationship between stress and student attitudes, and (3) explore coping behaviors in response to stress, among a sample of students in two academically high-achieving environments.MethodThree hundred thirty-three students in grades 9 through 12 from two college-preparatory high schools completed a cross-sectional online survey that included the Students' Life Satisfaction Scale, School Attitude Assessment Questionnaire-Revised, and assessments for stress-related indicators, including eating, sleeping and exercise, and strategies they utilized for coping with stress.ResultsStudents reported a high prevalence of physical and psychological correlates of stress, and related unhealthy behaviors such as widespread and chronic sleep deprivation and rushed meals.ConclusionsThe results suggest areas to focus attention for identifying and addressing maladaptive responses to stress among high-achieving student populations.