electroencephalographic (EEG) information is used to monitor the level of cortical depression of a patient undergoing surgical intervention under general anesthesia. The dynamic state transitions ...into and out of anesthetic-induced loss and return of responsiveness (LOR, ROR) present a possibility to evaluate the dynamics of the EEG induced by different substances. We evaluated changes in the EEG power spectrum during anesthesia emergence for three different anesthetic regimens. We also assessed the possible impact of these changes on processed EEG parameters such as the permutation entropy (PeEn) and the cerebral state index (CSI).
we analyzed the EEG from 45 patients, equally assigned to three groups. All patients were induced with propofol and the groups differed by the maintenance anesthetic regimen, i.e., sevoflurane, isoflurane, or propofol. We evaluated the EEG and parameter dynamics during LOR and ROR. For the emergence period, we focused on possible differences in the EEG dynamics in the different groups.
depending on the substance, the EEG emergence patterns showed significant differences that led to a substance-specific early activation of higher frequencies as indicated by the "wake" CSI values that occurred minutes before ROR in the inhalational anesthetic groups.
our results highlight substance-specific differences in the emergence from anesthesia that can influence the EEG-based monitoring that probably have to be considered in order to improve neuromonitoring during general anesthesia.
Chicken culling has been forbidden in Germany since 2022; male/female selection and male elimination must be brought to an embryonic status prior to the onset of nociception. The present study ...evaluated the ontogenetic point at which noxious stimuli could potentially be perceived/processed in the brain in ovo. EEG recordings from randomized hyperpallial brain sites were recorded in ovo and noxious stimuli were applied. Temporal and spectral analyses of the EEG were performed. The onset of physiological neuronal signals could be determined at developmental day 13. ERP/ERSP/ITC analysis did not reveal phase-locked nociceptive responses. Although no central nociceptive responses were documented, adequate EEG responses to noxious stimuli from other brain areas cannot be excluded. The extreme stress impact on the embryo during the recording may overwrite the perception of noniceptive stimuli. The results suggest developmental day 13 as the earliest embryonal stage being able to receive and process nociceptive stimuli.
The TM14RE2B-based phases (TM = transition metal, RE = rare earth metal; hereafter called 14:2:1) enable permanent magnets with outstanding magnetic properties. Novel chemical compositions that ...represent new 14:2:1 phases necessitate that they do not demagnetize at application-specific operating temperatures. Therefore, an accurate knowledge of the Curie temperature (Tc) is important. For magnetic 14:2:1 phases, we present a machine learning model that predicts Tc by using merely chemical compositional features. Hyperparameter tuning on bagging and boosting models, as well as averaging predictions from individual models using the voting regressor, enables a low mean-absolute-error of 16 K on an unseen test set. The training set and a test set have been constructed by randomly splitting, in an 80:20 ratio, of a database that contains 449 phases (270 compositionally unique) mapped with their Tc, taken from distinct publications. The model correctly identifies the relative importance of key substitutional elements that influence Tc, especially in an Fe base such as Co, Mn, and Al. This paper is expected to serve as a basis for accurate Curie temperature predictions in the sought-after 14:2:1 permanent magnet family, particularly for transition metal substitution of within 20% in an Fe or Co base.
Laser powder bed fusion (L-PBF) was used to produce stator half-shells of a transverse flux machine from pure iron (99.9% Fe). In order to reduce iron losses in the bulk components, radially ...extending slits with a nominal width of 150 and 300 µm, respectively, were integrated during manufacturing. The components were subjected to a suitable heat treatment. In addition to a microscopic examination of the slit quality, the iron losses were also measured using both a commercial and a self-developed measurement setup. The investigations showed the iron losses can be reduced by up to 49% due to the integrated slits and the heat treatment.
Premedication of surgical patients with benzodiazepines has become questionable regarding risk-benefit ratio and lack of evidence. Though preoperative benzodiazepines might alleviate preoperative ...anxiety, a higher risk for adverse events is described, particularly for elderly patients (≥ 65 years). Several German hospitals already withhold benzodiazepine premedication from elderly patients, though evidence for this approach is lacking. The patient-centred outcome known as global postoperative patient satisfaction is recognised as a substantial quality indicator of anaesthesia care incorporated by the American Society of Anesthesiologists. Therefore, we aim to assess whether the postoperative patient satisfaction after premedication with placebo compared to the preoperative administration of 3.75 mg midazolam in elderly patients differs.
This study is a multicentre, randomised, placebo-controlled, double-blinded, two-arm parallel, interventional trial, conducted in nine German hospitals. In total 614 patients (≥ 65-80 years of age) undergoing elective surgery with general anaesthesia will be randomised to receive either 3.75 mg midazolam or placebo. The primary outcome (global patient satisfaction) will be assessed with the validated EVAN-G questionnaire on the first postoperative day. Secondary outcomes will be assessed until the first postoperative day and then 30 days after surgery. They comprise among other things: functional and cognitive recovery, postoperative delirium, health-related quality of life assessment, and mortality or new onset of serious cardiac or pulmonary complications, acute stroke, or acute kidney injury. Analysis will adhere to the intention-to-treat principle. The primary outcome will be analysed with the use of mixed linear models including treatment effect and study centre as factors and random effects for blocks. Exploratory adjusted and subgroup analyses of the primary and secondary outcomes with regard to gender effects, frailty, pre-operative anxiety level, patient demographics, and surgery experience will also be performed.
This is, to the best of our knowledge, the first study analysing patient satisfaction after premedication with midazolam in elderly patients. In conclusion, this study will provide high-quality data for the decision-making process regarding premedication in elderly surgical patients.
ClinicalTrials.gov, NCT03052660 . Registered on 14 February 2017. EudraCT 2016-004555-79 .
Trauma as a monstrous quasi-object Schneider, Gerhard
International journal of psychoanalysis,
11/2019, Letnik:
100, Številka:
6
Journal Article
Recenzirano
It is characteristic of a trauma that the subject cannot process and symbolically represent the traumatic experience. With Lacan's theory of 'the real', the traumatic experience is understood as one ...of being overwhelmed by a monstrous quasi-object. In developmental terms, I refer to a traumatic core (birth) and the subject's traumatic susceptibility. It manifests itself during childhood in transitions from one ontological constitution to another that are necessitated by internal or external changes. Such transitions involve the child's particular reliance on his primary objects, and they require specific appropriate reactions from them. This also applies to the child's general dependence, as his primary objects must react appropriately to his constitution as a child, so that he can feel existentially affirmed by them in his being. The adult, also, is reliant on knowing that he is affirmed as a human being in his existence, which can be experienced in the affirmative gaze of the other. Metaphorically speaking, this also applies to the gaze and behaviour of the natural and technological environment, which can transform, like a personal object, into a traumatic monstrous quasi-object. The paper concludes with a clinical vignette in which the emergence and transformation of a monstrous quasi-object is illustrated in the treatment of a female patient suffering from severe early traumata.
Background Surveys suggest a low level of implementation of clinical guidelines, although they are intended to improve the quality of treatment and patient safety. Which guideline recommendations are ...not followed and why has yet to be analysed. In this study, we investigate the proportion of European and national guidelines followed in the area of pre-operative anaesthetic evaluation prior to non-cardiac surgery. Methods We conducted this monocentric retrospective observational study at a German university hospital with the help of software that logically links guidelines in such a way that individualised recommendations can be derived from a patient's data. We included routine logs of 2003 patients who visited our pre-anaesthesia outpatient clinic between June 2018 and June 2020 and compared the actual conducted pre-operative examinations with the recommendations issued by the software. We descriptively analysed the data for examinations not performed that would have been recommended by the guidelines and examinations that were performed even though they were not covered by a guideline recommendation. The guidelines examined in this study are the 2018 ESAIC guidelines for pre-operative evaluation of adults undergoing elective non-cardiac surgery, the 2014 ESC/ESA guidelines on non-cardiac surgery and the German recommendations on pre-operative evaluation on non-cardiothoracic surgery from the year 2017. Results Performed ECG (78.1%) and cardiac stress imaging tests (86.1%) indicated the highest guideline adherence. Greater adherence rates were associated with a higher ASA score (ASA I: 23.7%, ASA II: 41.1%, ASA III: 51.8%, ASA IV: 65.8%, P < 0.001), lower BMI and age > 65 years. Adherence rates in high-risk surgery (60.5%) were greater than in intermediate (46.5%) or low-risk (44.6%) surgery (P < 0.001). 67.2% of technical and laboratory tests performed preoperatively were not covered by a guideline recommendation. Conclusions Guideline adherence in pre-operative evaluation leaves room for improvement. Many performed pre-operative examinations, especially laboratory tests, are not recommended by the guidelines and may cause unnecessary costs. The reasons for guidelines not being followed may be the complexity of guidelines and organisational issues. A software-based decision support tool may be helpful. Trial registration ClinicalTrials.gov ID NCT04843202. Keywords: Pre-operative evaluation, Guidelines, Adherence, Decision-making, Decision support
Prediction probability (P(K)) and the area under the receiver operating characteristic curve (AUC) are statistical measures to assess the performance of anesthetic depth indicators, to more precisely ...quantify the correlation between observed anesthetic depth and corresponding values of a monitor or indicator. In contrast to many other statistical tests, they offer several advantages. First, P(K) and AUC are independent from scale units and assumptions on underlying distributions. Second, the calculation can be performed without any knowledge about particular indicator threshold values, which makes the test more independent from specific test data. Third, recent approaches using resampling methods allow a reliable comparison of P(K) or AUC of different indicators of anesthetic depth. Furthermore, both tests allow simple interpretation, whereby results between 0 and 1 are related to the probability, how good an indicator separates the observed levels of anesthesia. For these reasons, P(K) and AUC have become popular in medical decision making. P(K) is intended for polytomous patient states (i.e., >2 anesthetic levels) and can be considered as a generalization of the AUC, which was basically introduced to assess a predictor of dichotomous classes (e.g., consciousness and unconsciousness in anesthesia). Dichotomous paradigms provide equal values of P(K) and AUC test statistics. In the present investigation, we introduce a user-friendly computer program for computing P(K) and estimating reliable bootstrap confidence intervals. It is designed for multiple comparisons of the performance of depth of anesthesia indicators. Additionally, for dichotomous classes, the program plots the receiver operating characteristic graph completing information obtained from P(K) or AUC, respectively. In clinical investigations, both measures are applied for indicator assessment, where ambiguous usage and interpretation may be a consequence. Therefore, a summary of the concepts of P(K) and AUC including brief and easily understandable proof of their equality is presented in the text. The exposure introduces readers to the algorithms of the provided computer program and is intended to make standardized performance tests of depth of anesthesia indicators available to medical researchers.
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