Search results for: Anesthesia

Authors: Babak Borzouei, Seyed Habibollah Mousavi-Bahar

Abstract:

Recently, there has been a considerable increase in the number of procedures carried out under regional anesthesia. However, percutaneous nephrolithotomy (PCNL) procedures are usually performed under general anesthesia. The aim of this study was to assess the safety and efficacy of PCNL under spinal anesthesia in patients with renal calculi. We describe our 9 years experience of performing PCNL under spinal anesthesia for 387 patients with large stones of the upper urinary tract, with regard to the effectiveness and side effects. All patients received spinal anesthetics (Lidocain 5%, or Bupivacaine 0.75%) and underwent PCNL in prone position. The success rate was 94.1%. The incidence of complications was 11.6%. PCNL under spinal anesthesia is feasible, safe, and well-tolerated in management of patients with renal stones.

Keywords: percutaneous nephrolithotomy, spinal anesthesia, renal calculi

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Authors: Seong-wan Baik, Soo-young Ye, Byeong-cheol Choi, Gye-rok Jeon

Abstract:

The measurement of anesthetic depth is necessary in anesthesiology. NN10 is very simple method among the RR intervals analysis methods. NN10 parameter means the numbers of above the 10 ms intervals of the normal to normal RR intervals. Bispectrum analysis is defined as 2D FFT. EEG signal reflected the non-linear peristalsis phenomena according to the change brain function. After analyzing the bispectrum of the 2 dimension, the most significant power spectrum density peaks appeared abundantly at the specific area in awakening and anesthesia state. These points are utilized to create the new index since many peaks appeared at the specific area in the frequency coordinate. The measured range of an index was 0-100. An index is 20-50 at an anesthesia, while the index is 90-60 at the awake. In this paper, the relation between NN10 parameter using ECG and bisepctrum index using EEG is observed to estimate the depth of anesthesia during anesthesia and then we estimated the utility of the anesthetic.

Keywords: Anesthesia, Bispectrum index, ECG, EEG

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Authors: Toktam Zoughi, Reza Boostani

Abstract:

Determining depth of anesthesia is a challenging problem in the context of biomedical signal processing. Various methods have been suggested to determine a quantitative index as depth of anesthesia, but most of these methods suffer from high sensitivity during the surgery. A novel method based on energy scattering of samples in the wavelet domain is suggested to represent the basic content of electroencephalogram (EEG) signal. In this method, first EEG signal is decomposed into different sub-bands, then samples are squared and energy of samples sequence is constructed through each scale and time, which is normalized and finally entropy of the resulted sequences is suggested as a reliable index. Empirical Results showed that applying the proposed method to the EEG signals can classify the awake, moderate and deep anesthesia states similar to BIS.

Keywords: Depth of anesthesia, EEG, BIS, Wavelet transforms.

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Authors: Soo-young Ye, Jun-mo Park, Jae-hyung Kim, Jae-hee Jung, Ah-young Jeon, In-cheol Kim, Jung-man Son, Ki-gon Nam, Seong-wan Baik, Jung-hoon Ro, Gye-rok Jeon

Abstract:

The linear SEF (Spectral Edge Frequency) parameter and spectrum analysis method can not reflect the non-linear of EEG. This method can not contribute to acquire real time analysis and obtain a high confidence in the clinic due to low discrimination. To solve the problems, the development of a new index is carried out using the bispectrum analyzing the EEG(electroencephalogram) including the non-linear characteristic. After analyzing the bispectrum of the 2 dimension, the most significant power spectrum density peaks appeared abundantly at the specific area in awakening and anesthesia state. These points are utilized to create the new index since many peaks appeared at the specific area in the frequency coordinate. The measured range of an index was 0-100. An index is 20-50 at an anesthesia, while the index is 90-60 at the awake. New index could afford to effectively discriminate the awake and anesthesia state.

Keywords: Bispectrum, anesthesia depth, EEG, SEF.

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Authors: Gorazd Karer

Abstract:

When performing a diagnostic procedure or surgery in general anesthesia (GA), a proper introduction and dosing of anesthetic agents is one of the main tasks of the anesthesiologist. That being said, depth of anesthesia (DoA) also seems to be a suitable process for closed-loop control implementation. To implement such a system, one must be able to acquire the relevant signals online and in real-time, as well as stream the calculated control signal to the infusion pump. However, during a procedure, patient monitors and infusion pumps are purposely unable to connect to an external (possibly medically unapproved) device for safety reasons, thus preventing closed-loop control. This paper proposes a conceptual solution to the aforementioned problem. First, it presents some important aspects of contemporary clinical practice. Next, it introduces the closed-loop-control-system structure and the relevant information flow. Focusing on transferring the data from the patient to the computer, it presents a non-invasive image-based system for signal acquisition from a patient monitor for online depth-of-anesthesia assessment. Furthermore, it introduces a User-Datagram-Protocol-based (UDP-based) communication method that can be used for transmitting the calculated anesthetic inflow to the infusion pump. The proposed system is independent of medical-device manufacturer and is implemented in MATLAB-Simulink, which can be conveniently used for DoA control implementation. The proposed scheme has been tested in a simulated GA setting and is ready to be evaluated in an operating theatre. However, the proposed system is only a step towards a proper closed-loop control system for DoA, which could routinely be used in clinical practice.

Keywords: Closed-loop control, Depth of Anesthesia, DoA, optical signal acquisition, Patient State index, PSi, UDP communication protocol.

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Authors: Abdulrahim Shamayleh

Abstract:

In this work, the surgical theater of a local hospital in KSA was analyzed using simulation. The focus was on attempting to answer questions related to how many Operating Rooms (ORs) to open and to analyze the performance of the surgical theater in general and mainly the Post Anesthesia Care Unit (PACU) to assist making decisions regarding PACU staffing. The surgical theater consists of ten operating rooms and the PACU unit which has a maximum capacity of fifteen beds. Different sequencing rules to sequence the surgical cases were tested and the Longest Case First (LCF) were superior to others. The results of the different alternatives developed and tested can be used by the manager as a tool to plan and manage the OR and PACU

Keywords: Operating room, post anesthesia care unit, PACUstaffing, sequencing, healthcare

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Authors: H. A. Alzomor, B. K. Ouda, A. M. Eldeib

Abstract:

Successful regional anesthesia depends upon precise location of the peripheral nerve or nerve plexus. Locating peripheral nerves is preferred to be done using nerve stimulation. In order to generate a nerve impulse by electrical means, a minimum threshold stimulus of current “rheobase” must be applied to the nerve. The technique depends on stimulating muscular twitching at a close distance to the nerve without actually touching it. Success rate of this operation depends on the accuracy of current intensity pulses used for stimulation .In this paper, we will discuss a circuit and algorithm for closed loop control for the current, theoretical analysis and test results is discussed and results is compared to previous techniques.

Keywords: Close Loop Control, Constant Current, Nerve Locator.

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Authors: K. Bensafia, A. Mansour, G. Le Maillot, B. Clement, O. Reynet, P. Ariès, S. Haddab

Abstract:

This paper presents a system designed for wireless acquisition, the recording of electrocardiogram (ECG) signals and the monitoring of the heart’s health during surgery. This wireless recording system allows us to visualize and monitor the state of the heart’s health during a surgery, even if the patient is moved from the operating theater to post anesthesia care unit. The acquired signal is transmitted via a Bluetooth unit to a PC where the data are displayed, stored and processed. To test the reliability of our system, a comparison between ECG signals processed by a conventional ECG monitoring system (Datex-Ohmeda) and by our wireless system is made. The comparison is based on the shape of the ECG signal, the duration of the QRS complex, the P and T waves, as well as the position of the ST segments with respect to the isoelectric line. The proposed system is presented and discussed. The results have confirmed that the use of Bluetooth during surgery does not affect the devices used and vice versa. Pre- and post-processing steps are briefly discussed. Experimental results are also provided.

Keywords: Electrocardiography, monitoring, surgery, wireless system.

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Authors: Khelood A. Mkalaf, Peter Gibson, John Flanagan

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This study investigates the relationship between the reliability of critical medical equipment (CME) and the effectiveness of CME maintenance management strategies in relation to patient outcomes in 84 public hospitals of a top 20 OECD country. The work has examined the effectiveness of CME maintenance management strategies used by the public hospital system of a large state run health organization. The conceptual framework was designed to examine the significance of the relationship between six variables: (1) types of maintenance management strategies, (2) maintenance services, (3) maintenance practice, (4) medical equipment reliability, (5) maintenance costs and (6) patient outcomes. The results provide interesting insights into the effectiveness of the maintenance strategies used. For example, there appears to be about a 1 in 10 000 probability of failure of anesthesia equipment, but these seem to be confined to specific maintenance situations. There are also some findings in relation to outsourcing of maintenance. For each of the variables listed, results are reported in relation to the various types of maintenance strategies and services. Decision-makers may use these results to evaluate more effective maintenance strategies for their CME and generate more effective patient outcomes.

Keywords: Critical medical equipment, maintenance strategy, patient outcomes, reliability.

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Authors: C. Gallottini, W. Di Mari, A. Amaddeo, K. Barbaro, A. Dolci, G. Dolci, L. Gallottini, G. Barraco, S. Eramo

Abstract:

A group of 10 dogs (group A) with Periodontal Disease in the third stage, were subjected to regenerative therapy of periodontal tissues, by use of nano hydroxy apatite (NHA). These animals induced by general anesthesia, where treated by ultrasonic scaling, root planning, and at the end by a mucogingival flap in which it was applied NHA. The flap was closed and sutured with simple steps. Another group of 10 dogs (group B), control group, was treated only by scaling and root planning. No patient was subjected to antibiotic therapy. After three months, a check was made by inspection of the oral cavity, radiography and bone biopsy at the alveolar level. Group A showed a total restitutio ad integrum of the periodontal structures, and in group B still mild gingivitis in 70% of cases and 30% of the state remains unchanged. Numerous experimental studies both in animals and humans have documented that the grafts of porous hydroxyapatite are rapidly invaded by fibrovascular tissue which is subsequently converted into mature lamellar bone tissue by activating osteoblast. Since we acted on the removal of necrotic cementum and rehabilitating the root tissue by polishing without intervention in the ligament but only on anatomical functional interface of cement-blasts, we can connect the positive evolution of the clinical-only component of the cement that could represent this perspective, the only reason that Periodontal Disease become a Cement Disease, while all other clinical elements as nothing more than a clinical pathological accompanying.

Keywords: Nanoidroxiaphatite, Parodontal Disease, Rigenerative Therapy.

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Authors: Chiung-Yun Chang, Po-Chou Chen, Jiun-Shiang Tzeng, Ka-Wai Mac, Chia-Chi Hsiao, Jo-Chi Jao

Abstract:

This study was aimed to measure effective transverse relaxation rates (R2*) in the liver and muscle of normal New Zealand White (NZW) rabbits. R2* relaxation rate has been widely used in various hepatic diseases for iron overload by quantifying iron contents in liver. R2* relaxation rate is defined as the reciprocal of T2* relaxation time and mainly depends on the constituents of tissue. Different tissues would have different R2* relaxation rates. The signal intensity decay in Magnetic resonance imaging (MRI) may be characterized by R2* relaxation rates. In this study, a 1.5T GE Signa HDxt whole body MR scanner equipped with an 8-channel high resolution knee coil was used to observe R2* values in NZW rabbit’s liver and muscle. Eight healthy NZW rabbits weighted 2 ~ 2.5 kg were recruited. After anesthesia using Zoletil 50 and Rompun 2% mixture, the abdomen of rabbit was landmarked at the center of knee coil to perform 3-plane localizer scan using fast spoiled gradient echo (FSPGR) pulse sequence. Afterwards, multi-planar fast gradient echo (MFGR) scans were performed with 8 various echo times (TEs) to acquire images for R2* measurements. Regions of interest (ROIs) at liver and muscle were measured using Advantage workstation. Finally, the R2* was obtained by a linear regression of ln(sı) on TE. The results showed that the longer the echo time, the smaller the signal intensity. The R2* values of liver and muscle were 44.8 ± 10.9 s-1 and 37.4 ± 9.5 s-1, respectively. It implies that the iron concentration of liver is higher than that of muscle. In conclusion, the more the iron contents in tissue, the higher the R2*. The correlations between R2* and iron content in NZW rabbits might be valuable for further exploration.

Keywords: Liver, MRI, multi-planar fast gradient echo, muscle, R2* relaxation rate.

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Authors: Sanchita B. Sarma, M. P. Nath

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Adequate analgesia following caesarean section decreases morbidity, hastens ambulation, improves patient outcome and facilitates care of the newborn. Intrathecal magnesium, an NMDA antagonist, has been shown to prolong analgesia without significant side effects in healthy parturients. The aim of this study was to evaluate the onset and duration of sensory and motor block, hemodynamic effect, postoperative analgesia, and adverse effects of magnesium or fentanyl given intrathecally with hyperbaric 0.5% bupivacaine in patients with mild preeclampsia undergoing caesarean section. Sixty women with mild preeclampsia undergoing elective caesarean section were included in a prospective, double blind, controlled trial. Patients were randomly assigned to receive spinal anesthesia with 2 mL 0.5% hyperbaric bupivacaine with 12.5 μg fentanyl (group F) or 0.1 ml of 50% magnesium sulphate (50 mg) (group M) with 0.15ml preservative free distilled water. Onset, duration and recovery of sensory and motor block, time to maximum sensory block, duration of spinal anaesthesia and postoperative analgesic requirements were studied. Statistical comparison was carried out using the Chi-square or Fisher’s exact tests and Independent Student’s t-test where appropriate. The onset of both sensory and motor block was slower in the magnesium group. The duration of spinal anaesthesia (246 vs. 284) and motor block (186.3 vs. 210) were significantly longer in the magnesium group. Total analgesic top up requirement was less in group M. Hemodynamic parameters were similar in both the groups. Intrathecal magnesium caused minimal side effects. Since Fentanyl and other opioid congeners are not available throughout the country easily, magnesium with its easy availability and less side effect profile can be a cost effective alternative to fentanyl in managing pregnancy induced hypertension (PIH) patients given along with Bupivacaine intrathecally in caesarean section.

Keywords: Analgesia, magnesium, preeclampsia, spinal anaesthesia.

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