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Anesthesia and consciousness

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https://www.readbyqxmd.com/read/28092321/dexmedetomidine-disrupts-the-local-and-global-efficiencies-of-large-scale-brain-networks
#1
Javeria A Hashmi, Marco L Loggia, Sheraz Khan, Lei Gao, Jieun Kim, Vitaly Napadow, Emery N Brown, Oluwaseun Akeju
BACKGROUND: A clear understanding of the neural basis of consciousness is fundamental to research in clinical and basic neuroscience disciplines and anesthesia. Recently, decreased efficiency of information integration was suggested as a core network feature of propofol-induced unconsciousness. However, it is unclear whether this finding can be generalized to dexmedetomidine, which has a different molecular target. METHODS: Dexmedetomidine was administered as a 1-μg/kg bolus over 10 min, followed by a 0...
January 16, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28092095/noradrenergic-transmission-in-the-central-medial-thalamic-nucleus-modulates-the-electroencephalographic-activity-and-emergence-from-propofol-anesthesia-in-rats
#2
Bao Fu, Tian Yu, Jie Yuan, Xingrui Gong, Mazhong Zhang
At present, the mechanisms by which general anesthetics causing loss of consciousness remain unclear. The central medial thalamic nucleus (CMT) is a rarely studied component of the midline thalamic complex, which is deemed to be a part of the nonspecific arousal system. Despite the fact that CMT participates in modulating arousal and receives excitatory noradrenergic projections from locus coeruleus (LC), it remains unknown whether the noradrenergic pathway in the CMT takes part in modulating the arousal system...
January 16, 2017: Journal of Neurochemistry
https://www.readbyqxmd.com/read/28070000/anesthesia-technique-and-outcomes-of-mechanical-thrombectomy-in-patients-with-acute-ischemic-stroke
#3
Kimon Bekelis, Symeon Missios, Todd A MacKenzie, Stavropoula Tjoumakaris, Pascal Jabbour
BACKGROUND AND PURPOSE: The impact of anesthesia technique on the outcomes of mechanical thrombectomy for acute ischemic stroke remains an issue of debate. We investigated the association of general anesthesia with outcomes in patients undergoing mechanical thrombectomy for ischemic stroke. METHODS: We performed a cohort study involving patients undergoing mechanical thrombectomy for ischemic stroke from 2009 to 2013, who were registered in the New York Statewide Planning and Research Cooperative System database...
January 9, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28069540/multi-modal-analysis-of-functional-connectivity-and-cerebral-blood-flow-reveals-shared-and-unique-effects-of-propofol-in-large-scale-brain-networks
#4
Maolin Qiu, Dustin Scheinost, Ramachandran Ramani, R Todd Constable
Anesthesia-induced changes in functional connectivity and cerebral blow flow (CBF) in large-scale brain networks have emerged as key markers of reduced consciousness. However, studies of functional connectivity disagree on which large-scale networks are altered or preserved during anesthesia, making it difficult to find a consensus amount studies. Additionally, pharmacological alterations in CBF could amplify or occlude changes in connectivity due to the shared variance between CBF and connectivity. Here, we used data-driven connectivity methods and multi-modal imaging to investigate shared and unique neural correlates of reduced consciousness for connectivity in large-scale brain networks...
January 6, 2017: NeuroImage
https://www.readbyqxmd.com/read/28059836/neurally-mediated-syncope-during-cesarean-delivery-a-case-report
#5
Seiko Sato, Erisa Nakamori, Go Kusumoto, Kenji Shigematsu, Ken Yamaura
A 28-year-old woman with preeclampsia at 32 weeks of gestation underwent a cesarean delivery under spinal anesthesia. Administration of nitroglycerin at 200 μg to relax uterine smooth muscles and the application of fundal pressure led to severe bradycardia and loss of consciousness, followed by cardiac arrest. Delivery was completed immediately and recovery was achieved 10 seconds later following cardiopulmonary resuscitation. Neurally mediated syncope was considered the cause of cardiac arrest. Anesthetists should be aware of the potential risk during cesarean delivery following the administration of nitroglycerin, fundal pressure, regional anesthesia, and hypovolemia because of preeclampsia...
January 4, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28056870/anti-n-methyl-d-aspartate-receptor-nmdar-antibody-encephalitis-presents-in-atypical-types-and-coexists-with-neuromyelitis-optica-spectrum-disorder-or-neurosyphilis
#6
Kaiyu Qin, Wenqing Wu, Yuming Huang, Dongmei Xu, Lei Zhang, Bowen Zheng, Meijuan Jiang, Cheng Kou, Junhua Gao, Wurong Li, Jinglin Zhang, Sumei Wang, Yanfei Luan, Chaoling Yan, Dan Xu, Xinmei Zheng
BACKGROUND: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a clinically heterogeneous disorder characterized by epileptic seizures, psychosis, dyskinesia, consciousness impairments, and autonomic instability. Symptoms are always various. Sometimes it presents in milder or incomplete forms. We report 4 cases of anti-NMDAR encephalitis with incomplete forms, 3 cases of which were accompanied by neuromyelitis optica spectrum disorder or neurosyphilis respectively. CASE PRESENTATION: A 33-year-old man presented with dysarthria, movement disorder and occasional seizures...
January 5, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28056813/hemodynamic-effects-of-intraoperative-anesthetics-administration-in-photothrombotic-stroke-model-a-study-using-laser-speckle-imaging
#7
Hongyang Lu, Yao Li, Bin Bo, Lu Yuan, Xiaodan Lu, Hangdao Li, Shanbao Tong
BACKGROUND: Previous neuroimaging studies have shown the hemodynamic effect of either preconditioning or postconditioning anesthesia in ischemic stroke model. However, the anesthetic effect in hemodynamics during and immediately after the stroke modeling surgery remains unknown due to the lack of appropriate anesthesia-free stroke model and intraoperative imaging technology. In the present study, we utilized our recently developed photothrombotic model of focal cerebral ischemia in conscious and freely moving rats, and investigated transient hemodynamic changes with or without isoflurane administration...
January 5, 2017: BMC Neuroscience
https://www.readbyqxmd.com/read/28040235/-the-effect-of-palonosetron-on-rocuronium-induced-withdrawal-movement
#8
Ki-Bum Park, Younghoon Jeon, Junggu Yi, Ji-Hyun Kim, Seung-Yeon Chung, Kyung-Hwa Kwak
BACKGROUND: Rocuronium causes pain and withdrawal movement during induction of anesthesia. In this study, palonosetron was investigated to have analgesic effect on the reduction of rocuronium-induced withdrawal movement. METHODS: 120 patients were randomly assigned to one of three groups to receive either saline, lidocaine 20mg, or palonosetron 0.075mg with a tourniquet applied two minutes before thiopental sodium (5mg·kg(-1)) was given intravenously. After loss of consciousness, rocuronium (0...
December 29, 2016: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28033111/improved-spectrum-analysis-in-eeg-for-measure-of-depth-of-anesthesia-based-on-phase-rectified-signal-averaging
#9
Quan Liu, Yi-Feng Chen, Shou-Zen Fan, Maysam F Abbod, Jiann-Shing Shieh
The definition of the depth of anesthesia (DOA) is still controversial and its measurement is not completely standardized in modern anesthesia. Power spectral analysis is an important method for feature detection in electroencephalogram (EEG) signals. Several spectral parameters derived from EEG have been proposed for measuring DOA in clinical applications. In the present paper, an improved method based on phase-rectified signal averaging (PRSA) is designed to improve the predictive accuracy of relative alpha and beta power, a frequency band power ratio, total power, median frequency (MF), spectral edge frequency 95 (SEF95), and spectral entropy for assessing anesthetic drug effects...
December 29, 2016: Physiological Measurement
https://www.readbyqxmd.com/read/27993673/propofol-attenuates-low-frequency-fluctuations-of-resting-state-fmri-bold-signal-in-the-anterior-frontal-cortex-upon-loss-of-consciousness
#10
Xiaolin Liu, Kathryn K Lauer, B Douglas Ward, Christopher Roberts, Suyan Liu, Suneeta Gollapudy, Robert Rohloff, William Gross, Guangyu Chen, Zhan Xu, Jeffrey R Binder, Shi-Jiang Li, Anthony G Hudetz
Recent studies indicate that spontaneous low-frequency fluctuations (LFFs) of resting-state functional magnetic resonance imaging (rs-fMRI) blood oxygen level-dependent (BOLD) signals are driven by the slow (<0.1Hz) modulation of ongoing neuronal activity synchronized locally and across remote brain regions. How regional LFFs of the BOLD fMRI signal are altered during anesthetic-induced alteration of consciousness is not well understood. Using rs-fMRI in 15 healthy participants, we show that during administration of propofol to achieve loss of behavioral responsiveness indexing unconsciousness, the fractional amplitude of LFF (fALFF index) was reduced in comparison to wakeful baseline in the anterior frontal regions, temporal pole, hippocampus, parahippocampal gyrus, and amygdala...
December 16, 2016: NeuroImage
https://www.readbyqxmd.com/read/27992862/endobronchial-valves-for-endoscopic-lung-volume-reduction-best-practice-recommendations-from-expert-panel-on-endoscopic-lung-volume-reduction
#11
Dirk-Jan Slebos, Pallav L Shah, Felix J F Herth, Arschang Valipour
Endoscopic lung volume reduction (ELVR) is being adopted as a treatment option for carefully selected patients suffering from severe emphysema. ELVR with the one-way endobronchial Zephyr valves (EBV) has been demonstrated to improve pulmonary function, exercise capacity, and quality of life in patients with both heterogeneous and homogenous emphysema without collateral ventilation. In this "expert best practices" review, we will highlight the practical aspects of this therapy. Key selection criteria for ELVR are hyperinflation with a residual volume >175% of predicted, forced expiratory volume <50% of predicted, and a 6-min walking distance >100 m...
December 20, 2016: Respiration; International Review of Thoracic Diseases
https://www.readbyqxmd.com/read/27989710/death-related-to-dental-treatment-a-systematic-review
#12
Nathan G Reuter, Philip M Westgate, Mark Ingram, Craig S Miller
OBJECTIVE: The aim of this study was to identify factors associated with death in relation to dental care. STUDY DESIGN: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Dental and Oral Sciences Source, Web of Science, and the Cochrane database were searched, and the references of all retrieved articles were analyzed. Studies were included if death had occurred within 90 days of the dental appointment, and if the patient's age, procedure, and information regarding cause or time of death were provided...
November 2, 2016: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
https://www.readbyqxmd.com/read/27989078/intravenous-recombinant-tissue-plasminogen-activator-therapy-for-acute-basilar-artery-ischemic-stroke-following-transfemoral-transcatheter-aortic-valve-implantation
#13
Nicholas J Montarello, Adam J Nelson, Samuel L Sidharta, Stephen G Worthley
Transcatheter aortic valve implantation (TAVI) can now be considered a standard of care for inoperable and high-risk surgical patients with severe aortic stenosis, and its uptake worldwide is rapidly increasing. Indeed, many centers performing the procedure have now moved towards treating intermediate-risk patients with TAVI rather than referring them for surgical aortic valve replacement. Although the incidence of peri-procedural acute and subacute stroke following TAVI has fallen to 2-5%, its occurrence can be life-threatening and life-changing, and every effort must be made to improve patient outcome should stroke occur...
January 2016: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/27984382/diagnostic-yield-and-complications-of-ebus-tbna-performed-under-bronchoscopist-directed-conscious-sedation-single-center-experience-of-1004-subjects
#14
Sahajal Dhooria, Inderpaul S Sehgal, Nalini Gupta, Ashutosh N Aggarwal, Digambar Behera, Ritesh Agarwal
BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can be performed under either conscious sedation or general anesthesia. Herein, we describe the diagnostic yield and complications of EBUS-TBNA performed under bronchoscopist-directed conscious sedation. METHODS: This is a retrospective analysis of data collected in the bronchoscopy suite of this center on EBUS-TBNA or endoscopic ultrasound with a bronchoscope-guided fine needle aspiration (EUS-B-FNA) procedures performed between July 2011 and January 2016...
January 2017: Journal of Bronchology & Interventional Pulmonology
https://www.readbyqxmd.com/read/27984262/incidence-of-connected-consciousness-after-tracheal-intubation-a-prospective-international-multicenter-cohort-study-of-the-isolated-forearm-technique
#15
Robert D Sanders, Amy Gaskell, Aeyal Raz, Joel Winders, Ana Stevanovic, Rolf Rossaint, Christina Boncyk, Aline Defresne, Gabriel Tran, Seth Tasbihgou, Sascha Meier, Phillip E Vlisides, Hussein Fardous, Aaron Hess, Rebecca M Bauer, Anthony Absalom, George A Mashour, Vincent Bonhomme, Mark Coburn, Jamie Sleigh
BACKGROUND: The isolated forearm technique allows assessment of consciousness of the external world (connected consciousness) through a verbal command to move the hand (of a tourniquet-isolated arm) during intended general anesthesia. Previous isolated forearm technique data suggest that the incidence of connected consciousness may approach 37% after a noxious stimulus. The authors conducted an international, multicenter, pragmatic study to establish the incidence of isolated forearm technique responsiveness after intubation in routine practice...
December 15, 2016: Anesthesiology
https://www.readbyqxmd.com/read/27973590/investigating-power-density-and-the-degree-of-nonlinearity-in-intrinsic-components-of-anesthesia-eeg-by-the-hilbert-huang-transform-an-example-using-ketamine-and-alfentanil
#16
Feng-Fang Tsai, Shou-Zen Fan, Yi-Shiuan Lin, Norden E Huang, Jia-Rong Yeh
Empirical mode decomposition (EMD) is an adaptive filter bank for processing nonlinear and non-stationary signals, such as electroencephalographic (EEG) signals. EMD works well to decompose a time series into a set of intrinsic mode functions with specific frequency bands. An IMF therefore represents an intrinsic component on its correspondingly intrinsic frequency band. The word of 'intrinsic' means the frequency is totally adaptive to the nature of a signal. In this study, power density and nonlinearity are two critical parameters for characterizing the amplitude and frequency modulations in IMFs...
2016: PloS One
https://www.readbyqxmd.com/read/27911815/nicotinic-receptors-in-mouse-prefrontal-cortex-modulate-ultraslow-fluctuations-related-to-conscious-processing
#17
Fani Koukouli, Marie Rooy, Jean-Pierre Changeux, Uwe Maskos
The prefrontal cortex (PFC) plays an important role in cognitive processes, including access to consciousness. The PFC receives significant cholinergic innervation and nicotinic acetylcholine receptors (nAChRs) contribute greatly to the effects of acetylcholine signaling. Using in vivo two-photon imaging of both awake and anesthetized mice, we recorded spontaneous, ongoing neuronal activity in layer II/III in the PFC of WT mice and mice deleted for different nAChR subunits. As in humans, this activity is characterized by synchronous ultraslow fluctuations and neuronal synchronicity is disrupted by light general anesthesia...
December 20, 2016: Proceedings of the National Academy of Sciences of the United States of America
https://www.readbyqxmd.com/read/27903341/-the-application-of-conscious-sedation-with-a-small-dose-of-dexmedetomidine-and-sufentanil-in-elderly-patients-undergoing-multiple-intestinal-polyps-resection
#18
C M Shi, Y D Zhou, M Xu, X D Wang, L M Meng, X J Liu, X Y Guo
Objective: To explore the effectiveness and feasibility of conscious sedation with a low dose of dexmedetomidine and sufentanil during multiple intestinal polyps resection in elderly patients. Methods: Sixty elderly patients who underwent multiple intestinal polyps resection in Peking University Third Hospital from Janurary to May 2016 were randomly divided into dexmedetomidine group (D group, n=30) and propofol group (P group, n=30). There were 28 males and 32 females with a mean age of (70.4±4.5) years old (range: 65-80 years old)...
November 22, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/27898546/lateral-position-for-cesarean-delivery-because-of-severe-aortocaval-compression-in-a-patient-with-marfan-syndrome-a-case-report
#19
John C Coffman, Russell L Legg, Catherine F Coffman, Kenneth R Moran
Prompt recognition and management of hypotension resulting from aortocaval compression syndrome are essential to optimize the maternal and fetal outcomes. Management involves increasing leftward uterine displacement and sometimes full lateral positioning, although lateral position during cesarean delivery is typically considered to be impractical. We report an obstetric patient case of severe aortocaval compression syndrome resulting in hypotension and loss of consciousness that ultimately underwent cesarean delivery under general anesthesia in the lateral position...
November 28, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27893492/safety-of-local-intracutaneous-lidocaine-anesthesia-used-by-dermatologic-surgeons-for-skin-cancer-excision-and-postcancer-reconstruction-quantification-of-standard-injection-volumes-and-adverse-event-rates
#20
Murad Alam, Matthew R Schaeffer, Amelia Geisler, Emily Poon, Scott W Fosko, Divya Srivastava
BACKGROUND: Intracutaneous lidocaine is used for anesthesia in dermatologic surgery for skin cancer excision and repair with exceedingly low incidence of reported adverse events. OBJECTIVE: To measure (1) the quantity of lidocaine typically used for facial skin cancer excision and reconstruction; and (2) the frequency and character of associated adverse events. METHODS: Survey study of dermatologic surgeons with longitudinal reporting. Reported practice during 10 business days: (1) mean volume of 1% lidocaine per skin cancer excision; (2) maximum per excision; (3) mean per reconstruction; and (4) maximum per reconstruction...
December 2016: Dermatologic Surgery: Official Publication for American Society for Dermatologic Surgery [et Al.]
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