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1761. The bispectral index declines during neuromuscular block in fully awake persons. (Abstract)

of BIS coincided with the reappearance of spontaneous electromyographic activity. During the entire experiment, the volunteers had full consciousness. BIS, assessed by software Version 3.31, correlates with spontaneous electromyographic activity of the facial muscles. BIS failed to detect awareness in completely paralyzed subjects. Thus, in paralyzed patients, BIS monitoring may not reliably indicate a decline in sedation and imminent awareness.The bispectral index (BIS) is an electroencephalographic (...) variable intended for measuring depth of anesthesia. Electromyographic activity influences the calculation of BIS. We found that the administration of a muscle relaxant to unanesthetized volunteers decreases the bispectral index value. Thus, awareness in totally paralyzed patients cannot be excluded.

2003 Anesthesia and Analgesia

1762. Gastrointestinal symptoms secondary to implanted spinal cord stimulators. (Abstract)

Gastrointestinal symptoms secondary to implanted spinal cord stimulators. We report severe gastrointestinal symptoms in two patients who had implanted spinal cord stimulators. These side effects were severe enough to require cessation of the stimulation, even though the patients reported significantly improved analgesia. It is important for clinicians caring for patients with these devices to be aware of these potentially severe side effects.

2003 Anesthesia and Analgesia

1763. Sino-atrial block during anesthesia in a patient with breast cancer being treated with the anticancer drug epirubicin. (Abstract)

Sino-atrial block during anesthesia in a patient with breast cancer being treated with the anticancer drug epirubicin. Epirubicin, an anticancer drug, causes cardiotoxicity. We reported a case of sino-atrial block during general anesthesia in a woman with breast cancer who had received epirubicin. Anesthesiologists should be aware of the possible occurrence of sino-atrial block with epirubicin, and planting a pacemaker might be considered even in asymptomatic patients.

2003 Anesthesia and Analgesia

1764. Omitting nitrous oxide in general anaesthesia: meta-analysis of intraoperative awareness and postoperative emesis in randomized controlled trials

Omitting nitrous oxide in general anaesthesia: meta-analysis of intraoperative awareness and postoperative emesis in randomized controlled trials Omitting nitrous oxide in general anaesthesia: meta-analysis of intraoperative awareness and postoperative emesis in randomized controlled trials Omitting nitrous oxide in general anaesthesia: meta-analysis of intraoperative awareness and postoperative emesis in randomized controlled trials Tramer M, Moore A, McQuay H Authors' objectives To carry out (...) were not sought, and abstracts were not considered. Study selection Study designs of evaluations included in the review RCTs were included. Specific interventions included in the review Administration of general anaesthetic with and without nitrous oxide. Participants included in the review Surgical patients, adults and paediatrics were included. Outcomes assessed in the review Post-operative nausea and vomiting or retching (early and late, i.e. 6 and 48 hours). Intra-operative awareness. How were

1996 DARE.

1765. Anesthesia awareness and the bispectral index. (Abstract)

Anesthesia awareness and the bispectral index. Awareness during anesthesia is a serious complication with potential long-term psychological consequences. Use of the bispectral index (BIS), developed from a processed electroencephalogram, has been reported to decrease the incidence of anesthesia awareness when the BIS value is maintained below 60. In this trial, we sought to determine whether a BIS-based protocol is better than a protocol based on a measurement of end-tidal anesthetic gas (ETAG (...) ) for decreasing anesthesia awareness in patients at high risk for this complication.We randomly assigned 2000 patients to BIS-guided anesthesia (target BIS range, 40 to 60) or ETAG-guided anesthesia (target ETAG range, 0.7 to 1.3 minimum alveolar concentration [MAC]). Postoperatively, patients were assessed for anesthesia awareness at three intervals (0 to 24 hours, 24 to 72 hours, and 30 days after extubation).We assessed 967 and 974 patients from the BIS and ETAG groups, respectively. Two cases of definite

2008 NEJM Controlled trial quality: predicted high

1766. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. (Abstract)

Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Awareness is an uncommon complication of anaesthesia, affecting 0.1-0.2% of all surgical patients. Bispectral index (BIS) monitoring measures the depth of anaesthesia and facilitates anaesthetic titration. In this trial we determined whether BIS-guided anaesthesia reduced the incidence of awareness during surgery in adults.We did a prospective, randomised, double-blind, multicentre (...) trial. Adult patients at high risk of awareness were randomly allocated to BIS-guided anaesthesia or routine care. Patients were assessed by a blinded observer for awareness at 2-6 h, 24-36 h, and 30 days after surgery. An independent committee, blinded to group identity, assessed every report of awareness. The primary outcome measure was confirmed awareness under anaesthesia at any time.Of 2463 eligible and consenting patients, 1225 were assigned to the BIS group and 1238 to the routine care group

2004 Lancet Controlled trial quality: predicted high

1767. Awareness during anesthesia (Full text)

Awareness during anesthesia 18073268 2008 02 05 2018 11 13 1488-2329 178 2 2008 Jan 15 CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne CMAJ Awareness during anesthesia. 185-8 Orser Beverley A BA Department of Anesthesia, University of Toronto, Toronto, Ont. beverley.orser@utoronto.ca Mazer C David CD Baker Andrew J AJ eng Journal Article Research Support, Non-U.S. Gov't Review 2007 12 11 Canada CMAJ 9711805 0820-3946 0 Anesthetics AIM IM Anesthesia (...) , General adverse effects methods Anesthetics administration & dosage adverse effects Awareness drug effects Female Humans Intraoperative Period Male Monitoring, Intraoperative instrumentation methods Patient Satisfaction Postoperative Period Risk Assessment Sensitivity and Specificity 17 2007 12 13 9 0 2008 2 6 9 0 2007 12 13 9 0 ppublish 18073268 cmaj.071761 10.1503/cmaj.071761 PMC2175003 Lancet. 2000 Feb 26;355(9205):707-11 10703802 Pharmacol Biochem Behav. 2008 Jul;90(1):105-12 18201756 Hippocampus

2008 CMAJ : Canadian Medical Association Journal PubMed abstract

1768. Recovery from bispectral index-guided anaesthesia in a large randomized controlled trial of patients at high risk of awareness. (Full text)

Recovery from bispectral index-guided anaesthesia in a large randomized controlled trial of patients at high risk of awareness. Electroencephalographic monitors of anaesthetic depth are reported to assist anaesthetists in reducing recovery times. We explored the effect of bispectral index (BIS) monitoring on recovery times in a double-blind, randomized controlled trial of 2,463 patients at high risk of awareness. Patients were randomized to BIS-guided anaesthesia or routine care. In the BIS

2005 Anaesthesia and intensive care Controlled trial quality: predicted high PubMed abstract

1769. The effects of two different anaesthesia techniques on bispectral index values and awareness during off-pump coronary artery bypass grafting. (Abstract)

The effects of two different anaesthesia techniques on bispectral index values and awareness during off-pump coronary artery bypass grafting. The aim of this study was to evaluate Bispectral Index values and awareness during two different anaesthesia regimens (fentanyl-propofol and fentanyl-midazolam) in patients undergoing off-pump CABG surgery.Fifty patients were included in the study. Patients were premedicated with midazolam and were randomly divided into two groups. Anaesthesia was induced (...) index values were recorded for nine phases. Twenty-four hours after the operation, the patients were interviewed to determine intraoperative awareness and recall.In all patients, Bispectral index values were found to decrease after induction (in Group I, p = 0.005, in Group II, p = 0.008) with the mean values remaining below 60 for all phases. The differences between the groups were not statistically significant in inter-group comparison. No patients were noted to recall the sounds presented during

2004 Journal of clinical monitoring and computing Controlled trial quality: uncertain

1770. Awareness and the EEG power spectrum: analysis of frequencies. (Full text)

Awareness and the EEG power spectrum: analysis of frequencies. Power spectral analysis is a well-established method for the analysis of EEG signals. Spectral parameters can be used to quantify pharmacological effects of anaesthetics on the brain and the level of sedation. This method, in numerous variations, has been applied to depth of anaesthesia monitoring and has been incorporated into several commercially available EEG monitors. Because of the importance of EEG spectral analysis, we (...) evaluated the performance of each frequency in the power spectrum regarding detection of awareness.Ninety artefact-free EEG segments of length 8 s were obtained from a database that contains perioperatively recorded EEG data. For the present analysis, EEG data were selected from 39 patients with propofol-remifentanil or sevoflurane-remifentanil anaesthesia with a period of awareness. Half of the EEG segments were recorded during periods of awareness as defined by an adequate response to the command

2004 British Journal of Anaesthesia Controlled trial quality: uncertain PubMed abstract

1771. Narcotrend does not adequately detect the transition between awareness and unconsciousness in surgical patients. (Abstract)

Narcotrend does not adequately detect the transition between awareness and unconsciousness in surgical patients. The Narcotrend index (MonitorTechnik, Bad Bramstedt, Germany) is a dimensionless number between 0 and 100 that is calculated from the electroencephalogram and inversely correlates with depth of hypnosis. The current study evaluates the capability of the Narcotrend to separate awareness from unconsciousness at the transition between these levels.Electroencephalographic recordings (...) and return of consciousness were found. In group 1, Narcotrend values were significantly higher than in group 3. Prediction probability was 0.501.In these challenging data, the Narcotrend did not differentiate between awareness and unconsciousness. In addition, Narcotrend values were not independent from the anesthetic regimen.

2004 Anesthesiology Controlled trial quality: uncertain

1772. Dreaming during anaesthesia in patients at high risk of awareness. (Abstract)

Dreaming during anaesthesia in patients at high risk of awareness. Dreaming during anaesthesia is commonly reported but remains poorly understood. In this study, adult surgical patients at high risk of awareness were randomly assigned to receive bispectral index (BIS)-guided anaesthesia or routine care, and were interviewed about dreaming three times postoperatively. Dreaming patients (n = 134) were compared with all other patients who were interviewed at least once (n = 2251). Intraoperative

2005 Anaesthesia Controlled trial quality: uncertain

1773. Awareness and memory function during paediatric anaesthesia. (Full text)

Awareness and memory function during paediatric anaesthesia. Previous research indicates a much higher incidence of awareness during anaesthesia in children than in adults. The present study is the first large-scale, intraoperative assessment of awareness during paediatric anaesthesia using the isolated forearm technique, and the first large-scale study of memory function during paediatric anaesthesia.One hundred and eighty-four children, 5-18 yr, underwent the isolated forearm technique during (...) questionnaires.No child had explicit recall of intraoperative events on recovery, and there was no evidence of implicit memory for words presented during anaesthesia. Two of 184 children made unambiguous and verified responses on the modified isolated forearm technique, an incidence of intraoperative awareness of 1.1%. One of these children reported that he was uncomfortable and not completely unconscious during surgery. Neither child had implicit memory for the neutral words, or adverse behaviour change.The

2008 British Journal of Anaesthesia PubMed abstract

1774. Crisis management during anaesthesia: awareness and anaesthesia. (Full text)

Crisis management during anaesthesia: awareness and anaesthesia. Patient awareness during general anaesthesia has considerable potential for severe emotional distress in the patient as well as professional, personal, and financial consequences for the anaesthetist.To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK", supplemented by a specific sub-algorithm for awareness, in the detection and management of potential awareness in association with general (...) anaesthesia.The potential performance of this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved.Of the first 4000 reports received by AIMS, there were 21 incidents of patient awareness under general anaesthesia, and 20 of patients being paralysed while awake from "syringe swaps" before induction of anaesthesia. In 12 of the 21 reports

2005 Quality and Safety in Health Care PubMed abstract

1775. The association of a decreased level of awareness and blood alcohol concentration with both agitation and sedation in intoxicated patients in the ED. (Abstract)

The association of a decreased level of awareness and blood alcohol concentration with both agitation and sedation in intoxicated patients in the ED. This study was conducted to compare the level of awareness as determined by serial bispectral index (BIS) electroencephalogram scores to a standardized Altered Mental Status (AMS) scale used to define a patient's clinical level of agitation or sedation, and the patient's concurrent breath/blood alcohol concentration (BAC).This was an institutional (...) (SD, 0.07; range, 0.049-0.43). The mean BIS index varied from 59.6 +/- 16.9 for AMS scores of -4, to 96.3 +/- 2.7 for AMS scores of 0, to 90.5 +/- 4.9 for AMS scores of 4. The AMS scale correlated with the BIS scale (Spearman's rho = 0.67, P < or = .001), but did not correlate with BAC (Spearman's rho = -0.14, P = 0.15).Changes in the AMS scale corresponded to changes in the BIS index score. A decreased level of awareness, as determined on the BIS index, was observed in patients who were either

2007 American Journal of Emergency Medicine

1776. Use of the bispectral index to predict a positive awareness reaction to laryngeal mask airway-Fastrach insertion and intubation. (Abstract)

Use of the bispectral index to predict a positive awareness reaction to laryngeal mask airway-Fastrach insertion and intubation. To determine whether the bispectral index (BIS) can be monitored to predict and indicate an awareness reaction to laryngeal mask airway-Fastrach (LMA-Fastrach) insertion and intubation at BIS values between 40 and 60.Fifty-one American Society of Anesthesiologists' (ASA) class I or II status patients aged over 20 years were included in this study. Midazolam 0.1 mg/kg (...) was given for pre-medication, 30 min before induction. For induction, a 0.1-microg/kg bolus injection of remifentanil was followed by infusion, and propofol was administered until the eyelash reflex disappeared; the infusion rate was adjusted to maintain BIS values between 40 and 60. Loss of the eyelash reflex, loss of response to verbal commands, yawning and total propofol consumption were recorded. Patients were tested for awareness twice at 1-min intervals using the isolated forearm technique

2007 Acta Anaesthesiologica Scandinavica

1777. Attitudes of anaesthetists to awareness and depth of anaesthesia monitoring in the UK. (Abstract)

Attitudes of anaesthetists to awareness and depth of anaesthesia monitoring in the UK. Awareness with postoperative recall of intraoperative events is a rare but serious complication of general anaesthesia. This survey investigated the attitude of anaesthetists in the UK to awareness and depth of anaesthesia monitoring.Questionnaires were sent to 4927 consultant anaesthetists in 285 hospitals in the UK in September 2004. The responses were recorded in an electronic database, summarized (...) and compared with the results of studies performed in Australia and the USA.The response rate was 44%. When judged against published awareness rates, anaesthetists underestimated the incidence of awareness in their own practice (median 1: 5000). One-third of respondents have dealt with patients who have experienced intraoperative recall. The majority of anaesthetists perceived awareness as a minor problem on an 11-point scale (modal score 2, median score 3, IQR 2-5). Eighty-six percent of anaesthetists

2006 European Journal of Anaesthesiology

1778. Detecting awareness in children by using an auditory intervention. (Full text)

Detecting awareness in children by using an auditory intervention. The incidence of awareness has been reported to be higher in children than in adults. Accurately assessing awareness in children is difficult, and the lack of a specific measure of awareness makes it difficult to determine exactly how many and why children are aware. The aim of this study was to determine the incidence and timing of awareness in children by using auditory stimuli applied during anesthesia.Three easily identified (...) animal noises were played repeatedly through headphones during three specific phases of anesthesia in 539 children aged 5-12 yr. Children were not told that this would happen. Awareness was determined with a structured interview on days 1 and 3 after the anesthetic. All positive responses were sent to four adjudicators for assessment, and awareness was defined as having occurred if all adjudicators agreed that the child was aware.Five hundred children were interviewed at least once after

2008 Anesthesiology PubMed abstract

1779. Intraoperative awareness during paediatric anaesthesia. (Full text)

Intraoperative awareness during paediatric anaesthesia. Previous studies indicate a higher incidence of awareness during anaesthesia in children than in adults, that is, around 1% vs 0.2%. In this prospective cohort study, we determined the incidence of intraoperative awareness in children undergoing elective or emergency surgery at a university children's hospital.Data from 928 consecutive paediatric patients, aged 5-18 yr, were collected prospectively over a 12 month period. Interviews using (...) a structured questionnaire were scheduled at three time points: within 24 h after the operation, and 3-7 and 30 days after operation. Reports of suspected awareness were sent to four independent adjudicators. If they all agreed, the case was classified as a true awareness case.The interviews generated 26 cases of suspected awareness. Six cases were judged to be true awareness, equalling a 0.6% incidence (95% confidence interval 0.03-1.40%). Auditory and sensory perceptions were the sensations most reported

2008 British Journal of Anaesthesia PubMed abstract

1780. Awareness with recall during general anaesthesia: a prospective observational evaluation of 4001 patients. (Full text)

Awareness with recall during general anaesthesia: a prospective observational evaluation of 4001 patients. We have prospectively evaluated the incidence and characteristics of awareness with recall (AWR) during general anaesthesia in a tertiary care hospital.This study involves a prospective observational investigation of AWR in patients undergoing general anaesthesia. Blinded structured interviews were conducted in the postanaesthesia care unit, on postoperative day 7 and day 30. Definition (...) of AWR was 'when the patient stated or remembered that he or she had been awake at a time when consciousness was not intended'. Patient characteristics, perioperative, and drug-related factors were investigated. Patients were classified as not awake during surgery, AWR, AWR-possible, AWR-not evaluable. The perceived quality of the awareness episode, intraoperative dreaming, and sequelae were investigated. The anaesthetic records were reviewed to search for data that might explain the awareness

2008 British Journal of Anaesthesia PubMed abstract

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