BJA open最新文献_第2页

Both the extended neck position and insertion of a supraglottic airway device increases the height of the cricothyroid membrane in females. A prospective observational study 颈部位置的延长和声门上气道装置的插入都增加了女性环甲膜的高度。一项前瞻性观察研究。

BJA open

Pub Date : 2024-12-20 DOI: 10.1016/j.bjao.2024.100364

Ankita Miglani , Sandeep Miglani , Hassan M. Tawfik , Thomas Drew

Background

Emergency Front of Neck access (eFONA) via cricothyroidotomy using a size 6 internal diameter tracheal tube is recommended by the Difficult Airway Society in the event of a ‘can't intubate, can't oxygenate’ (CICO) scenario in adults. There is a lack of clear guidance on whether to retain or remove a previously inserted supraglottic airway device (SAD) before eFONA. We aimed to study the effect of both neck extension and insertion of an SAD on sagittal cricothyroid membrane (CTM) height.

Methods

We recruited 40 adult female patients attending for minor gynaecological surgery under general anaesthesia and suitable for an SAD. Sagittal ultrasound images of the CTM were obtained in the neutral and extended neck position, both before and after insertion of the i-gel® (160 images). The CTM height was measured from the images by a blinded assessor and the data analysed to determine the magnitude of change in CTM height and its relevance for cricothyroidotomy.

Results

There was a significant difference in the height of the CTM between the groups (P<0.001). The extended neck position accounted for 10% increase over the neutral position. Inserting an i-gel® and extending the neck increased the CTM height by 26% over neutral position, thereby lengthening it sufficiently to accommodate a size 6.0 tracheal tube in 100% of the patients.

Conclusions

Both neck extension and the insertion of an i-gel® increased the sagittal height of the CTM. This suggests there may be benefit to retaining or re-inserting an SAD during eFONA.

背景：在成人“不能插管，不能充氧”（CICO）的情况下，困难气道学会推荐使用6内径气管管经环甲状腺切开术的紧急颈前通道（eFONA）。对于在eFONA前是否保留或移除先前插入的声门上气道装置（SAD），缺乏明确的指导。我们的目的是研究颈部伸展和插入SAD对矢状环甲膜（CTM）高度的影响。方法：我们招募了40例在全身麻醉下接受小妇科手术的成年女性患者。在i-gel®植入前后，分别获得中性位和伸展颈位CTM的矢状位超声图像（160张图像）。CTM高度由盲法评估者从图像中测量，并分析数据以确定CTM高度变化的幅度及其与环甲状软骨切开术的相关性。结果：两组间CTM高度差异有统计学意义(p)。结论：颈部伸展和i-gel®植入均可增加CTM的矢状高度。这表明在eFONA期间保留或重新插入SAD可能是有益的。

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引用次数: 0

Noradrenergic suppression to reduce electroencephalographic arousal after intubation: a randomised, placebo-controlled trial 抑制去甲肾上腺素能以降低插管后的脑电唤醒：随机安慰剂对照试验。

BJA open

Pub Date : 2024-12-16 DOI: 10.1016/j.bjao.2024.100359

Kaitlin Kramer , Thomas Payne , Mitchell Brooks , Jessica Barry , Neha Mahajan , Samantha Malcolm , Hannah Braithwaite , Alex Wang , Chris Thompson , Keith Liyanagama , Robert D. Sanders

Background

Intraoperative awareness, without explicit recall, occurs after induction of anaesthesia in approximately 10% of persons under 40 yr of age. Most anaesthetic agents minimally suppress the noradrenergic system. We hypothesised that addition of dexmedetomidine, which suppresses noradrenergic activity, may reduce encephalographic (EEG) arousal in response to tracheal intubation; such an effect would lay the foundation for future studies of dexmedetomidine in reducing intraoperative awareness.

Methods

A single-site randomised, placebo-controlled trial with sex-based stratification was conducted. Participants, aged 18–40 yr old, undergoing intubation for general anaesthesia were eligible for recruitment and randomly allocated to receive dexmedetomidine or placebo. Dexmedetomidine (0.5 μg kg⁻¹) was given as a 5-min loading dose before induction. Bispectral index (BIS) values were collected during the induction phase of anaesthesia and the isolated forearm technique was used to assess patients' responsiveness before and after tracheal intubation. The primary outcome was the effect of dexmedetomidine on changes in BIS from pre-to postintubation.

Results

A total of 51 patients were recruited and included in the primary analysis. We did not observe an effect of dexmedetomidine on changes in BIS after tracheal intubation (mean difference –1.13, 95% confidence interval [CI] –4.87 to 2.62; p=0.556). Dexmedetomidine reduced the estimated plasma propofol concentration at loss of responsiveness (difference [dexmedetomidine – placebo]: –1.06 μg ml⁻¹, 95% CI –1.66 to –0.46; p<0.001) and before intubation (difference [dexmedetomidine – placebo]: –1.84 μg ml⁻¹, 95% CI –2.79 to –0.90; p<0.001). There was one patient in the placebo group who gave positive responses in the isolated forearm test before and after tracheal intubation.

Conclusions

Dexmedetomidine demonstrated an anaesthetic-sparing effect at induction of anaesthesia but did not prevent EEG arousal after tracheal intubation, as defined by an increase in the BIS value.

Clinical Trial Registration

Australia and New Zealand Clinical Trials Registry (Trial ID: ACTRN12622000754741).

背景：在 40 岁以下的人群中，约有 10% 的人在麻醉诱导后会出现术中意识，但没有明确的回忆。大多数麻醉剂对去甲肾上腺素能系统的抑制作用微乎其微。我们假设，加入右美托咪定可抑制去甲肾上腺素能活性，从而降低气管插管时的脑电图（EEG）唤醒；这种效果将为今后研究右美托咪定降低术中意识奠定基础：方法：进行了一项基于性别分层的单点随机安慰剂对照试验。年龄在18-40岁之间、接受插管全身麻醉的参与者均符合招募条件，并被随机分配接受右美托咪定或安慰剂。右美托咪定（0.5 μg kg-1）在诱导前 5 分钟以负荷剂量给药。在麻醉诱导阶段收集双谱指数（BIS）值，并在气管插管前后使用孤立前臂技术评估患者的反应性。主要结果是右美托咪定对插管前到插管后 BIS 变化的影响：共招募了 51 名患者并纳入主要分析。我们没有观察到右美托咪定对气管插管后 BIS 变化的影响（平均差-1.13，95% 置信区间 [CI] -4.87 至 2.62；P=0.556）。右美托咪定降低了失去响应时的估计血浆异丙酚浓度（差异[右美托咪定-安慰剂]：-1.06 μg ml-1，95% CI -1.66 至 -0.46；p-1，95% CI -2.79 至 -0.90；p结论：右美托咪定在麻醉诱导时显示出了节省麻醉剂的效果，但并不能防止气管插管后的脑电图唤醒，脑电图唤醒的定义是BIS值的增加：临床试验注册：澳大利亚和新西兰临床试验注册中心（试验编号：ACTRN12622000754741）。

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引用次数: 0

The unseen animal behind medicine: exploring considerations of animal-derived medications and anaesthetics in today's landscape 医学背后看不见的动物：探讨当今动物源药物和麻醉剂的考虑因素。

BJA open

Pub Date : 2024-12-16 DOI: 10.1016/j.bjao.2024.100360

Jennifer R. Wang, Eric Oh, Benjamin Aronow, Wendy K. Bernstein

Requests for medical and anaesthetic care that is ‘vegan’ or free of animal-derived components are becoming increasingly common in the cultural landscape. Such requests are often rooted in religious beliefs and practices. There are currently no requirements for the disclosure of animal-derived components in medical items. However, both patients and medical professionals agree that greater transparency regarding such items is needed in obtaining informed consent. Although the ethical argument for disclosure has been established, there remain gaps in practical guidelines in recognising animal-derived components in medical items and understanding how to avoid them. This lack of comprehensive knowledge leads to challenges in initiating conversations about appropriate medication selection.

This manuscript will outline the common dietary restrictions of various religious groups and provide instruction on common animal-derived ingredients in medications. It will also introduce potential viable animal-free alternatives for some commonly used medications in the perioperative environment which has not been done previously in the literature. Moreover, we note the broader implications and reasoning behind considering dietary restrictions in medication choices.

在文化景观中，对“纯素”或不含动物来源成分的医疗和麻醉护理的要求正变得越来越普遍。这些要求往往源于宗教信仰和习俗。目前没有要求披露医疗项目中的动物源性成分。然而，患者和医疗专业人员都认为，在获得知情同意的过程中，需要提高这类项目的透明度。尽管已经建立了披露的伦理论据，但在识别医疗物品中的动物来源成分和了解如何避免这些成分方面，在实际指导方针方面仍然存在差距。缺乏全面的知识导致在发起关于适当药物选择的对话时面临挑战。本文将概述各种宗教团体的共同饮食限制，并提供有关药物中常见动物源性成分的说明。它还将介绍一些在围手术期环境中常用药物的潜在可行的无动物替代品，这在以前的文献中还没有做过。此外，我们注意到在药物选择中考虑饮食限制的更广泛的含义和原因。

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引用次数: 0

Xenon anaesthesia is associated with a reduction in frontal electroencephalogram peak alpha frequency 氙气麻醉与额叶脑电图α峰频率降低有关

BJA open

Pub Date : 2024-12-01 DOI: 10.1016/j.bjao.2024.100358

Steven McGuigan , Andria Pelentritou , David A. Scott , Jamie Sleigh

Background

Administration of conventional anaesthetic agents is associated with changes in electroencephalogram (EEG) oscillatory dynamics, including a reduction in the peak alpha frequency. Computational models of neurones can reproduce such phenomena and are valuable tools for investigating their underlying mechanisms. We hypothesised that EEG data acquired during xenon anaesthesia in humans would show similar changes in peak alpha frequency and that computational neuronal models of recognised cellular actions of xenon would be consistent with the observed changes.

Methods

EEG recordings were obtained for 11 participants from a randomised controlled trial of xenon anaesthesia and for 21 participants from a volunteer study of xenon administration. The frontal peak alpha frequency was calculated for both cohorts at awake baseline and during xenon administration. In silico simulations with two computational models of neurones were performed to investigate how xenon antagonism of hyperpolarisation-activated cyclic nucleotide-gated channel 2 (HCN2) and glutamatergic excitatory neurotransmission would influence peak alpha frequency.

Results

Compared with awake baseline, frontal peak alpha frequency was significantly lower during xenon administration in the randomised controlled trial cohort, median (inter-quartile range) frequency 7.73 Hz (7.27–8.08 Hz) vs 8.81 Hz (8.35–9.03 Hz), P=0.012, and the volunteer cohort, 8.69 Hz (8.34–8.98 Hz) vs 9.41 Hz (9.11–9.92 Hz), P=0.001. In silico simulations with both computational models suggest that antagonism of HCN2 and glutamatergic excitatory neurotransmission are associated with a reduction in peak alpha frequency.

Conclusions

Xenon administration is associated with a reduction of peak alpha frequency in the frontal EEG. In silico simulations utilising two computational models of neurones suggest that these changes are consistent with antagonism of HCN2 and glutamatergic excitatory neurotransmission.

Clinical trial registration

The Australian New Zealand Clinical Trials Registry: ANZCTR number 12618000916246.

背景：常规麻醉药的施用与脑电图振荡动力学的变化有关，包括α峰频率的降低。神经元的计算模型可以再现这种现象，并且是研究其潜在机制的宝贵工具。我们假设人类在氙气麻醉期间获得的脑电图数据将显示出类似的α峰频率变化，并且识别氙气细胞作用的计算神经元模型将与观察到的变化一致。方法收集11例氙气麻醉随机对照试验和21例氙气给药志愿者的脑电图记录。计算两组受试者在清醒基线和氙气治疗期间的额叶α峰频率。利用两种神经元计算模型进行了计算机模拟，研究了超极化激活的环核苷酸门控通道2 （HCN2）和谷氨酸能兴奋性神经传递的氙拮抗作用如何影响α峰频率。结果与清醒基线相比，随机对照试验队列中（四分位数范围）中位频率7.73 Hz (7.27-8.08 Hz) vs 8.81 Hz （8.35-9.03 Hz）显著降低，志愿者队列中（四分位数范围）中位频率为8.69 Hz (8.34-8.98 Hz) vs 9.41 Hz (9.11-9.92 Hz)， P=0.012。两种计算模型的计算机模拟表明，HCN2和谷氨酸能兴奋性神经传递的拮抗作用与α峰频率的降低有关。结论氙气处理与额叶脑电图α峰频率降低有关。利用两种神经元计算模型的计算机模拟表明，这些变化与HCN2和谷氨酸能兴奋性神经传递的拮抗作用是一致的。临床试验注册澳大利亚新西兰临床试验注册中心：ANZCTR编号12618000916246。

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引用次数: 0

Moderate or severe pain in recovery after major elective surgery: A pilot retrospective analysis to identify those at risk 择期大手术后恢复中的中度或重度疼痛：一项识别高危人群的试点回顾性分析

BJA open

Pub Date : 2024-12-01 DOI: 10.1016/j.bjao.2024.100361

Andy Yuet Meng Ng, Thomas Emery

引用次数: 0

Association between plasma-free haemoglobin and postoperative acute kidney injury in paediatric cardiac surgery: a prospective observational study 小儿心脏手术中无血浆血红蛋白与术后急性肾损伤之间的关系：一项前瞻性观察研究

BJA open

Pub Date : 2024-10-26 DOI: 10.1016/j.bjao.2024.100348

Takanobu Sakura, Tomoyuki Kanazawa, Tatsuhiko Shimizu, Kazuyoshi Shimizu, Tatsuo Iwasaki, Hiroshi Morimatsu

Background

Acute kidney injury (AKI) is a common complication among patients requiring cardiopulmonary bypass (CPB) during paediatric cardiac surgery. Plasma-free haemoglobin (PFH) produced by haemolysis during CPB contributes to AKI. This study aimed to determine the association between PFH and postoperative AKI during paediatric cardiac surgery requiring CPB.

Methods

This prospective, single-centre, observational study included children aged <5 yr who underwent cardiac surgery requiring CPB. PFH was measured pre-CPB, every 30 min during CPB, after modified ultrafiltration, on ICU admission, and once a day at 1–3 days after surgery. The study outcome included the relationship between peak PFH concentrations and the development of postoperative AKI up to 3 days after surgery. Additionally, multivariable analysis was performed to determine the risk factors for AKI.

Results

Of 179 patients, 74 (41%) developed postoperative AKI. Patients who developed AKI had significantly higher peak PFH concentrations (80 mg dl⁻¹ [inter-quartile range, 50–132.5] vs 60 mg dl⁻¹ [40–100]; P=0.006). Multivariable analysis did not identify peak PFH concentrations as an independent risk factor for postoperative AKI (odds ratio [OR] 1.00; 95% confidence interval [CI]: 0.99–1.00; P=0.268). Factors associated with postoperative AKI were age in months (OR 0.96; 95% CI: 0.94–0.99; P=0.007) and CPB duration (OR 1.02; 95% CI: 1.01–1.02; P<0.001).

Conclusions

There was an association between postoperative AKI and CPB time rather than PFH. Perioperative peak PFH concentrations were significantly higher in patients with postoperative AKI after paediatric cardiac surgery requiring CPB.

背景急性肾损伤（AKI）是儿科心脏手术中需要进行心肺旁路术（CPB）的患者常见的并发症。CPB 期间溶血产生的无血浆血红蛋白（PFH）是导致 AKI 的原因之一。本研究旨在确定需要进行 CPB 的儿科心脏手术中 PFH 与术后 AKI 之间的关系。方法这项前瞻性、单中心、观察性研究纳入了接受需要进行 CPB 的心脏手术的 5 岁儿童。在 CPB 前、CPB 期间每 30 分钟、改良超滤后、ICU 入院时以及术后 1-3 天每天测量一次 PFH。研究结果包括 PFH 峰值浓度与术后 3 天内发生术后 AKI 的关系。结果在179名患者中，74人（41%）发生了术后AKI。发生 AKI 的患者的 PFH 峰值浓度明显更高（80 毫克/升 [四分位间范围，50-132.5] vs 60 毫克/升 [40-100]；P=0.006）。多变量分析并未发现峰值 PFH 浓度是术后 AKI 的独立风险因素（几率比 [OR] 1.00；95% 置信区间 [CI]：0.99-1.00；P=0.268）。与术后 AKI 相关的因素是以月为单位的年龄（OR 0.96；95% CI：0.94-0.99；P=0.007）和 CPB 持续时间（OR 1.02；95% CI：1.01-1.02；P<0.001）。需要 CPB 的儿科心脏手术后出现术后 AKI 的患者围术期 PFH 峰值浓度明显更高。

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引用次数: 0

Oxygen insufflation via the working channel during tracheal intubation guided by a flexible optical scope and benefits, dangers, and future of the method: a narrative review 在气管插管过程中，在柔性光学镜的引导下通过工作通道充氧，以及该方法的益处、危险和前景：叙述性综述

BJA open

Pub Date : 2024-10-17 DOI: 10.1016/j.bjao.2024.100346

Alexandre Garioud, Michael Seltz Kristensen

When performing tracheal intubation guided by a flexible optical scope, the operator may lose the anatomical orientation and hypoxia may occur. Oxygen insufflation through the working channel of the flexible optical scope is used by anaesthetists to prevent blurring of the lens and to prevent hypoxia. However, fatal iatrogenic injuries from this method are reported. Our aim is to review the current literature on oxygen insufflation through the working channel during tracheal intubation guided by a flexible optical scope, to identify its benefits and the source of its dangers, and ultimately to provide a basis for the development of a safer technique. We conducted a literature search of databases, guidelines, and textbooks using search terms related to oxygen insufflation through the working channel during intubation guided by a flexible optical scope. Clinical trials confirm that the technique results in better visibility and better oxygenation during intubation. Gastric rupture and pneumothorax were the most frequent types of injury. We identified that oxygen insufflation without pressure limitation during accidental misplacement of the flexible optical scope in the oesophagus, deep in the lower airways, or via a tear of the airway mucosa was the cause of barotrauma. We conclude that a delivered pressure below 40 cm H₂O will likely carry a low risk of serious adverse outcomes. The technique in its current form seems unsafe, and future research should aim at developing a system that delivers oxygen at pressures respecting gastric and airway physiologic pressure thresholds with a flow sufficient to obtain the documented advantages of the technique.

在柔性光学瞄准镜的引导下进行气管插管时，操作员可能会失去解剖方向，从而导致缺氧。麻醉师会通过柔性光学瞄准镜的工作通道充入氧气，以防止镜片模糊和缺氧。然而，有报道称这种方法会造成致命的先天性损伤。我们的目的是回顾目前关于在柔性光学镜引导下进行气管插管时通过工作通道充氧的文献，找出其优点和危险来源，最终为开发更安全的技术提供依据。我们对数据库、指南和教科书进行了文献检索，并使用了与在柔性光学镜引导下插管时通过工作通道充氧相关的检索词。临床试验证实，该技术能在插管过程中实现更好的可视性和更好的充氧。胃破裂和气胸是最常见的损伤类型。我们发现，在柔性光学镜意外误入食道、下呼吸道深部或气道粘膜撕裂时，在没有压力限制的情况下充氧是造成气压创伤的原因。我们的结论是，低于 40 厘米 H2O 的输送压力很可能会带来较低的严重不良后果风险。该技术目前的形式似乎并不安全，未来研究的目标应该是开发一种系统，在尊重胃和气道生理压力阈值的压力下输送氧气，并提供足够的流量，以获得该技术已被证实的优势。

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引用次数: 0

Incidence and trajectories of subclinical and KDIGO-defined postoperative acute kidney injury in patients undergoing major abdominal surgery 腹部大手术患者亚临床和 KDIGO 定义的术后急性肾损伤的发生率和轨迹

BJA open

Pub Date : 2024-10-14 DOI: 10.1016/j.bjao.2024.100345

Jakob Zeuchner , Louise Elander , Jessica Frisk , Michelle S. Chew

Background

Postoperative acute kidney injury is a common occurrence among patients undergoing major abdominal surgery and is associated with adverse outcomes. The effect of an incremental increase in serum creatinine concentration not meeting the KDIGO criteria for acute kidney injury is poorly studied. We evaluated the incidence and trajectories of postoperative subclinical acute kidney injury (sPO-AKI), acute kidney injury (PO-AKI), acute kidney disease (PO-AKD), and their relationships with chronic kidney disease (CKD), major adverse kidney events (MAKE30), and all-cause mortality at 30 days after surgery.

Methods

In a pre-planned, nested cohort sub study of the Myocardial Injury in Noncardiac Surgery in Sweden (MINSS) study, we included 588 patients from two hospitals. We determined the incidence of PO-AKI, PO-AKD, and CKD according to the ADQI-POQI consensus criteria. sPO-AKI was defined as a 25–49% increase in serum creatinine concentration within 7 days of surgery.

Results

A total of 59 (10.2%) patients fulfilled the criteria for sPO-AKI, 41 (7.1%) patients for PO-AKI, 29 (6.2%) for PO-AKD, and 6 (1.2%) for CKD. Similar proportions of patients with sPO-AKI and PO-AKI developed PO-AKD. An association was identified between the combined group of sPO-AKI and PO-AKI and 30-day mortality (Cramer's V: 0.1, P=0.037). PO-AKD (Cramer's V: 0.4, P<0.001) was associated with MAKE30 and 30-day mortality. All patients with CKD had pre-existing PO-AKD.

Conclusions

Subclinical postoperative kidney injury not fulfilling the KDIGO criteria occurred in every 10th patient, and one in 14 suffered from PO-AKI after major abdominal surgery. A majority of PO-AKD cases was preceded by sPO-AKI and PO-AKI. Early kidney injuries were associated with longer-term adverse outcomes including MAKE30, 30-day mortality, and CKD.

背景术后急性肾损伤是腹部大手术患者的常见病，与不良预后有关。对于不符合 KDIGO 急性肾损伤标准的血清肌酐浓度递增所产生的影响，目前研究较少。我们评估了术后亚临床急性肾损伤（sPO-AKI）、急性肾损伤（PO-AKI）、急性肾脏病（PO-AKD）的发生率和轨迹，以及它们与慢性肾脏病（CKD）、主要不良肾脏事件（MAKE30）和术后 30 天全因死亡率的关系。方法在瑞典非心脏手术心肌损伤（MINSS）研究的一项预先计划的巢式队列子研究中，我们纳入了两家医院的 588 名患者。我们根据 ADQI-POQI 共识标准确定了 PO-AKI、PO-AKD 和 CKD 的发生率。结果共有 59 名（10.2%）患者符合 sPO-AKI 标准，41 名（7.1%）患者符合 PO-AKI 标准，29 名（6.2%）患者符合 PO-AKD 标准，6 名（1.2%）患者符合 CKD 标准。sPO-AKI和PO-AKI患者发展为PO-AKD的比例相似。sPO-AKI 和 PO-AKI 合并组与 30 天死亡率之间存在关联（Cramer's V：0.1，P=0.037）。PO-AKD（Cramer's V：0.4，P<0.001）与 MAKE30 和 30 天死亡率相关。结论不符合 KDIGO 标准的亚临床术后肾损伤每 10 例患者中就有 1 例，腹部大手术后每 14 例患者中就有 1 例患有 PO-AKI。大多数 PO-AKD 病例在发生之前都有 sPO-AKI 和 PO-AKI。早期肾损伤与长期不良后果相关，包括MAKE30、30天死亡率和CKD。

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引用次数: 0

Deep learning models using intracranial and scalp EEG for predicting sedation level during emergence from anaesthesia 利用颅内和头皮脑电图预测麻醉后镇静水平的深度学习模型

BJA open

Pub Date : 2024-10-12 DOI: 10.1016/j.bjao.2024.100347

Lichy Han , David A. Purger , Sarah L. Eagleman , Casey H. Halpern , Vivek Buch , Samantha M. Gaston , Babak Razavi , Kimford Meador , David R. Drover

Background

Maintaining an appropriate depth of anaesthesia is important for avoiding adverse effects from undermedication or overmedication during surgery. Electroencephalography (EEG) has become increasingly used to achieve this balance. Investigating the predictive power of intracranial EEG (iEEG) and scalp EEG for different levels of sedation could increase the utility of EEG monitoring.

Methods

Simultaneous iEEG, scalp EEG, and Observer's Assessment of Alertness/Sedation (OAA/S) scores were recorded during emergence from anaesthesia in seven patients undergoing placement of intracranial electrodes for medically refractory epilepsy. A deep learning model was constructed to predict an OAA/S score of 0–2 vs 3–5 using iEEG, scalp EEG, and their combination. An additional five patients with only scalp EEG data were used for independent validation. Models were evaluated using the area under the receiver-operating characteristic curve (AUC).

Results

Combining scalp EEG and iEEG yielded significantly better prediction (AUC=0.795, P<0.001) compared with iEEG only (AUC=0.750, P=0.02) or scalp EEG only (AUC=0.764, P<0.001). The validation scalp EEG only data resulted in an AUC of 0.844. Combining the two modalities appeared to capture spatiotemporal advantages from both modalities.

Conclusions

The combination of iEEG and scalp EEG better predicted sedation level than either modality alone. The scalp EEG only model achieved a similar AUC to the combined model and maintained its performance in additional patients, suggesting that scalp EEG models are likely sufficient for real-time monitoring. Deep learning approaches using multiple leads to capture a wider area of brain activity may help augment existing EEG monitors for prediction of sedation.

背景保持适当的麻醉深度对于避免手术过程中用药不足或用药过度造成的不良影响非常重要。脑电图（EEG）越来越多地被用于实现这一平衡。研究颅内脑电图（iEEG）和头皮脑电图对不同镇静水平的预测能力可以提高脑电图监测的实用性。方法在七名因药物难治性癫痫而接受颅内电极置入手术的患者麻醉苏醒期间同时记录iEEG、头皮脑电图和观察者警觉/镇静评估（OAA/S）评分。利用 iEEG、头皮脑电图和它们的组合，构建了一个深度学习模型来预测 0-2 与 3-5 的 OAA/S 评分。另外五名只有头皮脑电图数据的患者被用于独立验证。结果与仅使用 iEEG（AUC=0.750，P=0.02）或仅使用头皮脑电图（AUC=0.764，P<0.001）相比，头皮脑电图和 iEEG 的组合预测效果明显更好（AUC=0.795，P<0.001）。仅验证头皮脑电图数据的 AUC 为 0.844。结论 iEEG 和头皮脑电图的结合比单独使用任何一种模式都能更好地预测镇静水平。仅头皮脑电图模型的 AUC 与组合模型相似，并在更多患者中保持其性能，这表明头皮脑电图模型可能足以用于实时监测。使用多导线捕捉更广泛的大脑活动区域的深度学习方法可能有助于增强现有的脑电图监护仪对镇静的预测能力。

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引用次数: 0

Association of preoperative to postoperative change in cerebrospinal fluid fibrinogen with postoperative delirium 脑脊液纤维蛋白原从术前到术后的变化与术后谵妄的关系

BJA open

Pub Date : 2024-10-05 DOI: 10.1016/j.bjao.2024.100349

Thomas Payne , Jennifer Taylor , David Kunkel , Katherine Konieczka , Frankie Ingram , Kaj Blennow , Henrik Zetterberg , Robert A. Pearce , Anke Meyer-Franke , Niccolò Terrando , Katerina Akassoglou , Robert D. Sanders , Richard C. Lennertz

Background

We aimed to assess perioperative changes in fibrinogen in the cerebrospinal fluid (CSF), their association with markers of blood–brain barrier breakdown and neuroinflammation, and their association with postoperative delirium severity.

Methods

We conducted a secondary analysis of the Interventions for Postoperative Delirium-Biomarker 2 (IPOD-B2, NCT02926417) study, a prospective observational cohort study. We included 24 patients aged >21 yr undergoing aortic aneurysm repair. CSF samples were obtained before (n=24) and after surgery (n=13), with some participants having multiple postoperative samples. Our primary outcome was the perioperative change in CSF fibrinogen. Delirium was assessed using the Delirium Rating Scale-Revised-98.

Results

CSF fibrinogen increased after surgery (P<0.001), and this was associated with an increase in CSF/plasma albumin ratio (β=1.09, 95% CI 0.47–1.71, P=0.004). The peak change in CSF fibrinogen was associated with the change in CSF interleukin (IL)-10 and IL-12p70. The peak change in CSF fibrinogen was associated with the change in CSF total tau (β=0.47, 95% CI 0.24–0.71, P=0.002); however, we did not observe an association with postoperative delirium severity (incidence rate ratio = 1.20, 95% CI 0.66–2.17, P=0.540).

Conclusions

Our preliminary findings support the hypothesis that fibrinogen enters the brain via blood-brain barrier disruption, promoting neuroinflammation and neuronal injury. However, we did not observe an association between cerebrospinal fluid fibrinogen and peak delirium severity in this limited cohort.

背景我们旨在评估围手术期脑脊液（CSF）中纤维蛋白原的变化、它们与血脑屏障破坏和神经炎症标志物的关联以及它们与术后谵妄严重程度的关联。方法我们对一项前瞻性观察性队列研究--术后谵妄干预-生物标志物 2（IPOD-B2，NCT02926417）研究进行了二次分析。我们纳入了 24 名年龄为 21 岁、接受主动脉瘤修补术的患者。我们在手术前（24 人）和手术后（13 人）采集了 CSF 样本，其中一些参与者在术后采集了多个样本。我们的主要结果是围手术期 CSF 纤维蛋白原的变化。结果手术后CSF纤维蛋白原增加（P<0.001），这与CSF/血浆白蛋白比值的增加有关（β=1.09，95% CI 0.47-1.71，P=0.004）。CSF 纤维蛋白原的峰值变化与 CSF 白细胞介素（IL）-10 和 IL-12p70 的变化相关。CSF纤维蛋白原的峰值变化与CSF总tau的变化相关（β=0.47，95% CI 0.24-0.71，P=0.002）；但是，我们没有观察到纤维蛋白原与术后谵妄严重程度相关（发病率比=1.20，95% CI 0.66-2.17，P=0.540）。然而，在这个有限的队列中，我们并未观察到脑脊液纤维蛋白原与谵妄严重程度峰值之间存在关联。

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