BJA open最新文献

{"title":"Environmental impact of commonly used anaesthetic agents: systematic literature review with narrative synthesis","authors":"Philippa Lloyd ,&nbsp;Alexander J. Fowler ,&nbsp;Anna Wozniak ,&nbsp;William Rattenberry ,&nbsp;Sara Scott ,&nbsp;Vikas Tripurneni ,&nbsp;Mark Earl ,&nbsp;Rupert M. Pearse ,&nbsp;Sarah-Louise Watson ,&nbsp;Tom.E.F. Abbott ,&nbsp;Sarah Hare","doi":"10.1016/j.bjao.2024.100362","DOIUrl":"10.1016/j.bjao.2024.100362","url":null,"abstract":"<div><h3>Background</h3><div>Increasing awareness of the potential environmental impact of volatile anaesthetic agents has stimulated increased use of total i.v. anaesthesia. However, consolidated comparative evidence of the environmental impact of anaesthetic agents across the whole life cycle is lacking.</div></div><div><h3>Methods</h3><div>We performed a systematic review and narrative evidence synthesis of the environmental impact of anaesthetic agents stratified by drug life cycle. We searched MEDLINE (PubMed), Excerpta Medica dataBASE (EMBASE), Cumulative index to nursing and allied health literature (CINAHL), and DrugBank, from inception until 05 March 2023, for studies describing the environmental impact of anaesthetic drugs on the WHO essential medicine list. Independent review and data extraction were performed by pairs of reviewers. Data on any aspect of cradle-to-grave life cycle analysis were reported, with narrative synthesis grouped according to life cycle domains.</div></div><div><h3>Results</h3><div>From 15 229 records, 42 unique reports met our inclusion criteria. The predominant environmental impact of inhalation anaesthetic agents is atmospheric release, contributing to global warming. This may be improved with the emergence of more efficacious scavenging and capture systems. Packaging and waste contributed most to the environmental impact of i.v. anaesthetic agents. There is increasing concern over the ecological impact of i.v. agents entering water sources, either by disposal of unused medication or through the excretion of drug post-administration.</div></div><div><h3>Conclusions</h3><div>There is increasing concern about the global warming impact of inhalation anaesthetic agents. However, there are insufficient ‘cradle-to-grave’ comparative analyses of the environmental impact of i.v. and inhalation anaesthesia to form evidence-based conclusions. Further research is urgently needed to guide clinical practice.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"13 ","pages":"Article 100362"},"PeriodicalIF":0.0,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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","authors":"Ankita Miglani ,&nbsp;Sandeep Miglani ,&nbsp;Hassan M. Tawfik ,&nbsp;Thomas Drew","doi":"10.1016/j.bjao.2024.100364","DOIUrl":"10.1016/j.bjao.2024.100364","url":null,"abstract":"<div><h3>Background</h3><div>Emergency Front of Neck access <strong>(</strong>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>There was a significant difference in the height of the CTM between the groups (<em>P</em>&lt;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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"13 ","pages":"Article 100364"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noradrenergic suppression to reduce electroencephalographic arousal after intubation: a randomised, placebo-controlled trial","authors":"Kaitlin Kramer ,&nbsp;Thomas Payne ,&nbsp;Mitchell Brooks ,&nbsp;Jessica Barry ,&nbsp;Neha Mahajan ,&nbsp;Samantha Malcolm ,&nbsp;Hannah Braithwaite ,&nbsp;Alex Wang ,&nbsp;Chris Thompson ,&nbsp;Keith Liyanagama ,&nbsp;Robert D. Sanders","doi":"10.1016/j.bjao.2024.100359","DOIUrl":"10.1016/j.bjao.2024.100359","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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; <em>p</em>=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; <em>p</em>&lt;0.001) and before intubation (difference [dexmedetomidine – placebo]: –1.84 μg ml⁻¹, 95% CI –2.79 to –0.90; <em>p</em>&lt;0.001). There was one patient in the placebo group who gave positive responses in the isolated forearm test before and after tracheal intubation.</div></div><div><h3>Conclusions</h3><div>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.</div></div><div><h3>Clinical Trial Registration</h3><div>Australia and New Zealand Clinical Trials Registry (Trial ID: ACTRN12622000754741).</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"13 ","pages":"Article 100359"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The unseen animal behind medicine: exploring considerations of animal-derived medications and anaesthetics in today's landscape","authors":"Jennifer R. Wang,&nbsp;Eric Oh,&nbsp;Benjamin Aronow,&nbsp;Wendy K. Bernstein","doi":"10.1016/j.bjao.2024.100360","DOIUrl":"10.1016/j.bjao.2024.100360","url":null,"abstract":"<div><div>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.</div><div>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.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"13 ","pages":"Article 100360"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Xenon anaesthesia is associated with a reduction in frontal electroencephalogram peak alpha frequency","authors":"Steven McGuigan ,&nbsp;Andria Pelentritou ,&nbsp;David A. Scott ,&nbsp;Jamie Sleigh","doi":"10.1016/j.bjao.2024.100358","DOIUrl":"10.1016/j.bjao.2024.100358","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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. <em>In silico</em> 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.</div></div><div><h3>Results</h3><div>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) <em>vs</em> 8.81 Hz (8.35–9.03 Hz), <em>P</em>=0.012, and the volunteer cohort, 8.69 Hz (8.34–8.98 Hz) <em>vs</em> 9.41 Hz (9.11–9.92 Hz), <em>P</em>=0.001. <em>In silico</em> simulations with both computational models suggest that antagonism of HCN2 and glutamatergic excitatory neurotransmission are associated with a reduction in peak alpha frequency.</div></div><div><h3>Conclusions</h3><div>Xenon administration is associated with a reduction of peak alpha frequency in the frontal EEG. <em>In silico</em> simulations utilising two computational models of neurones suggest that these changes are consistent with antagonism of HCN2 and glutamatergic excitatory neurotransmission.</div></div><div><h3>Clinical trial registration</h3><div>The Australian New Zealand Clinical Trials Registry: ANZCTR number 12618000916246.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"12 ","pages":"Article 100358"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moderate or severe pain in recovery after major elective surgery: A pilot retrospective analysis to identify those at risk","authors":"Andy Yuet Meng Ng,&nbsp;Thomas Emery","doi":"10.1016/j.bjao.2024.100361","DOIUrl":"10.1016/j.bjao.2024.100361","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"12 ","pages":"Article 100361"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142759047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between plasma-free haemoglobin and postoperative acute kidney injury in paediatric cardiac surgery: a prospective observational study","authors":"Takanobu Sakura,&nbsp;Tomoyuki Kanazawa,&nbsp;Tatsuhiko Shimizu,&nbsp;Kazuyoshi Shimizu,&nbsp;Tatsuo Iwasaki,&nbsp;Hiroshi Morimatsu","doi":"10.1016/j.bjao.2024.100348","DOIUrl":"10.1016/j.bjao.2024.100348","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>This prospective, single-centre, observational study included children aged &lt;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.</div></div><div><h3>Results</h3><div>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] <em>vs</em> 60 mg dl⁻¹ [40–100]; <em>P</em>=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; <em>P</em>=0.268). Factors associated with postoperative AKI were age in months (OR 0.96; 95% CI: 0.94–0.99; <em>P</em>=0.007) and CPB duration (OR 1.02; 95% CI: 1.01–1.02; <em>P</em>&lt;0.001).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"12 ","pages":"Article 100348"},"PeriodicalIF":0.0,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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","authors":"Alexandre Garioud,&nbsp;Michael Seltz Kristensen","doi":"10.1016/j.bjao.2024.100346","DOIUrl":"10.1016/j.bjao.2024.100346","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"12 ","pages":"Article 100346"},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142444855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and trajectories of subclinical and KDIGO-defined postoperative acute kidney injury in patients undergoing major abdominal surgery","authors":"Jakob Zeuchner ,&nbsp;Louise Elander ,&nbsp;Jessica Frisk ,&nbsp;Michelle S. Chew","doi":"10.1016/j.bjao.2024.100345","DOIUrl":"10.1016/j.bjao.2024.100345","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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, <em>P</em>=0.037). PO-AKD (Cramer's V: 0.4, <em>P</em>&lt;0.001) was associated with MAKE30 and 30-day mortality. All patients with CKD had pre-existing PO-AKD.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"12 ","pages":"Article 100345"},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep learning models using intracranial and scalp EEG for predicting sedation level during emergence from anaesthesia","authors":"Lichy Han ,&nbsp;David A. Purger ,&nbsp;Sarah L. Eagleman ,&nbsp;Casey H. Halpern ,&nbsp;Vivek Buch ,&nbsp;Samantha M. Gaston ,&nbsp;Babak Razavi ,&nbsp;Kimford Meador ,&nbsp;David R. Drover","doi":"10.1016/j.bjao.2024.100347","DOIUrl":"10.1016/j.bjao.2024.100347","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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 <em>vs</em> 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).</div></div><div><h3>Results</h3><div>Combining scalp EEG and iEEG yielded significantly better prediction (AUC=0.795, <em>P</em>&lt;0.001) compared with iEEG only (AUC=0.750, <em>P</em>=0.02) or scalp EEG only (AUC=0.764, <em>P</em>&lt;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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"12 ","pages":"Article 100347"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142417278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}