The Dynamic Relationship Between End-Tidal Sevoflurane Concentrations, Bispectral Index, and Cerebral State Index in Children

BACKGROUND: To guide anesthetic administration with electroencephalogram monitors in children, an adequate characterization of the anesthetic effect measured by these monitors in this population is needed. We sought to quantify and compare the dynamic profile of sevoflurane's effect measured with the cerebral state index (CST) and the bispectral index (BIS) in children. METHODS: Fifteen healthy children, aged 3-15 yr, scheduled to undergo minor surgery were prospectively studied. During the simultaneous recording of CST and % for 5 min and then decreased. BIS, the sevoflurane vaporizer was set at 6 vol End-tidal concentrations (C-ET) were measured. The C-ET-sevoflurane effect-site concentration equilibration and pharmacodynamics were modeled. Goodness of fit between models was compared. Data are typical value (coefficient of variation). RESULTS: Within the anesthetic depth range studied, the rate of change of sevoflurane's effect expressed as the effect-site equilibration half-life (t(1/2) k(e0)) was slower with the CST [2.0 (14) min] than with BIS [1.2 (53) min] (P < 0.05). The estimated baseline effect of BIS and CST before sevoflurane administration (E-0) was 84 (39) for CST and 87 (7) for BIS (NS). The sensitivity to sevoflurane hypnotic effect expressed in the C-50 [steady-state C-ET eliciting half of the maximum response (E-max)] was 2.1 (68) % with CST and 2.1. (16)% with BIS (NS). The E-max with CST 45 (0) was higher than that with BIS 27 (39) (P < 0.05). The population prediction error was significantly better for BIS (-0.7 +/- 26.9) than for CST (-3.0 +/- 178.6) (P < 0.05). CONCLUSIONS: In children, the t(1/2) k(e0) of sevoflurane and the pharmacodynamics of sevoflurane were quantified and the results were entirely dependent on the monitor used to measure its hypnotic effect. Within the anesthetic depth range studied, the rate of change of sevoflurane's effect was slower with the CST. To adequately guide sevoflurane administration with these monitors in children, these differences should be considered

The impact of the COVID-19 pandemic on anaesthesia trainees and their training

12 months embargo applies but removed due to subject matter

Nutritional and metabolic benefits associated with active and public transport: Results from the Chilean National Health Survey, ENS 2016–2017

Background: Physical inactivity is one of the main risk factors for death worldwide. There is a paucity of studies about the association between transport and objective health measures using nationally representative samples worldwide, especially from Latin American countries. The aim of this research is to explore the relationship between active transportation and objective health measures in Chile. Methods: We analysed the Chilean National Health Survey (ENS) 2016–2017, based on a nationally representative sample of non-institutionalised adults aged ≥15 years (n = 6,113). ENS included anthropometric measures (weight, height, waist circumference), a specific question about the main mode of transportation and several metabolic markers. Results: 41%, 38% and 21% of participants used public transport, motor vehicles and active (cycling and walking) transport respectively. Higher levels of active transport were observed in males, younger groups, less educated and rural populations. Both active and public transport were associated with multiple nutritional and metabolic benefits such as lower BMI, lower waist circumference, less obesity, higher vitamin D, lower cholesterol and lower hepatic inflammation. Associations persisted after adjusting for other healthy lifestyles. Stronger benefits were observed in males than in females. Conclusions: Promoting active transportation in urban planning policies may help Chile tackle the growing burden of chronic diseases

Regeneration of Hair Cells from Endogenous Otic Progenitors in the Adult Mammalian Cochlea: Understanding Its Origins and Future Directions

Sensorineural hearing loss is caused by damage to sensory hair cells and/or spiral ganglion neurons. In non-mammalian species, hair cell regeneration after damage is observed, even in adulthood. Although the neonatal mammalian cochlea carries regenerative potential, the adult cochlea cannot regenerate lost hair cells. The survival of supporting cells with regenerative potential after cochlear trauma in adults is promising for promoting hair cell regeneration through therapeutic approaches. Targeting these cells by manipulating key signaling pathways that control mammalian cochlear development and non-mammalian hair cell regeneration could lead to regeneration of hair cells in the mammalian cochlea. This review discusses the pathways involved in the development of the cochlea and the impact that trauma has on the regenerative capacity of the endogenous progenitor cells. Furthermore, it discusses the effects of manipulating key signaling pathways targeting supporting cells with progenitor potential to promote hair cell regeneration and translates these findings to the human situation. To improve hearing recovery after hearing loss in adults, we propose a combined approach targeting (1) the endogenous progenitor cells by manipulating signaling pathways (Wnt, Notch, Shh, FGF and BMP/TGFβ signaling pathways), (2) by manipulating epigenetic control, and (3) by applying neurotrophic treatments to promote reinnervation

Performance evaluation of paediatric propofol pharmacokinetic models in healthy young children

Background. The performance of eight currently available paediatric propofol pharmacokinetic models in target-controlled infusions (TCIs) was assessed, in healthy children from 3 to 26 months of age. Methods. Forty-one, ASA I-II children, aged 3-26 months were studied. After the induction of general anaesthesia with sevoflurane and remifentanil, a propofol bolus dose of 2.5 mg kg 21 followed by an infusion of 8 mg kg 21 h 21 was given. Arterial blood samples were collected at 1, 2, 3, 5, 10, 20, 40, and 60 min post-bolus, at the end of surgery, and at 1, 3, 5, 30, 60, and 120 min after stopping the infusion. Model performance was visually inspected with measured/predicted plots. Median performance error (MDPE) and the median absolute performance error (MDAPE) were calculated to measure bias and accuracy of each model. Results. Performance of the eight models tested differed markedly during the different stages of propofol administration. Most models underestimated propofol concentration 1 min after the bolus dose, suggesting an overestimation of the initial volume of distribution. Six of the eight models tested were within the accepted limits of performance (MDPE Conclusions. Our results suggest that six of the eight models tested perform well in young children. Since most models overestimate the initial volume of distribution, the use for TCI might result in the administration of larger bolus doses than necessary

Transporte, Salud, Equidad: acercamientos urgents en un mundo con y post-covid19

Acercamiento urgente en un Mundo con y post-Covid 19. A fines del siglo pasado, surgió una preocupación por las intersecciones entre transporte y salud, plasmadas principalmente en artículos en inglés, provenientes del Norte Global, seguido actualmente por temas de equidad e inclusión, en línea con el marco de los determinantes sociales de la salud. La pandemia COVID-19 realza la urgente necesidad de planear sistemas urbanos que simultáneamente conversen con la mirada de la salud pública. La urgencia de abordar estos temas ha aumentado con las crisis sociales y movimientos masivos en varios países, en años recientes. En este contexto, desarrollamos un análisis resumen en español, conscientes de que la cantidad de información disponible es más restringida en nuestro idioma y en nuestro hemisferio. Destacamos además la ciencia emergente de América Latina y el Caribe, por su alto grado de urbanización y por los desafíos en contextos de democracias más frágiles. Este surge de una colaboración del grupo Movilidad & Salud en América Latina (MOVISAL) del Transport & Health Science Group (Reino Unido), para difundir información sobre las interacciones vitales entre estos temas, en nuestra región