Spectral edge frequency during general anaesthesia: A narrative literature review

Previous studies have attempted to determine the depth of anaesthesia with different anaesthetic agents using electroencephalogram (EEG) measurements with variable success. Measuring depth of anaesthesia is confounded by the complexity of the EEG and the fact that different agents create different pattens. A narrative review was undertaken to examine the available research evidence on the effect and reliability of spectral edge frequency (SEF) for assessing the depth of anaesthesia in adult patients under general anaesthesia. A systematic search of the PubMed®, Scopus®, CINAHL and Cochrane databases identified six randomized controlled trials and five observational studies. The findings of these studies suggest that SEF varies according to the anaesthetic drugs used. Remifentanil and age are two factors that can affect SEF, while other opioids and benzodiazepine (administered separately) seem to have no effect. No patients experienced intraoperative awareness. However, this does not indicate that SEF can provide full protection against it and the number of articles in which intraoperative awareness was studied was too small to afford any certainty. None of the studies demonstrated a reliable SEF interval associated with adequate general anaesthesia. SEF must be adapted to the anaesthetic drug used, the patient’s age and state while under general anaesthesia

Current state of noninvasive, continuous monitoring modalities in pediatric anesthesiology

Purpose of review The last decades, anesthesia has become safer, partly due to developments in monitoring. Advanced monitoring of children under anesthesia is

Auditory event-related potentials

Auditory event related potentials are electric potentials (AERP, AEP) and magnetic fields (AEF) generated by the synchronous activity of large neural populations in the brain, which are time-locked to some actual or expected sound event

Individen i det aktivitetsbaserade kontoret En studie av Skanskas fysiska och psykosociala arbetsmiljö

Syftet är att undersöka hur medarbetare på Skanska upplever förändringsprocessen och sin nuvarande arbetsmiljösituation efter införandet av det aktivitetsbaserade kontoret. Teoretiska perspektiven behandlar två olika sätt att mäta hälsa utifrån den psykosociala arbetsmiljön samt hur dessa kan bidra till att påvisa hälsosamma och ohälsosamma förhållanden i arbetslivet. Dessa är krav-kontroll och stödmodellen samt KASAM. Tidigare forskning i uppsatsen behandlar forskning kring olika kontorsutformningars påverkan på individers psykosociala arbetsmiljö. Fokus har legat på olika flexibla organiseringssätt i förhållande till produktivitet och arbetstillfredsställelse med två olika resultat. Metoden för uppsatsen har varit ett semistrukturerat kvalitativt upplägg där sju intervjuer genomförts med fyra definierade teman. Fokus har legat på att identifiera olika strukturer som påverkar upplevelsen av det aktivitetsbaserade arbetssättet för att sedan analysera dessa tillsammans med den tidigare forskningen samt teorierna. Resultat: Studien har kommit fram till att upplevelserna av förändringsprocessen har varit avgörande för hur det aktivitetsbaserat arbetssättet tagits emot. Detta har i sin tur påverkat upplevelserna av den psykosociala arbetsmiljön samt den upplevda känslan av arbetstillfredsställelse och produktivitet

Registered Nurse Anesthetists’ Perceptions of Providing Care Within a Global Health Framework : A Qualitative Study

Purpose: The purpose of this study was to investigate how Registered Nurse Anesthetists (RNAs) who have been working for nongovernmental organizations in low- and middle-income countries perceive their role in global health. Design: A qualitative design was used in this study. Methods: Data were collected by means of semistructured interviews with 11 participants who met the inclusion criteria, and qualitative analysis of the interview content was performed. Findings: The analysis resulted in three categories and six subcategories. Of the categories, “Using skills” includes the respondents’ varying levels of responsibility, tasks, and perceptions of how far they are applying their expertise. “Encountering new cultures” is about adapting to new cultural norms in nursing, education, and cooperation in the international team. “Promoting change through volunteerism” comprises personal and professional development, and impact — both local and potentially global. Conclusions: This study highlights the relevance of RNAs in global health and emphasizes the cultural encounters, exchanges, and challenges associated with volunteer medical missions. RNAs’ knowledge of, and humble approach to the host country's culture are essential for their ability to provide nursing care, engage in cooperation and training, and promote global health in a high-quality, sustainable and effective way

At-home monitoring after surgery/anaesthesia – a challenge

Rationale, aims and objectives: Day surgery is evolving, with a majority of recoveries occurring at home. There is, in parallel, an evolution in telemedical technology. The aim of the present project was to identify patients’ willingness to use predefined follow-up techniques and to clinically test preferred techniques at home using a two-step study.┅. Methods: In Part I, a paper-based questionnaire study of identified patients’ attitudes with three follow-up techniques was used. In Part II, a feasibility test of a mobile (smart-phone) application for follow-up at home was used. Results: Part I showed overall positive attitudes to telemedical follow-ups. Part II showed the preference for a follow-up technique with a mobile application was not fully consistent with the clinical study of the smart-phone app, where there was a large non-response. The application provided safe transfer of data to the hospital and helped make it easy to retrieve and analyse patient self-assessment of recovery. This application is one-way directed, and no feedback to the patient was given, which may have influenced the non-response. Conclusion: Bringing telemedicine into follow-up after surgery/anaesthesia is requested, and furthermore, the feasibility study on day surgery presented here shows that it is technically easy to perform and will provide robust information. It should be noted that further studies are needed in order to find better patient cooperation

Evaluation of the Postoperative Quality of Recovery Scale test and re-test in Swedish among healthy volunteers [version 1; referees: 2 approved]

Introduction Patient outcome measures are required to assess the quality of healthcare. Tools for a patients’ self-assessment of quality of recovery, during perioperative care, have been developed during the last decade. The Postoperative Quality of Recovery Scale (PostopQRS) questionnaire is one of the most well-accepted and validated tools available. Here we assess the PostopORS questionnaire in Swedish. Methods Sixty-one students from the Bachelor Program in Nursing, (50 female and 11 male; mean age, 25; range, 21-46) filled in the Swedish translation of the PostopQRS questionnaire twice. They also evaluated whether they found the queries easy to understand and respond to. Results The participants found the Swedish translation of the PostopQRS questionnaire easy to read and understand. There were minor differences in test responses between the initial test and the re-test 48 hours later. We found that the PostopQRS questionnaire has some background noise; 12 out of 61 participants (20%) reported mild pain, 25 (41%) scored some depression and 33 scored mild anxiety (54%). The cognitive domain showed a learning effect between tests in “word recall” and “word generation”, while “digit recall forward” and “digit recall backward” showed no change. We found a difference in cognitive test performance with age; younger participants had higher mean cognitive test scores compared to participants >30 years. Overall, nine participants showed a decrease in re-test scores; two experienced a mild increase in pain; one experienced a mild increase in anxiety; and six performed more poorly on cognitive tests. Conclusion The Swedish translation of the PostopQRS was found to be adequate for use in the assessment of quality of recovery, and the questions were well understood by participants. Our study shows the importance of baseline testing for assessment of recovery, since recovery is assessed as a return to or improvement in each individual’s baseline score

Anaesthesia for open wrist fracture surgery in adults/elderly [version 1; referees: 2 approved]

Anaesthetic technique for open surgery of acute distal for arm fracture in adults/elderly is not well defined. Regional anaesthesia, general anaesthesia or a combined general and regional block may be considered. General anaesthetic technique, the timing and drug/drug combination for the regional block must also be considered. This is a study around published studies assessing anaesthtic technique for wrist surgery. A systematic database search was performed and papers describing the effect of anaesthetic techniques were included. We found sparse evidence for what anaesthetic technique is optimal for open wrist fracture repair. In total only six studies were found using our inclusion criteria, which all supported the short term, early recovery benefits of regional anaesthesia as part of multi-modal analgesia. More protracted outcomes and putting the type of block into context of quality of recovery and patients’ satisfaction is lacking in the literature. The risk for a pain rebound when the block vanishes should also be acknowledged. Therefore, further high quality studies are warranted concerning the anaesthetic technique for this type of surgery

Cerebral autoregulation in infants during sevoflurane anesthesia for craniofacial surgery

Background: Data on cerebral pressure-flow autoregulation in the youngest children are scarce. We studied the correlation between mean arterial pressure and cerebral tissue oxygen saturation (rSO2) by near-infrared spectroscopy (NIRS) in patients undergoing nose, lip, and palate surgery. Aim: We tested the hypothesis that cerebral pressure-flow autoregulation is impaired in children less than 1 year undergoing surgery and general anesthesia with sevoflurane under controlled mechanical ventilation. Method: After approval from the Ethical board, 15 children aged <1 year were included. Before anesthesia induction, a NIRS sensor (INVOSTM, Medtronic, Minneapolis, USA) was placed over the cerebral frontal lobe. Frontal rSO2, a surrogate for cerebral perfusion, mean arterial pressure, end-tidal CO2- and sevoflurane concentration, and arterial oxygen saturation were sampled every minute after the induction. A repeated measures correlation analysis was performed to study correlation between mean arterial pressure and cerebral rSO2, and the repeated measures correlation coefficient (rrm) was calculated. Results: Fifteen patients, aged 7.7 ± 1.9 months, were studied. rSO2 showed a positive correlation with mean arterial pressure ([95% CI: 9.0-12.1], P < 0.001) with a moderate to large effect size (rrm = 0.462), indicating an impaired cerebral pressure-flow autoregulation. The slopes of the rSO2-mean arterial pressure correlations were steeper in patients who were hypotensive (mean arterial pressure <50 mm Hg) compared to patients having a mean arterial pressure ≥50 mm Hg, indicating that at lower mean arterial pressure, the cerebral pressure dependence of cerebral oxygenation is even more pronounced. Conclusion: During sevoflurane anesthesia in the youngest pediatric patients, cerebral perfusion is pressure-dependent, suggesting that the efficiency of the cerebral blood flow autoregulation is limited

Total opioid-free general anaesthesia can improve postoperative outcomes after surgery, without evidence of adverse effects on patient safety and pain management : A systematic review and meta-analysis

Background: Opioid-based treatment is used to manage stress responses during surgery and postoperative pain. However, opioids have both acute and long-term side effects, calling for opioid-free anaesthetic strategies. This meta-analysis compares adverse events, postoperative recovery, discharge time from post-anaesthesia care unit, and postoperative pain, nausea, vomiting, and opioid consumption between strict opioid-free and opioid-based general anaesthesia. Methods: We conducted a systematic review and meta-analysis. We searched PubMed, Embase, Cinahl, Cochrane Library, selected reference lists, and Google Scholar. We included randomised controlled trials (RCTs) published between January 2000 and February 2021 with at least one opioid-free study arm, i.e. no opioids administered preoperatively, during anaesthesia induction, before skin closure, or before emergence from anaesthesia. Results: The study comprised 1934 patients from 26 RCTs. Common interventions included laparoscopic gynaecological surgery, upper gastrointestinal surgery, and breast surgery. There is firm evidence that opioid-free anaesthesia significantly reduced adverse postoperative events (OR 0.32, 95% CI 0.22 to 0.46, I2 = 56%, p < 0.00001), mainly driven by decreased nausea (OR 0.27, (0.17 to 0.42), p < 0.00001) and vomiting (OR 0.22 (0.11 to 0.41), p < 0.00001). Postoperative opioid consumption was significantly lower in the opioid-free group (−6.00 mg (−8.52 to −3.48), p < 0.00001). There was no significant difference in length of post-anaesthesia care unit stay and overall postoperative pain between groups. Conclusions: Opioid-free anaesthesia can improve postoperative outcomes in several surgical settings without evidence of adverse effects on patient safety and pain management. There is a need for more evidence-based non-opioid anaesthetic protocols for different types of surgery as well as postoperative phases