Editorial: Optimizing opioid prescriptions in the emergency department.

Optimizing opioid prescriptions in the emergency department is essential to address the opioid pandemic while ensuring patient wellbeing. This requires a comprehensive approach that includes exploring alternatives to opioids for pain management, identifying individuals at risk for opioid addiction, implementing evidence-based guidelines, and involving doctors in the management of opioid addiction.

Difficult airway management and low Bispectral Index (BIS) in a patient with left Bochdalek congenital diaphragmatic hernia (CDH).

Background: Bochdalek congenital diaphragmatic hernia (CDH) is a developmental defect in the posterolateral diaphragm, allowing herniation of abdominal contents into the thorax causing mechanical compression of the developing lung parenchyma and lung hypoplasia. We describe a case of an adult patient with a Bochdalek hernia who underwent minimally invasive right thoracotomy Perceval bioprosthetic aortic valve replacement (AVR) requiring one-lung ventilation (OLV) on the side of the hernia. This is a complex and challenging case that brings up numerous thought-provoking anesthetic implications.

Migraine, interferon β1a and siponimod immunomodulator therapies.

Background: Autoimmunity seems to play a great role in the pathogenesis of migraine headache pain. There is far more evidence that interferon can exacerbate migraines. We report a case where remission of severe comorbid migraine attacks happened with the start of interferon β1a (Merck, Netherlands) immunomodulation therapy.

Location matters: Overlooked ethnic-geographic effect in China and Austria on propofol/cisatracurium sex differences among a population pharmacokinetic/pharmacodynamic (PopPK/PD) covariate analysis in men, women, and one transgender subject.

A quick literature search using "sex/gender" vs. the commonly used hypnotic propofol or neuromuscular-blocking agent cisatracurium will reveal numerous contradictory sex difference publications depending on the ethnic-geographic location of where these studies were conducted. We induced anesthesia with cisatracurium besylate (GlaxoSmithKline) 100 μg kg administered exactly 1 minute following propofol (AstraZeneca) 2 mg kg .

Propofol-Bispectral Index (BIS) Electroencephalography (EEG) Pharmacokinetic-Pharmacodynamic Model in Patients With Post-Cerebral Hemorrhage Hydrocephalus.

. Titrating hypnotic agents for patients who suffer from a cerebral insult is a challenging task. To date there is no real gold standard to precisely quantify electroencephalography (EEG) response in a fashion that could be utilized for patients with post-cerebral hemorrhage hydrocephaly.

Age progression from vicenarians (20-29 year) to nonagenarians (90-99 year) among a population pharmacokinetic/pharmacodynamic (PopPk-PD) covariate analysis of propofol-bispectral index (BIS) electroencephalography.

Background: Pharmacokinetic/pharmacodynamic (PK/PD) modeling has made an enormous contribution to intravenous anesthesia. Because of their altered physiological, pharmacological and pathological aspects, titrating general anesthesia in the elderly is a challenging task.

Methods: Eighty patients were consecutively enrolled divided by decades from vicenarians (20-29 year) to nonagenarians (90-99 year) into eight groups.

Benefits and boundaries of processed electroencephalography (pEEG) monitors when they do not concur with standard anesthetic clinical monitoring: lights and shadows.

Numerous clinical conditions that have a direct effect on electroencephalography (EEG) cerebral function could also directly influence brain function monitors (BFM) indices. There is no conventional comparator technology for BFM assessment. The conventional comparator technology used as a benchmark for assessing BFMs technologies chosen by the UK National Institute for Health and Care Excellence (NICE) to reflect the currently used standards in the National Health Service (NHS), was demarcated as "standard anesthetic clinical monitoring" and precisely defined as "the combination of routine clinical observation and electronic monitoring used in clinical practice to assess the adequacy of anesthesia.

Correction to: Mindray 3-directional NMT Module (a new generation "Tri-axial" neuromuscular monitor) versus the Relaxometer mechanomyograph and versus the TOF-Watch SX acceleromyograph.

In the original publication of the article, the article note "Ashraf A. Dahaba and Zhao Yang Xiao equally contributed to the study and are both first authors." was published incorrectly.

Mindray 3-directional NMT Module (a new generation "Tri-axial" neuromuscular monitor) versus the Relaxometer mechanomyograph and versus the TOF-Watch SX acceleromyograph.

Recently introduced Mindray "3-directional" neuromuscular transmission transducer (NMT, Shenzhen, China) acceleromyograph) claim to monitor thumb movement in 3 different directions. We compared NMT with the gold standard Relaxometer® mechanomyograph (MMG, Groningen University, Netherlands) in Study-1 and with TOF-Watch SX™ (WTCH) acceleromyograph from which it was developed in Study-2. We used first twitch (T%) and train-of-four (TOF) ratio rocuronium 0.

Thinking outside the box. Off-label use of Bispectral Index within context and limitations for conditions other than depth of anesthesia.

Numerous articles appeared in literature using brain function monitors (BFM), such as Bispectral Index (BIS) to assess cerebral cognitive conditions not related to depth of anesthesia. BIS cannot be considered a "true" reflection of the electroencephalography (EEG) signal nor an independent measure of brain function. BIS algorithm was retrospectively derived from EEG changes with incremental doses of γ-amino butyric acid (GABA)ergic anesthetic agents while measuring 3 descriptors.

Correction to: Advances in anesthesia technology are improving patient care, but many challenges remain.

Unfortunately, after publication of this article [1], it was noticed that the name of Ashraf A. Dahaba is incorrectly displayed as Ashraf Dahaba. The full, corrected author list can be seen here.

Advances in anesthesia technology are improving patient care, but many challenges remain.

Although significant advances in clinical monitoring technology and clinical practice development have taken place in the last several decades, in this editorial we argue that much more still needs to be done. We begin by identifying many of the improvements in perioperative technology that have become available in recent years; these include electroencephalographic depth of anesthesia monitoring, bedside ultrasonography, advanced neuromuscular transmission monitoring systems, and other developments. We then discuss some of the perioperative technical challenges that remain to be satisfactorily addressed, such as products that incorporate poor software design or offer a confusing user interface.

The "Plateau" Phenomenon of Stepwise Extracorporeal Albumin Dialysis Bispectral Index Hepatic Encephalopathy Recovery.

The Bispectral Index™ monitor, an electroencephalographic-derived parameter, can quantify hepatic encephalopathy cerebral function recovery and differentiate between West Haven grades 1 to 4. I report a very peculiar "plateau" phenomenon of 3 clear distinct plateaus of stepwise albumin dialysis Bispectral Index hepatic encephalopathy recovery during an 8-hour Molecular Adsorbent Recirculating System™ (MARS™) liver-assist extracorporeal detoxification, manifesting in conjunction with 3 West Haven grade recoveries. In the patients, I observed recovery of cerebral function after hepatic encephalopathy as a series of plateaus with abrupt transitions between the plateaus, rather than the gradual recovery I anticipated.

Different propofol-remifentanil or sevoflurane-remifentanil bispectral index levels for electrocorticographic spike identification during epilepsy surgery.

Background: Medical therapy, the cornerstone of managing epilepsy, still fails a substantial portion of patients. Little information is available regarding the potential impact of different bispectral index (BIS) levels on electrocorticographic spike identification for surgical epileptic foci resection.

Methods: Twenty-two intractable epilepsy subjects were randomly allocated to the propofol-remifentanil or sevoflurane-remifentanil groups, and were further randomized to four BIS85 (BIS 71-85), BIS70 (BIS 56-70), BIS55 (BIS 41-55), and BIS40 (BIS ≤40) sequence order.

Mass casualties in Tahrir Square at the climax of the Egyptian uprising: evidence of an emerging pattern of regime's organized escalating violence during 10 hours on the night of January 28, 2011.

Objective: Documentation of the management of mass casualties in Tahrir Square.

Background: We documented the sequences of our medical response to mass casualties in Tahrir Square between January 28, 2011, and February 4, 2011, at "Kasr El-Ainy" Cairo University Hospital, the largest hospital in the Middle East and the tertiary referral center for all hospitals in Egypt that happened to be the closest to Tahrir Square.

Methods: At the peak of Tahrir Square demonstrations, injured protesters received first aid in a makeshift clinic inside Tahrir Square, manned by volunteer doctors and nurses, before they were evacuated to the Cairo University Hospital Surgical Casualty Department.

Geographic differences in the target-controlled infusion estimated concentration of propofol: bispectral index response curves.

Purpose: Variability in drug responses could result from both genetic and environmental factors. Thus, drug effect could depend on geographic location, although regional variation is not generally acknowledged as a basis for stratification. There is evidence that the pharmacokinetic set developed in a European population for the target-controlled infusion (TCI) of propofol does not apply in Chinese patients; however, we are not aware of previous studies comparing the estimated concentration-bispectral index (BIS) response of Caucasian patients in Europe with that of Chinese patients in China.

The utility of using the bispectral index-Vista for detecting cross-clamping decline in cerebral blood flow velocity.

Background: Patients undergoing carotid endarterectomy for extracranial internal carotid artery stenosis are at risk of cerebral ischemia/hypoperfusion. Criterion recommended by European and American committees to determine whether to place a shunt consisted of a decline in transcranial Doppler ultrasonography-measured middle cerebral artery blood flow velocity (MCBFV) to < 30% to 40% of intraoperative preclamp value.

Objective: To assess the discriminative power of the bispectral index (BIS)-Vista monitor for detecting a 40% decline in MCBFV with cross-clamping.

BIS-vista occipital montage in patients undergoing neurosurgical procedures during propofol-remifentanil anesthesia.

Background: Neurosurgical procedures that require a frontal approach could be an impediment for a successful Bispectral Index (BIS) frontal sensor placement. The aim of this study was to explore the utility of using the new BIS-Vista monitor (Aspect Medical Systems, Newton, MA) for occipital sensor placement in the patients undergoing brain neurosurgical procedures during propofol-remifentanil anesthesia.

Methods: Two BIS Quatro sensors (Aspect Medical Systems, Newton, MA) mounted on the occipital and frontal regions were connected to two BIS-Vista monitors at three anesthesia states: before induction, during anesthesia maintenance, and recovery.