Monitoring depth of anesthesia utilizing a combination of electroencephalographic and standard measures.

Background: For decades, monitoring depth of anesthesia was mainly based on unspecific effects of anesthetics, for example, blood pressure, heart rate, or drug concentrations. Today, electroencephalogram-based monitors promise a more specific assessment of the brain function. To date, most approaches were focused on a "head-to-head" comparison of either electroencephalogram- or standard parameter-based monitoring.

Postoperative cognitive dysfunction.

Background: Older patients in particular are vulnerable to memory disturbances and other types of cognitive impairment after surgical operations. In one study, roughly 12% of patients over age 60 had postoperative cognitive dysfunction (POCD) three months after surgery. This is an important issue in perioperative care as extensive surgery on older patients becomes more common.

[Drug addiction and anaesthesia: most popular recreational drugs in Germany and anaesthesiological management of drug addicts].

Drug addicts need special anesthesiological care due to their co-morbidities, their modified need for analgesics and anesthetics and/or their specific substitution therapies. In spite of the high incidence of addiction worldwide controlled studies and evidence based recommendations for the anaesthesiological management of the patients are missing. The perioperative care is not the treatment of addiction, on the contrary the specific aspects of a chronic disease have to be accepted.

[Pharmacotherapy--physostigmine administered post-operatively].

The central anticholinergic syndrome should be considered in patients with altered mental status following anaesthesia. Physostigmine, a reversible acetylcholinesterase inhibitor, is a first-line medicament for the therapy of the central anticholinergic syndrome. Physostigmine crosses the blood-brain barrier and elevates acetylcholine levels in the brain.

Electroencephalographic mapping during routine clinical practice: cortical arousal during tracheal intubation?

We used quantitative analysis of the electroencephalogram (EEG) in 42 patients to assess the effect of tracheal intubation after induction of anesthesia with etomidate and sufentanil using standard clinical practice. The EEG was recorded from eight bipolar electrode derivations and Z-transformed relative to age expected normative data for relative power in the delta, theta, alpha, and beta frequency bands. Tracheal intubation resulted in classical cortical arousal, as indicated by acceleration of the EEG frequencies.

Representation of somatosensory evoked potentials using discrete wavelet transform.

Objective: Somatosensory evoked potentials (SEP) have been shown to be a useful tool in monitoring of the central nervous system (CNS) during anaesthesia. SEP analysis is usually performed by an experienced human operator. For automatic analysis, appropriate parameter extraction and signal representation methods are required.

Midlatency auditory evoked potentials do not allow the prediction of recovery from general anesthesia with isoflurane.

Purpose: To investigate midlatency auditory evoked potentials (MLAEP) waveforms during recovery from anesthesia. The hypothesis was that MLAEP are sensitive variables to discriminate between states of consciousness and unconsciousness during emergence from anesthesia.

Methods: MLAEP were recorded in the awake state and during the wake-up phase from isoflurane anesthesia in 22 female patients undergoing ophthalmologic surgery.