The condition of pharmacologically induced unconsciousness that renders a patient unresponsive to uncomfortable surgical stimuli is known as general anesthesia. When it is used for surgery, a fairly rare but traumatiz...The condition of pharmacologically induced unconsciousness that renders a patient unresponsive to uncomfortable surgical stimuli is known as general anesthesia. When it is used for surgery, a fairly rare but traumatizing state known as anesthesia awareness might develop. What is the probability that a patient can be awake, conscious, and able to hear the surroundings and experience excruciating pain but be immobilized to communicate it during surgery? According to estimates, there are 1 to 2 cases for every 1000 patients who experience this phenomenon and retain various sensory information after general anesthesia was applied. Even with seemingly effective anesthetic care, emerging consciousness states during anesthesia are reported and often come with various degrees of memory loss mechanisms. Some researchers and the experiments covered in this paper suggest anesthesia is merely a memory loss or poorly understood neurological form of amnesia induced during the event itself and not a loss of consciousness per se during the traumatic event, as suggested by studies described in this article. In some instances, the agony may be unbearable, with long-term neuropsychiatric effects such as post-traumatic stress disorder. Although the neurobiological phenomenon of consciousness regained during anesthesia is still poorly understood, these continuously reported events carry significant medical and legal ramifications. The numerous contributing elements that may increase the risk of intraoperative raised levels of consciousness are gathered, analyzed, and discussed in this research study. Preventive methods for both preinduction and intraoperative usage, as well as corrective actions to take after such occurrences, are also discussed.展开更多
Emergence from anesthesia(AE) is the ending stage of anesthesia featuring the transition from unconsciousness to complete wakefulness and recovery of consciousness(RoC). A wide range of undesirable complications, incl...Emergence from anesthesia(AE) is the ending stage of anesthesia featuring the transition from unconsciousness to complete wakefulness and recovery of consciousness(RoC). A wide range of undesirable complications, including coughing, respiratory/cardiovascular events, and mental status changes such as emergence delirium, and delayed RoC, may occur during this critical phase. In general anesthesia processes, induction and AE represent a neurobiological example of "hysteresis". Indeed, AE mechanisms should not be simply considered as reverse events of those occurring in the induction phase. Anesthesia-induced loss of consciousness(LoC) and AE until RoC are quite distinct phenomena with, in part, a distinct neurobiology. Althoughanaesthetics produce LoC mostly by affecting cortical connectivity, arousal processes at the end of anesthesia are triggered by structures deep in the brain, rather than being induced within the neocortex. This work aimed to provide an overview on AE processes research, in terms of mechanisms, and EEG findings. Because most of the research in this field concerns preclinical investigations, translational suggestions and research perspectives are proposed. However, little is known about the relationship between AE neurobiology, and potential complications occurring during the emergence, and after the RoC. Thus, another scope of this review is to underline why a better understanding of AE mechanisms could have significant clinical implications, such as improving the patients' quality of recovery, and avoiding early and late postoperative complications.展开更多
The brain constitutes a formidably complicated structural network. There are three main types of connectivity used to describe neuronal networks, which reflect three parallel levels of investigation: anatomical connec...The brain constitutes a formidably complicated structural network. There are three main types of connectivity used to describe neuronal networks, which reflect three parallel levels of investigation: anatomical connectivity, functional connectivity and effective connectivity. Effective connectivity indicates the direct influence that a node exerts on another, and in the context of neuronal?circuits, a causal relationship between the activities of two nodes. Since its definition, effective?connectivity analysis has been used to describe causal relationship across multiple spatial scales in?PET imaging, fMRI, electroencephalography (EEG) and magnetoencephalography (MEG), single-unit, and local field potential. There are diverse literatures which probe the anesthetized state?using effective connectivity analysis over the past two decades. The examination of effective connectivity in the anesthetized state is of relevance to both anesthesiologists and neuroscientists, as it has the potential to elucidate still unclear mechanisms of anesthesia while offering insight into intrinsic functional activity in the brain. The present review attempts to examine, elucidate, and integrate the insight that effective connectivity analysis of the anesthetized state has generated thus far.展开更多
目的 研究全身麻醉手术下慢性意识障碍(prolonged disorders of consciousness,pDOC)患者的临床特征,并探讨与患者术后意识改善的相关临床因素。方法 回顾性收集2022年2月至2022年12月pDOC患者择期手术围术期资料,应用Logistic回归探讨...目的 研究全身麻醉手术下慢性意识障碍(prolonged disorders of consciousness,pDOC)患者的临床特征,并探讨与患者术后意识改善的相关临床因素。方法 回顾性收集2022年2月至2022年12月pDOC患者择期手术围术期资料,应用Logistic回归探讨与术后意识改善的相关围术期临床因素。结果 研究纳入122例行择期全身麻醉手术的pDOC患者,其中包括植物状态患者72例(59.0%),微意识状态患者50例(41.0%),其中术后27例患者意识水平显著改善,使用Logistic回归模型校正年龄、美国麻醉医师学会身体状态分级(the American Society of Anesthesiologists Classification of Physical Status,ASA)、手术方式、舒芬太尼和瑞芬太尼使用剂量以及苏醒时间等相关变量后,发现术中舒芬太尼使用剂量(OR=17.23,95%CI:1.22~224.30,P=0.035)、苏醒时间(OR=1.03,95%CI:1.00~1.05,P=0.046)与患者术后意识状态改善相关。结论 pDOC患者术后短期意识状态的改善可能与完善的术中镇痛相关。全身麻醉后苏醒时间可能预测pDOC患者意识状态改善的因素。展开更多
目的:了解局部麻醉清醒病人术中信息支持研究现状,包括信息支持内容与方式,为构建局部麻醉清醒病人术中信息支持方案提供理论指导框架。方法:根据范围综述的研究方法,系统检索中国知网、万方数据库、中国生物医学文献数据库、PubMed、EM...目的:了解局部麻醉清醒病人术中信息支持研究现状,包括信息支持内容与方式,为构建局部麻醉清醒病人术中信息支持方案提供理论指导框架。方法:根据范围综述的研究方法,系统检索中国知网、万方数据库、中国生物医学文献数据库、PubMed、EMbase、MedLine、CINAHL、Web of Science国内外数据库,对纳入文献进行筛选、整理分析,检索时限为建库至2022年6月20日。结果:共纳入26篇文献,局部麻醉清醒病人术中信息支持涵盖手术程序、感觉、环境、设备以及其他信息。结论:关注局部麻醉病人术中信息需求,优化术中信息支持,提高护理服务质量。展开更多
目的探讨意识指数(index of consciousness,IoC)监测在妇科腹腔镜手术中应用的效果。方法 60例行全身麻醉下择期腹腔镜手术的妇科患者,随机均分为两组:对照组以传统指标判定麻醉深度,IoC组以IoC值判定麻醉深度。两组均采用丙泊酚靶控输...目的探讨意识指数(index of consciousness,IoC)监测在妇科腹腔镜手术中应用的效果。方法 60例行全身麻醉下择期腹腔镜手术的妇科患者,随机均分为两组:对照组以传统指标判定麻醉深度,IoC组以IoC值判定麻醉深度。两组均采用丙泊酚靶控输注(TCI)静脉全身麻醉。记录TCI即刻(T1)、推注咪达唑仑即刻(T2)、插管即刻(T3)、插管后2min(T4)、拔管即刻(T5)的SBP、HR和IoC值,出手术室时的IoC值以及丙泊酚用量、患者苏醒时间和术中知晓发生率。结果 IoC组患者的丙泊酚用量和苏醒时间均明显低于对照组(P<0.05),麻醉维持期间与出手术室时,IoC组患者的IoC值均明显高于对照组(P<0.05)。结论 IoC监测能够使患者处于适宜的麻醉深度且可以有效地减少患者丙泊酚的用量,缩短苏醒时间。展开更多
文摘The condition of pharmacologically induced unconsciousness that renders a patient unresponsive to uncomfortable surgical stimuli is known as general anesthesia. When it is used for surgery, a fairly rare but traumatizing state known as anesthesia awareness might develop. What is the probability that a patient can be awake, conscious, and able to hear the surroundings and experience excruciating pain but be immobilized to communicate it during surgery? According to estimates, there are 1 to 2 cases for every 1000 patients who experience this phenomenon and retain various sensory information after general anesthesia was applied. Even with seemingly effective anesthetic care, emerging consciousness states during anesthesia are reported and often come with various degrees of memory loss mechanisms. Some researchers and the experiments covered in this paper suggest anesthesia is merely a memory loss or poorly understood neurological form of amnesia induced during the event itself and not a loss of consciousness per se during the traumatic event, as suggested by studies described in this article. In some instances, the agony may be unbearable, with long-term neuropsychiatric effects such as post-traumatic stress disorder. Although the neurobiological phenomenon of consciousness regained during anesthesia is still poorly understood, these continuously reported events carry significant medical and legal ramifications. The numerous contributing elements that may increase the risk of intraoperative raised levels of consciousness are gathered, analyzed, and discussed in this research study. Preventive methods for both preinduction and intraoperative usage, as well as corrective actions to take after such occurrences, are also discussed.
文摘Emergence from anesthesia(AE) is the ending stage of anesthesia featuring the transition from unconsciousness to complete wakefulness and recovery of consciousness(RoC). A wide range of undesirable complications, including coughing, respiratory/cardiovascular events, and mental status changes such as emergence delirium, and delayed RoC, may occur during this critical phase. In general anesthesia processes, induction and AE represent a neurobiological example of "hysteresis". Indeed, AE mechanisms should not be simply considered as reverse events of those occurring in the induction phase. Anesthesia-induced loss of consciousness(LoC) and AE until RoC are quite distinct phenomena with, in part, a distinct neurobiology. Althoughanaesthetics produce LoC mostly by affecting cortical connectivity, arousal processes at the end of anesthesia are triggered by structures deep in the brain, rather than being induced within the neocortex. This work aimed to provide an overview on AE processes research, in terms of mechanisms, and EEG findings. Because most of the research in this field concerns preclinical investigations, translational suggestions and research perspectives are proposed. However, little is known about the relationship between AE neurobiology, and potential complications occurring during the emergence, and after the RoC. Thus, another scope of this review is to underline why a better understanding of AE mechanisms could have significant clinical implications, such as improving the patients' quality of recovery, and avoiding early and late postoperative complications.
文摘The brain constitutes a formidably complicated structural network. There are three main types of connectivity used to describe neuronal networks, which reflect three parallel levels of investigation: anatomical connectivity, functional connectivity and effective connectivity. Effective connectivity indicates the direct influence that a node exerts on another, and in the context of neuronal?circuits, a causal relationship between the activities of two nodes. Since its definition, effective?connectivity analysis has been used to describe causal relationship across multiple spatial scales in?PET imaging, fMRI, electroencephalography (EEG) and magnetoencephalography (MEG), single-unit, and local field potential. There are diverse literatures which probe the anesthetized state?using effective connectivity analysis over the past two decades. The examination of effective connectivity in the anesthetized state is of relevance to both anesthesiologists and neuroscientists, as it has the potential to elucidate still unclear mechanisms of anesthesia while offering insight into intrinsic functional activity in the brain. The present review attempts to examine, elucidate, and integrate the insight that effective connectivity analysis of the anesthetized state has generated thus far.
文摘目的 研究全身麻醉手术下慢性意识障碍(prolonged disorders of consciousness,pDOC)患者的临床特征,并探讨与患者术后意识改善的相关临床因素。方法 回顾性收集2022年2月至2022年12月pDOC患者择期手术围术期资料,应用Logistic回归探讨与术后意识改善的相关围术期临床因素。结果 研究纳入122例行择期全身麻醉手术的pDOC患者,其中包括植物状态患者72例(59.0%),微意识状态患者50例(41.0%),其中术后27例患者意识水平显著改善,使用Logistic回归模型校正年龄、美国麻醉医师学会身体状态分级(the American Society of Anesthesiologists Classification of Physical Status,ASA)、手术方式、舒芬太尼和瑞芬太尼使用剂量以及苏醒时间等相关变量后,发现术中舒芬太尼使用剂量(OR=17.23,95%CI:1.22~224.30,P=0.035)、苏醒时间(OR=1.03,95%CI:1.00~1.05,P=0.046)与患者术后意识状态改善相关。结论 pDOC患者术后短期意识状态的改善可能与完善的术中镇痛相关。全身麻醉后苏醒时间可能预测pDOC患者意识状态改善的因素。
文摘目的:了解局部麻醉清醒病人术中信息支持研究现状,包括信息支持内容与方式,为构建局部麻醉清醒病人术中信息支持方案提供理论指导框架。方法:根据范围综述的研究方法,系统检索中国知网、万方数据库、中国生物医学文献数据库、PubMed、EMbase、MedLine、CINAHL、Web of Science国内外数据库,对纳入文献进行筛选、整理分析,检索时限为建库至2022年6月20日。结果:共纳入26篇文献,局部麻醉清醒病人术中信息支持涵盖手术程序、感觉、环境、设备以及其他信息。结论:关注局部麻醉病人术中信息需求,优化术中信息支持,提高护理服务质量。
