PURPOSE: There is controversy about relevant EEG signal changes indicating adequate or inadequate anaesthesia. Differences of drug-induced and nociceptive mediated signal changes have not been studied in detail. The present study investigates whether signal changes during decreases of depth of anaesthesia due to surgical stimulation depend on different isoflurane concentrations during sufentanil anaesthesia. METHODS: Following IRB approval and written informed consent 28 patients (ASA: I; age 43 +/- 11 y) scheduled for elective abdominal surgery were included in the study. Anaesthesia: propofol (2.0 mg/kg) and sufentanil (1.0 micrograms/kg). Following endotracheal intubation (vecuronium 0.1 mg/kg) patients were normoventilated (P(ET)CO2: 36-38 mmHg). Randomly assigned to steady-state anaesthesia (group 1: P(ET)Isoflurane 0.2%, (14n); group 2: P(ET)Isoflurane 0.6%, (14n) during the start of surgery. Monitoring: heart rate (HF), mean arterial blood pressure (MAP), P(ET)CO2, arterial oxygen saturation and rectal temperature. EEG (16 channels referenced to Cz; CATEEM, Medisyst, Linden) recorded 5 min before until 10 min after the start of surgery. EEG-analysis (FFT: 4s, 256/s, 0.45-35.0 Hz): topographical distribution of power spectral densities (delta, theta, alpha 1, and alpha 2). Artifact control: ECG and EOG. RESULTS: Surgical stimulation resulted in increases of MAP in both groups (p < 0.05 vs BL), whereas HR was only slightly affected in group 2 when compared with BL. Other variables except of EEG data did not change over time. In group 1 (0.2% isoflurane) surgical stimulation resulted in decreases of delta over the whole cortex (F2, C3, P3, O1) and in marked increases of alpha predominantly at central leads (C3)(p < 0.05 vs BL). In group 2 (0.6% isoflurane) nociceptive stimulation was associated with decreases of faster waves (alpha: F3)(p < 0.05 vs BL) and increases in delta at fronto-central areas (F3, C3)(p < 0.05 vs BL). CONCLUSIONS: EEG recordings are useful in assessing pharmacodynamic drug effects. In contrast, intraoperative EEG recordings have a low correlation to clinical signs of changes in the anaesthetic state. Previous studies demonstrate paradoxical EEG-arousal reactions during isoflurane anaesthesia. The present data suggest that classical or even paradoxical EEG arousal due to nociceptive stimulation may depend on the isoflurane concentration. It seems reasonable that the ascending reticular formation is functionally blocked by isoflurane in a dose-dependent manner.
A prerequisite for the further improvement in the quality of warming therapy is an accurate knowledge of the interactions between the microclimate in warming therapy devices and the thermal balance of the infant. For generating this knowledge, thermal manikins can be helpful. Suitable models capable of also simulating evaporative heat loss in preterm infants have, however, not been available to date. A thermal manikin representing an infant weighing 530 g and capable of simulating convective, radiative and also evaporative heat loss has now been developed. It comprises an outer shell made of porous, anatomically shaped clay, and is divided into six compartments each of which can be heated individually. Water-filled Gore-Tex bags located immediately beneath the shell are provided to simulate evaporation. In a clinical study, temperature profiles of 8 very small preterm infants were measured thermographically. Measurements in the manikin showed that highly comparable temperature profiles with only minor differences could be obtained. Total heat and water losses by the manikin were in good agreement with clinical values. Using the model described here it is possible to simulate the heat exchange of premature infants under extreme and accurately reproducible environmental conditions. This manikin may thus serve as a tool for comparative studies, for the development of warming therapy equipment, or for training purposes.
R. T. Frankenberger, O. Bussmann, W. Nahm, E. Konecny, and L. Gortner. Messung seitlicher Haupttemperaturprofile von Frühgeborenen in Inkubatoren mittels Thermograhpie - Measuring lateral skin temperature profile of premature infants in incubators with thermography. In Biomedizinische Technik. Biomedical Engineering, vol. 43(6) , pp. 174-178, 1998
Thermography enables the measurement of patients skin temperature profiles without stress caused by direct contact of probes to the skin. In previous incubator studies, frontal recordings were made through a hole in the top wall of the incubator hood. Using this method it is not possible to record the lateral temperature gradient from the back to the abdomen of the infant (in supine position), which is due to very limited heat loss near the incubator mattress. In this study temperature recordings were made from a lateral position. For this purpose a new front door of the incubator (Draeger 8000) was designed, which replaced the standard front door during measurements. In a clinical study thermography was compared to temperature measurements by standard thermistors. The mean difference between thermography and thermistors was 0.16 degree C. These results verify the use of thermography for measuring skin temperature of preterm infants in incubators.
The present paper examined the question as to the extent to which the taking of gas samples for the purpose of measuring the breath alcohol concentration (BAC) in the expired air of patients on artificial respiration is influenced by temperature and humidity. For this purpose a lung model standardized at different alcohol concentrations was used, in which the temperature (T: 25, 30 and 35 degrees C) and the relative humidity (RH: 50, 75 and 95%) were varied.
UNLABELLED: When looking for the possible cause of distortions in values measured for the determination of breath ethanol concentration (BEC) in artificially respirated patients, consideration must be given to the humidity and temperature of the gas examined. In the present study, the effects of humidified and warmed and of dry and cold air on the accuracy of a newly developed BEC measuring device, as compared to a reference model and to a conventional system, were examined in a lung model. METHODS: A temperature-regulated pediatric incubator was used containing a 10 I gas reservoir and a breath humidifier with temperature regulated water bath. This setup provided constant temperature and humidity in the gas examined during measurement period. In the 'expiration' the air was directed from the breath humidifier through a measuring unit via a 'mouthpiece' into the reference system (Alcotest 7110, Dräger Inc., Lübeck) and then out. The measuring unit consisted of sensors for the temperature and relative humidity, and of a connector for the three sample extraction systems (PES). PES I was the conventional system with a 100-cm gas-sample pipe (Alcomed 3010), PES II the newly developed system (AlcoMed 3011, both from Envitec, Wismar) with a 10-cm gas-sample pipe, and PES III with a 20-cm heated gas-sample pipe. During 'inspiration' 2 l of air was fed into the system to rinse the measuring unit and to fill the reservoir. 61 measurements were performed with dry and cold air, and 71 with humidified and warmed air, in the course of which the ethanol concentration was increased from 0 to 1.5/1000. Data were evaluated using regression analysis and the Bland & Altman method. RESULTS AND CONCLUSIONS: The constancy of the values set for temperature, relative humidity and absolute humidity in the lung model was given for all measurements. In the dry and cold air, the results from all three test systems coincided almost perfectly with the reference values. The measured BEC in the humidified and warmed air using sample-extraction systems II and III corresponded to a high degree with the reference, while in the case of PES I, only a moderate linear correlation was achieved. The temperature and humidity of the expired gas during artificial respiration influence the gas samples extracted for the purposes of BEC measurement. Newly developed sample-extraction systems II and III coincide with the reference system, even under respiration-simulated gas conditions.
Book Chapters (2)
J. Abke, W. Nahm, and E. Konecny. Implementierung einer Bispektralanalyse in LabVIEW zur Beurteilung von Narkosetiefe über das EEG. In Virtuelle Instrumente in der Praxis - Meßtechnik, R. Jamal, H. Jaschinski (eds), VDE-Verlag, pp. 256-264, 1998
M. Daumer, W. Nahm, M. Scholz, and F. Danneger. Online Monitoring mit virtuellen Instrumenten. In Virtuelle Instrumente in der Praxis - Meßtechnik, R. Jamal, H. Jaschinski (eds), VDE-Verlag, pp. 265-270, 1998
Conference Contributions (7)
W. Nahm, G. Stockmanns, M. Daumer, J. Abke, and E. Konecny. Automatische EEG-Datenvorverarbeitung in einer Multicenterstudie - Automatic EEG data processing in a multicenter study. In Biomedizinische Technik/Biomedical Engineering, vol. 43(s1) , pp. 146-147, 1998
O. Bussmann, W. Nahm, and E. Konecny. Modell zur Simulation der Wärmeabgabe und Thermoregulation Frühgeborener - A Model for simulating heat transfer and thermoregulation of premature infants. In Biomedizinische Technik/Biomedical Engineering, vol. 43(s1) , pp. 300-301, 1998
M. Daumer, W. Nahm, M. Scholz, F. Dannegger, G. Morfill, E. Kochs, and A. Neiss. Konzept für eine Internet-basierte Datenbank zur Unterstützung von Projekten auf dem Gebiet der Biosignalanalys - Concept for an internet-based databank for supporting projects in the area of biosignal analysis. In Biomedizinische Technik. Biomedical Engineering, vol. 43 s3, pp. 23-26, 1998
M. Kelling, Z. Hussein, W. Nahm, and E. Konecny. Experimenteller Aufbau zur nicht-dispersiven Messung des Isotopenverhältnisses 13C/12C in Gasen - Experimental development of non-dispersive measurement of 13C/12C isotope relations in gases. In Biomedizinische Technik. Biomedical Engineering, vol. 43 Suppl, pp. 280-1, 1998
P. Knoop, C. Hornberger, W. Nahm, and E. Konecny. Entwicklung eines optischen Kalibrators für kommerzielle Pulsoximeter: Erste Erfolge - Development of an optical calibrator for commercial pulse oximeters: initial successes. In Biomedizinische Technik. Biomedical Engineering, vol. 43 s1, pp. 128-129, 1998