UNLABELLED: The electroencephalogram (EEG) and middle latency auditory evoked responses (MLAER) have been proposed for assessment of the depth of anesthesia. However, a reliable monitor of the adequacy of anesthesia has not yet been defined. In a multicenter study, we tested whether changes in the EEG and MLAER after a tetanic stimulus applied to the wrist could be used to predict subsequent movement in response to skin incision in patients anesthetized with 1 minimum alveolar anesthetic concentration (MAC) isoflurane in N2O. We also investigated whether the absolute values of any of these variables before skin incision was able to predict subsequent movement. After the induction of anesthesia with propofol and facilitation of tracheal intubation with succinylcholine, 82 patients received 1 MAC isoflurane (0.6%) in N2O 50% without an opioid or muscle relaxant. Spontaneous EEG and MLAER to auditory click-stimulation were recorded from a single frontoparietal electrode pair. MLAER were severely depressed at 1 MAC isoflurane. At least 20 min before skin incision, a 5-s tetanic stimulus was applied at the wrist, and the changes in EEG and MLAER were recorded. EEG and MLAER values were evaluated before and after skin incision for patients who did not move in response to tetanic stimulation. Twenty patients (24%) moved after tetanic stimulation. The changes in the EEG or MLAER variables were unable to predict which patients would move in response to skin incision. Preincision values were not different between patients who did and did not move in response to skin incision for any of the variables. MLAER amplitude increased after skin incision. We conclude that it is unlikely that linear EEG measures or MLAER variables can be of practical use in titrating isoflurane anesthesia to prevent movement in response to noxious stimulation. IMPLICATIONS: Reliable estimation of anesthetic adequacy remains a challenge. Changes in spontaneous or auditory evoked brain activity after a brief electrical stimulus at the wrist could not be used to predict whether anesthetized patients would subsequently move at the time of surgical incision.
BACKGROUND: The absorption of irrigation fluid during transurethral resection of the prostate (TURP) is determined primarily by hydrostatic pressure in the bladder and prostatic venous pressure. In comparison to spontaneously breathing patients, patients undergoing mechanical ventilation with positive pressure have a raised central venous pressure and a reduced venous return, both of which can influence intravascular absorption. The purpose of the prospective study was to compare the effects of general (GA) and spinal anaesthetic (SA) techniques on the perioperative absorption of irrigating fluid in patients undergoing TURP. METHODS: Forty patients undergoing TURP were randomised and assigned either to group GA or SA. Irrigating fluid absorption was traced by adding 1.5% (w/v) ethanol to the irrigating fluid. Perioperative blood ethanol concentration (BEC), haemoglobin concentration, haematocrit, serum sodium concentration and central venous pressure (CVP) were measured at 10-min intervals during TURP and at 30-min intervals while patients were recovering. Absorption routes were indexed by the BEC and changes in serum sodium concentrations. Where the BEC was greater than 0.05 mg.mL-1, absorption of irrigating fluid was assumed. For assessing the volume of irrigating fluid absorbed, the maximum BEC, the absorption rate, the area under the BEC curve (AUC), and the volumes calculated according to the Hahn nomogram (Volin) for each patient were taken into consideration. RESULTS: There were 15 cases of irrigating fluid absorption in patients receiving GA (75%), and 11 in those receiving SA (55%). CVP was significantly lower in spontaneously breathing patients with SA as compared to those with GA (P < 0.05). In patients with irrigating fluid absorption the maximum BEC (P < 0.02), as well as the rate of irrigant fluid absorption (P < 0.01), were significantly higher amongst patients receiving SA. In this group, the calculated area under the curve and the absorbed fluid volumes determined with the nomogram were significantly increased (P < 0.05). CONCLUSION: The absorption of irrigation fluid during the TURP is significantly more marked amongst spontaneously breathing patients with regional anaesthesia in comparison to patients undergoing general anaesthesia with positive pressure ventilation. The markedly lower central venous pressure before the start of irrigation should be considered as a possible cause of this effect.
BACKGROUND: The most common complication during percutaneous nephrolithotripsy (PNL) is the destruction of organ structures with extravasation of the irrigation fluid into the retroperitoneal space. Consequently, there is an increased risk of a urosepsis and a complicated therapeutic course. In this study we aimed to show that extravascular absorption could be differentiated from intravascular absorption due to their unique absorption characteristics, and that these characteristics enable a prediction of possible post-operative complications. METHODS: In a prospective study of 31 patients with PNL, ethanol was added to the irrigating fluid and blood ethanol concentration (BEC) was measured by gas chromatography during the endoscopic procedure and in the recovery room. Following the guidelines of Hahn, patients were divided into two groups: group EVA, in whom extravasation had occurred with subsequent absorption; group IVA, those with intravascular absorption. Patients' post-operative progress along with diagnoses of renal perforations or bleeding, or signs of infection or sepsis, were comprehensively listed. RESULTS: EVA was diagnosed in 19 cases, and IVA in 12 cases. Maximum BEC levels were achieved after 20 min (median) in the IVA group, and 75 min in the EVA group (P < 0.05). Apart from their significantly higher demand for opioids (P < 0.05), EVA patients had been hospitalised for a substantially and significantly longer period of time (P < 0.01). Although without statistical significance, there was a higher rate of peri-operatively confirmed complications and prolonged intensive therapeutic treatment in the extravasation group. CONCLUSION: Retroperitoneal extravasation can be identified by using ethanol monitoring during and after PNL. Afflicted patients require considerably longer hospitalisation, probably because of the additional injury to surrounding organ structures.
The imaging performance of metal plate/phosphor screens which are used for the creation of portal images in radiotherapy is investigated by using Monte Carlo simulations. To this end the modulation transfer function, the noise power spectrum and the detective quantum efficiency [DQE(f)] are calculated for different metals and phosphors and different thicknesses of metal and phosphor for a range of spatial resolutions. The interaction of x-rays with the metal plate/phosphor screen is modeled with the EGS4 electron gamma shower code. Optical transport in the phosphor is modeled by simulating scattering and reabsorption events of individual optical photons. It is shown that metals with a high atomic number perform better than lighter metals in maximizing the DQE(f). It is furthermore shown that the DQE(f) for the metal plate/phosphor screen alone is nearly x-ray quantum absorption limited up to spatial frequencies of 0.4 cycles/mm. In addition, it is argued that the secondary quantum sink of optical photons imposed by the optical chain (mirror, lenses and video camera) leads to a significant degradation of the signal-to-noise ratio at spatial frequencies which are most important for successful registration of portal images. Therefore, the conclusion is that a replacement of the optical chain by a flat array of photodiodes placed directly under the phosphor will lead to a substantial improvement in image quality of portal images.
Considering the fundamental difficulties to define the term 'depth of anaesthesia', a more feasible concept for assessment of 'adequacy of anaesthesia' will be explained. The basic requirements for a monitoring index are definite response, gradual scaling and independence from the anaesthetic technique used. Additionally the index should be predictive for appearance of clinical signs of an inadequate anaesthesia. Different signal-processing methods will be discussed to extract the relevant information from both the spontaneous and the evoked brain electrical activity. In this context well established methods like spectral analysis are investigated in combination with new and more sophisticated methods like bispectral analysis or wavelet decomposition. Since no single-parameter index has been defined for monitoring depth of anaesthesia, a set of EEG parameters may be more useful to take into account intra- and interindividual variability. In parallel to the description of the monitor concept, the investigation of neural nets and fuzzy techniques, in addition to or in substitution of conventional statistical methods, will be introduced. Examples are given for data quality assessment, parameter extraction and re-classification.
Book Chapters (1)
I. H. d. Boer, W. Maurer, F. R. Schneider, and O. Dössel. Matching von dreidimensionalen Elektrodenpositionen ausgehend von biplanaren Röntgenbildverstärkern und CCD-Farbkameras. In Bildverarbeitung für die Medizin 1999, Springer, Berlin Heidelberg New York, pp. 70-74, 1999
Conference Contributions (18)
I. H. d. Boer, F. B. Sachse, and O. Dössel. Matching of intracardial and extracorporal electrode positions with segmented volume datasets of the human thorax. In Proc. CARS 1999, pp. 1006, 1999
O. Dössel, and F. R. Schneider. Opportunities and limitation of non-invasive bioelectric imaging of the heart. In Proc. EMBEC 99, pp. 1188-1189, 1999
The spatial resolution of Bioelectric Imaging of the Heart was investigated. Based on the measurement of a multichannel Electrocardiogram (ECG) or Magnetocardiogram (MCG) images of epicardial potential distributions can be reconstructed. The imaging properties of this method have been investigated using Computer simulations. The spatial resolution depends strongly on the number and arrangement of electrodes and magnetometers, on the noise level of the sensors and on the individual morphology of the patient. Artefacts show up if errors in the torso model (geometry and/or impedance values) occur.
T. V. Franz, and O. Dössel. A three dimensional model for the simulation of arrythmia mechanic. In Proc. EMBEC 99, pp. 1226-1227, 1999
This study deals with a mathematical model of the cellular action potential with its underlying ionic currents in human myocardium based on the Luo-Rudy phase II cell model. The activation process is calculated in a three dimensional patch taking into account the behaviour of each single cell membrane and an anisotropic pattern as it is known for the right ventricel. The propagation is simulated using the Finite Difference Method in Time.
F. B. Sachse, C. D. Werner, and O. Dössel. A Software System for the Anatomically Contrained Reconstruction of Conductivity Distributions in Human Body. In Proc. 21th Conf. IEEE Eng. in Med. and Biol., pp. 886, 1999
A model based method is presented to assign the fibre orientation in the human heart. The approach uses anatomical models, which are derivable from medical tomographic images. These models describe the geometry of the atria and ventricles. The approach extends the models by applying information from morphological measurements, which examine the fibre orientation for the different anatomical structures in the dissected normal hearts. The orientation of myocardial fibres is interpolated based on restrictions, which are determined with automatic methods inside and on the surface of myocardial structures. For each structure a different rulebased method is chosen. The method is illustrated with an exemplary anatomical model, which was constructed with techniques of digital image processing based on the Visible Female data set
O. Dössel, and G. Seemann. Simulation of the cardial electrical activity: interactive control of the simulation process and modelling in pathologies. In Proceedings of European Medical and Biological Engineering Conference, pp. 1210-1211, 1999
Foreign Patent Documents from GermanyThe invention relates to a method of reconstructing the spatial current distribution in a biological object, at least one component of the magnetic field produced by the current sources being measured at a number of points outside the object, after which the current distribution at the volume elements situated within the object is reconstructed from the measuring values. In order to improve the accuracy of reconstruction, in a representation containing the morphological structure of the object the surfaces are specified on which the current sources are presumably present, the reconstruction being limited to the volume elements which are situated on these surfaces
F. R. Schneider. Das inverse Problem der Elektro- und Magnetokardiographie - Optimale Erfassung und Nutzung der meßbaren Information. Universität Karlsruhe (TH), Institut für Biomedizinische Technik. Dissertation. 1999
Student Theses (9)
C. Baltes. Measuring the optical properties of turbid media using a frequency-domain technique. Institut für Biomedizinische Technik, Universität Karlsruhe (TH). . 1999
S. Binhack. Vorverarbeitung des Visible Female Datensatzes. Universität Karlsruhe (TH), Institut für Biomedizinische Technik. . 1999
K. Chaisaowong, F. B. Sachse, and G. Seemann. Hybride Visualisierung der Menschlichen Anatomie und Physikalischer Felder: Interaktive Benutzeroberfläche mit Inter-Prozess Kommunikation. Universität Karlsruhe (TH), Institut für Biomedizinische Technik. . 1999
H. Kusenberg. Optimierung und Beschleunigung der 3D-Rekonstruktion nach Feldkamp. Universität Karlsruhe (TH), Institut für Biomedizinische Technik. Diplomarbeit. 1999
S. Metz. An intraoperative monitoring system for the analysis of evoked potential data. Universität Karlsruhe (TH), Institut für Biomedizinische Technik. Diplomarbeit. 1999
P. Mischinger. Erkennung einer Instrumentenspitze zur automatischen Nachführung eines Endoskops. Universität Karlsruhe (TH), Institut für Biomedizinische Technik. Diplomarbeit. 1999
D. Rinck. Entwicklung, Analyse und Vergleich von Segmentierungsverfahren für Gefäßstrukturen in medizinischen Volumendaten. Universität Karlsruhe (TH), Institut für Biomedizinische Technik. Diplomarbeit. 1999
F. Thiel. Entwicklung und Realisation eines DSP gestützten Signalanalysators zur Bestimmung der Impedanz von biologischem Gewebe. Universität Karlsruhe (TH), Institut für Biomedizinische Technik. Diplomarbeit. 1999
P. Vollmer. Meßdatenkonvertierung und Kalibrierung für ein 64-Kanal-EKG-Systems. Universität Karlsruhe (TH), Institut für Biomedizinische Technik. . 1999