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In kids, EEG monitoring of consciousness safely reduces anesthetic use

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Re: In kids, EEG monitoring of consciousness safely reduces anesthetic use

#41

Post by bookofjoe »

holowoodman wrote: post #25
bts327 wrote: post #17

Earlier quoted context omitted.

I’m good here. Thanks.

MAC doesn't indicate the depth of the anesthesia. It indicates the depth of the paralysis. Which is exactly the problem EEG monitoring is supposed to prevent: In some cases patients can have an insufficient response to analgesia (so they will feel pain) and hypnotics (so they are awake, aware and forming memories) but will respond to paralytics (so they are unable to move and communicate their predicament). So with t…

>Anesthesia Awareness and the Bispectral Index (2008)

https://www.nejm.org/doi/full/10.1056/NEJMoa0707361

........................................

>Awareness during anesthesia: how sure can we be that the patient is sleeping indeed? (2009)

https://pmc.ncbi.nlm.nih.gov/articles/PMC2683150/

........................................

>Awake Under Anesthesia (2018)

https://www.newyorker.com/books/page-turner/are-we-all-awake...

https://archive.ph/t9T7o

........................................ >Single-trial classification of awareness state during anesthesia by measuring critical dynamics of global brain activity (2019)

https://www.nature.com/articles/s41598-019-41345-4

........................................

>Intraoperative and Anesthesia Awareness (2023)

https://www.ncbi.nlm.nih.gov/books/NBK582138/

Re: In kids, EEG monitoring of consciousness safely reduces anesthetic use

#42

Post by holowoodman »

bts327 wrote: post #40
holowoodman wrote: post #25

Earlier quoted context omitted.

MAC doesn't indicate the depth of the anesthesia. It indicates the depth of the paralysis. Which is exactly the problem EEG monitoring is supposed to prevent: In some cases patients can have an insufficient response to analgesia (so they will feel pain) and hypnotics (so they are awake, aware and forming memories) but will respond to paralytics (so they are unable to move and communicate their predicament). So with t…

Good day to you.

Well... My textbook[0] says:

> The minimum alveolar concentration (MAC) is the minimum concentration of an inhaled anesthetic at 1 atm of pressure that prevents skeletal muscle movement in response to a surgical incision in 50% of patients.

So first, you do not measure the depth of anesthesia, you measure the concentration of the anesthetic. Second, you judge this concentration by the prevention of muscle movement. Called paralysis.

Please tell me you are not really a doctor.

[0] https://www.sciencedirect.com/topics/medicine-and-dentistry/...

Edit: In case you are wondering why this response doesn't really fit the parent comment, the parent saw fit to completely replace his comment without an indication that he did so. Originally there was a claim in the parent comment about "MAC being the primary indication of anesthetic depth being the textbook definition" or something to that effect. To which I responded. I guess I must have hit a nerve there ;)

Re: In kids, EEG monitoring of consciousness safely reduces anesthetic use

#43

Post by thelaxiankey2 »

Nifty3929 wrote: post #27
holowoodman wrote: post #7

"Kids don't need anesthetics. If they are young enough, they won't remember the pain, so you can just operate without anesthetics. They are also easier to restrain than adults." This was state of the art in medicine for quite some time. I fear the general trend of "medication bad" will get us back to those dark times. Btw, those dark times ended only as recently as 1987! https://www.newsweek.com/when-doctors-start-us…

This right here. Medicine is not bad in general. Mother Nature is a wicked mistress. Pain and suffering are her defaults, and glimmers of happiness fleeting. Modern technology and medicine in particular have made our lives better and longer in ways our near ancestors could not have dreamed of or hoped for. It's not hard to find counterexamples of course: opioid addiction, climate change, etc. But on balance we're a h…

Do notice that the comments about 'pain and suffering are mother nature's defaults' have very little to do with anything else you said, or with the discussion more broadly. I think these sorts of things are bad internet hygiene and promote an actively depressive state of mind. They can be memetic concepts, and should be treated with care. If you do actually feel this way about your own life, I'd encourage you to seek some kind of help. And besides, there's nothing natural about surgery...

I think the rest of what you're saying is fairly accurate, though.

Re: In kids, EEG monitoring of consciousness safely reduces anesthetic use

#44

Post by HocusLocus »

Why is there a sense that kids simply "don't remember" the pain of surgery if they are lightly anesthetized?

Do they think the nervous system is "turned off" in kids and "turns on" later? Likewise with the formation of memories. A human consciousness that is dealt searing pain under paralysis for an eon of thought-time, might trigger a life long psychosis that impairs living and learning.

Or a thirst for revenge.

Re: In kids, EEG monitoring of consciousness safely reduces anesthetic use

#45

Post by rscho »

HocusLocus wrote: post #44

Why is there a sense that kids simply "don't remember" the pain of surgery if they are lightly anesthetized? Do they think the nervous system is "turned off" in kids and "turns on" later? Likewise with the formation of memories. A human consciousness that is dealt searing pain under paralysis for an eon of thought-time, might trigger a life long psychosis that impairs living and learning. Or a thirst for revenge.

The theory wasn't about remembering, it was mostly about babies supposedly having a nervous system too immature to interpret pain as in adults. This is not the current opinion at all anymore.

Re: In kids, EEG monitoring of consciousness safely reduces anesthetic use

#46

Post by rscho »

crazygringo wrote: post #11

Why is this about kids? Do we already measure EEG for adults? Or not? If we do, why has it taken so long to do with kids? If not, is this a first step? Why start with kids rather than adults? This article provides shockingly little context.

We do it regularly in both kids and adults, and this is nothing new. It's just that a study confirms it's useful using statistics instead of common sense. We were already using EEG in both kids and adults 15 years ago.

Re: In kids, EEG monitoring of consciousness safely reduces anesthetic use

#47

Post by holowoodman »

rscho wrote: post #45
HocusLocus wrote: post #44

Why is there a sense that kids simply "don't remember" the pain of surgery if they are lightly anesthetized? Do they think the nervous system is "turned off" in kids and "turns on" later? Likewise with the formation of memories. A human consciousness that is dealt searing pain under paralysis for an eon of thought-time, might trigger a life long psychosis that impairs living and learning. Or a thirst for revenge.

The theory wasn't about remembering, it was mostly about babies supposedly having a nervous system too immature to interpret pain as in adults. This is not the current opinion at all anymore.

You are correct. But there is also the aspect that in current opinion, children below the age of 2 to 3 years do not form episodic memory. Which can reinforce the misconception about the necessity of anesthetics in children, because they are unable to recall and tell about the pain.

Re: In kids, EEG monitoring of consciousness safely reduces anesthetic use

#48

Post by rscho »

holowoodman wrote: post #25
bts327 wrote: post #17

Earlier quoted context omitted.

I’m good here. Thanks.

MAC doesn't indicate the depth of the anesthesia. It indicates the depth of the paralysis. Which is exactly the problem EEG monitoring is supposed to prevent: In some cases patients can have an insufficient response to analgesia (so they will feel pain) and hypnotics (so they are awake, aware and forming memories) but will respond to paralytics (so they are unable to move and communicate their predicament). So with t…

MAC is the alveolar concentration (so strictly speaking defined only for anesthetic gases) at which half of people show no motor reaction on surgical incision. I understand your interpretation about paralysis, but we know the measurement endpoint is not paralysis in practice. Gases are hypnotics, and although they do cause some amount of muscle relaxation they do not induce paralysis. Hence the need for other drugs when we need paralysis. BTW, there is evidence that EEG prevents awareness under anesthesia, but it's not a guarantee either. Fortunately, awareness is extremely rare even in the select cases where it occurs more often (emergency C-section and cardiac surgery, especially in seniors).

Re: In kids, EEG monitoring of consciousness safely reduces anesthetic use

#49

Post by riskassessment »

HocusLocus wrote: post #44

Why is there a sense that kids simply "don't remember" the pain of surgery if they are lightly anesthetized? Do they think the nervous system is "turned off" in kids and "turns on" later? Likewise with the formation of memories. A human consciousness that is dealt searing pain under paralysis for an eon of thought-time, might trigger a life long psychosis that impairs living and learning. Or a thirst for revenge.

Anaesthetics are far from harmless. Using the minimal amount necessary is a good thing, actually.

Re: In kids, EEG monitoring of consciousness safely reduces anesthetic use

#50

Post by rscho »

holowoodman wrote: post #47
rscho wrote: post #45

Earlier quoted context omitted.

The theory wasn't about remembering, it was mostly about babies supposedly having a nervous system too immature to interpret pain as in adults. This is not the current opinion at all anymore.

You are correct. But there is also the aspect that in current opinion, children below the age of 2 to 3 years do not form episodic memory. Which can reinforce the misconception about the necessity of anesthetics in children, because they are unable to recall and tell about the pain.

Anesthesia is mostly know-how. When you've put several hundred kids under, you (usually) become equipped with a good sense of what's going on, even without kids telling you.
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