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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

#61

Post by rscho »

holowoodman wrote: post #21
quantumwoke wrote: post #12

Earlier quoted context omitted.

My wife is a doctor and looked into the history of this for a bit more context. Apparently, there were some cases in 1987 where premature neonates were paralysed but not given general anaesthesia due to risk of immediate death. This led to a position statement from the paediatric society at the time that nobody should be operated on without pain relief / general anaesthetic. Note that this does not mean that general…

https://www.sciencedirect.com/science/article/pii/S152659001... > textbooks at the time taught that [open heart] surgery [...] ‘‘could be safely accomplished with only oxygen and a paralytic’’ 69(p.580) when performed on infants. Textbooks isn't "some doctors errorneously believed", it is what most doctors believed, taught and practiced. > infant surgery routinely conducted with no or minimal anesthesia well into the…

While the theory about pain in kids was certainly wrong, you are lacking some context about what 'safe' used to mean, and what it means nowadays. In the 80's, kids were under halothane and long-acting paralysis drugs which, especially in cardiac patients, are really dangerous. Halothane is now discontinued, as are many other common drugs from this time. Theories do not spring out in isolation. The evolution of technology, biological understanding and new pharmacology have all contributed to allow new opinions as incremental changes made old theories more and more evidently obsolete. Doctors 50 years from now will also wonder how we could be so stupid in 2025.

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

#62

Post by rscho »

Gravityloss wrote: post #60

I used to work in this field decades ago. It was relatively straightforward. You could see it with your plain eyes in the EEG, but also you could calculate metrics from it. One really fun way was to listen to the sped up EEG signal when a person is put into anesthesia. It sounded like you went underwater. The key thing is that when people are given muscle relaxants, you need an independent method to measure conscious…

It is mainstream. We have modules. It's useful, but unfortunately not a magic wand either.

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

#63

Post by rscho »

holowoodman wrote: post #33
quantumwoke wrote: post #24

Earlier quoted context omitted.

I think there is a definitional problem with "kids" vs "infants" vs "newborns" which are all difficult to define, the type of anaesthesia that was administered and we are also talking about 40 years ago. Our understanding of anaesthetics and heart surgery in newborns was much different than today. America definitely has a checkered and sordid past here and in psychiatry. But we also have a duty to be definitionally e…

I admit that "kids" is a bit imprecise and can lead to misunderstandings. But that is just not important to this discussion. And the exact definition of the anesthesia given to most infants before 1987: A paralytic. Nothing else. If you feel adventurous, have your family doctor give you a paralytic and then push a sterile needle under your fingernail. Then tell me the exact definition of sufficient anesthesia in that…

> And the exact definition of the anesthesia given to most infants before 1987: A paralytic. Nothing else.

To my knowledge, this was only true for newborns. Infants and up usually got some sort of hypnotic.

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

#64

Post by rscho »

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…

> I fear the general trend of "medication bad" will get us back to those dark times.

I think this won't ever happen. Modern docs would absolutely not accept working under such conditions. Anesthesia is not only comfort for the patient, but also for care providers. As you can often see when surgeons advise patients on refusing local anesthesia or nurses demanding benzos for the screaming demented patient at 2 a.m.

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

#65

Post by tzs »

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…

Another medical horror story that only ended way more recently than it should have (mid 1950's probably): https://www.straightdope.com/21341781/in-medicine-what-s-the...

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

#66

Post by louthy »

aziaziazi wrote: post #28
louthy wrote: post #4

Earlier quoted context omitted.

> very rough on you How so?

Rough like the roughest hangover you can have. I had a general anesthesia at 21 for dental surgery. The come back was a nightmare: nausea, shaking, cold and hot alternating, terrible headache, cramps, exhausted and mentally depressed during ~2 days. I couldn't eat, I couldn't drink (but brute force myself to do it), I couldn't think or concentrate on anything but the pain. The only close experience I can remember is…

> Rough like the roughest hangover you can have

I’ve had one for an operation on a broken jaw, just didn’t think it was particularly rough. Of course it takes time to come round and be clear headed, but the OP kinda implied serious physical problems with “dangerous and very rough on you”. Maybe I just misunderstood what they were saying, but I thought they meant rough as in long lasting damage (which I didn’t think was the case), not temporary discomfort.

Your situation obviously isn’t ideal, but doesn’t have the same implication.

> I always wonder what was that drug that produce so weird half-wake dreams

The sibling comment here mentions Ketamine, which is possible, but if they’re giving that to you intravenously then all perception of time and space will be warped. It’s extreme. So wild dreams is one thing, questioning what is even real is more like ketamine.

It is after effect free though and doesn’t last long, so once stopped you can be over it within the hour. It also has antidepressant effects afterwards.

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

#67

Post by leereeves »

baxtr wrote: post #58
bagels wrote: post #20

Earlier quoted context omitted.

Doctors not too long ago would tell you that infants don't experience pain. There are a lot of not backed by science beliefs in the medical field that won't die until the doctors that believe them do. https://pubmed.ncbi.nlm.nih.gov/23548489/

Too much protein is bad for your kidneys!!! PS: this has been debunked, still docs keep saying it.

I've heard there is good evidence that weightlifters eating an appropriate (high) protein intake for hypertrophy don't harm healthy kidneys, though the sources seemed biased.

But has that statement been debunked for sedentary people or people with kidney disease?

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

#68

Post by bookofjoe »

rscho wrote: post #52
holowoodman wrote: post #42

Earlier quoted context omitted.

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. C…

"MAC being the primary indication of anesthetic depth being the textbook definition" I am an attending anesthesiologist and this is true. MAC cannot be interpreted at face value, though. You've got other drugs on board (not accounted for in MAC), the patient might be frail or very old, etc. etc. All things changing MAC interpretation, which is why there are still anesthesia providers instead of robots ;-) We currentl…

>Robotic Anesthesia: A Vision for 2050

https://journals.lww.com/anesthesia-analgesia/fulltext/2024/...

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

#69

Post by tzs »

Nezghul wrote: post #14

What is the level of unconsciousness during anesthesia? Is it "sleep-like" unconsciousness or "neurons do basically nothing" level? Whenever I read about anesthesia I am wondering if we are not accidentally killing people (and creating new ones) like in teletransportation paradox. https://en.wikipedia.org/wiki/Teletransportation_paradox

To add to the examples others have given there is also some that makes you not feel pain but you do remain semi-conscious and when so can still form permanent memories. This is called conscious sedation. They can adjust your level of consciousness as they go, so they can make you more aware if they have to ask questions or need to you do something like move a body part for them and make you less aware when they don't need any interaction.

It combines a sedative from the benzodiazepine family with a synthetic opioid painkiller. This is the most common sedation for colonoscopies. I had a colonoscopy using this, with fentanyl as the opioid and probably midazolam for the benzodiazepine (if not that probably diazepam).

I was aware of the doctor starting the procedure and felt something cold. I could feel pushing sometimes. But nothing hurt or was even annoying (except that cold right at the start). I remember being asked how I was doing and answering. I remember the doctor talking about the quality of my prep--the laxatives had not been as effective as they could have been--and noting that it was still good enough to allow them to continue.

There are some gaps so I think at some points I was more out of it.

I had an earlier colonoscopy with deep sedation using propofol. Here's the experience with that: (1) they start it and I have maybe 10 seconds of memories after that point. At this point I wasn't even in the procedure room. I was in a bed in a waiting area. (2) My next memory is waking up, in the same waiting area, with a nurse telling me they are done, putting the basket with my pants and glasses and phone on the bed, and telling me I could put my pants on.

I've got no memory of being wheeled into the procedure area, or of anything that happened there, or being wheeled back.

That doesn't necessarily mean I didn't feel anything during the procedure. When we were going over the sedation options when arranging for that colonoscopy I asked if deep sedation means you don't feel anything at all, and all the doctor would say is that I would not have any memories of anything.

That isn't exactly reassuring.

If someone offered to pay me a large amount of money to undergo a couple of hours or horrible torture with a guarantee that they would give me a drug to prevent forming long term memories of that torture I would not accept. I would be too worried that there could be other negative persistent effects of such mental trauma than just the formation of long term recallable memories and that the memory preventing drug would not stop those other effect.

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

#70

Post by baxtr »

leereeves wrote: post #67
baxtr wrote: post #58

Earlier quoted context omitted.

Too much protein is bad for your kidneys!!! PS: this has been debunked, still docs keep saying it.

I've heard there is good evidence that weightlifters eating an appropriate (high) protein intake for hypertrophy don't harm healthy kidneys, though the sources seemed biased. But has that statement been debunked for sedentary people or people with kidney disease?

https://physiqonomics.com/are-high-protein-diets-bad-for-you...

Had a great overview.

> As long as you have don’t have pre-existing kidney issues, you don’t need to worry about high-protein intakes killing your kidneys, and it’s time to put this myth to bed.

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