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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

#71

Post by leereeves »

baxtr wrote: post #70
leereeves wrote: post #67

Earlier quoted context omitted.

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.

Unfortunately most of the research cited there was in "resistance-trained" individuals (and one in nurses, who are far from sedentary). The meta analysis also included at least some research on active individuals. And the author is a bodybuilder and fitness coach.

The one study of overweight individuals mentioned found no adverse side effects but only lasted six months, which may not be long enough for clinical effects to become obvious.

Also, the author overlooked gout entirely.

Based on all that, I'm not convinced it is safe for sedentary individuals.

I think the author should have written:

> As long as you are highly active and have don’t have pre-existing kidney issues...

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

#72

Post by kilimounjaro »

Paediatric anaesthesiologist here.

We mostly use propofol/remifent for maintenance of anaesthesia, and there is (some) reasonable evidence that this leads to less emergence delirium than sevoflurane. We use EEG-like monitors in all paralysed patients over a few months old.

Annoyingly I can’t access the full study, but would be interested to know why the kids in the low sevoflurane use group weren’t moving or coughing with surgical stimulation. The commonly used doses of sevoflurane are used because they are supposed to inhibit movement in response to noxious stimulus. So presumably these patients are all being paralysed or given a lot of opioid to stop them moving?

Using sevoflurane instead of propofol for maintenance if you are trying to reduce PAED is not really standard of care and makes me suspicious they are trying to overstate the effectiveness of their device.

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

#73

Post by codr7 »

accrual wrote: post #15
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

Just anecdata, but I was under a few times as kid. It was like teleporting into the future. Last memory was being told to count backwards, next memory was waking up in the recovery room. Apparently I had a small anesthetic overdose in the hospital as a kid and woke up a day or two later than expected, but from my perspective, nothing happened and I just went to sleep then woke up.

Agreed, super weird.

Did it once for a back injury as an adult, also only remember the countdown.

But my system was flushed with opiates when I woke up, so I was in a pretty good mood at least.

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

#74

Post by robbiep »

kilimounjaro wrote: post #72

Paediatric anaesthesiologist here. We mostly use propofol/remifent for maintenance of anaesthesia, and there is (some) reasonable evidence that this leads to less emergence delirium than sevoflurane. We use EEG-like monitors in all paralysed patients over a few months old. Annoyingly I can’t access the full study, but would be interested to know why the kids in the low sevoflurane use group weren’t moving or coughing…

Here you go: https://drive.google.com/file/d/1y3_fgi0prAUjLugQWUDylZL_TN8...

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

#75

Post by tapoxi »

kilimounjaro wrote: post #72

Paediatric anaesthesiologist here. We mostly use propofol/remifent for maintenance of anaesthesia, and there is (some) reasonable evidence that this leads to less emergence delirium than sevoflurane. We use EEG-like monitors in all paralysed patients over a few months old. Annoyingly I can’t access the full study, but would be interested to know why the kids in the low sevoflurane use group weren’t moving or coughing…

My family has a history of malignant hyperthermia, so I was recently put under without inhaled anesthetics and they put an EEG on me. It was wild, zero delerium, nausea, or grogginess. I just snapped back into full consciousness.

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

#76

Post by wl »

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 gasses aren't paralytics. MAC is not about chemically preventing muscles from activating but depressing consciousness to the point that muscles don't move in reaction to painful stimulus. Chemically blocking muscle movement (neuromuscular blockade) takes an actual paralytic like succinylcholine. Pain control is yet another, separate factor. Even with depressed consciousness from a gas/propofol infusion and neuromuscular blockade, blood pressure (which is part of standard monitoring!) still will spike in response to painful stimuli. So usually, anesthesiologists will give an opioid in addition to gas/propofol to control pain, even if the patient isn't conscious and wouldn't be consciously aware of the pain of surgery.

The nightmare scenario you describe is when a patient has neuromuscular blockade, is not being given sufficient gas/propofol to depress consciousness, and has inadequate pain control that isn't being picked up in the blood pressure either because the anesthesia provider isn't paying attention or is controlling blood pressure through drugs to the point they can't see anything. If, for some reason, that kind of anesthetic is medically necessary, benzodiazepines can (if tolerated) prevent memories from forming lessening the chances of psychological trauma.

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

#77

Post by sillysaurusx »

kilimounjaro wrote: post #72

Paediatric anaesthesiologist here. We mostly use propofol/remifent for maintenance of anaesthesia, and there is (some) reasonable evidence that this leads to less emergence delirium than sevoflurane. We use EEG-like monitors in all paralysed patients over a few months old. Annoyingly I can’t access the full study, but would be interested to know why the kids in the low sevoflurane use group weren’t moving or coughing…

> Annoyingly I can’t access the full study

If you post on https://www.reddit.com/r/scholar you’ll get access within 15 minutes or so. This is true of basically any paywalled academic article.

Just make sure you include a link to the actual paywall rather than just the doi.

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

#78

Post by kilimounjaro »

tapoxi wrote: post #75
kilimounjaro wrote: post #72

Paediatric anaesthesiologist here. We mostly use propofol/remifent for maintenance of anaesthesia, and there is (some) reasonable evidence that this leads to less emergence delirium than sevoflurane. We use EEG-like monitors in all paralysed patients over a few months old. Annoyingly I can’t access the full study, but would be interested to know why the kids in the low sevoflurane use group weren’t moving or coughing…

My family has a history of malignant hyperthermia, so I was recently put under without inhaled anesthetics and they put an EEG on me. It was wild, zero delerium, nausea, or grogginess. I just snapped back into full consciousness.

Propofol is great isn’t it! I worked with some old guys who did some of the original studies demonstrating safety of propofol anaesthesia in MH. The world is much better for people with MH than it was 30 years ago, as long as they have a way to inform their doctors of the condition.

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

#79

Post by kilimounjaro »

robbiep wrote: post #74
kilimounjaro wrote: post #72

Paediatric anaesthesiologist here. We mostly use propofol/remifent for maintenance of anaesthesia, and there is (some) reasonable evidence that this leads to less emergence delirium than sevoflurane. We use EEG-like monitors in all paralysed patients over a few months old. Annoyingly I can’t access the full study, but would be interested to know why the kids in the low sevoflurane use group weren’t moving or coughing…

Here you go: https://drive.google.com/file/d/1y3_fgi0prAUjLugQWUDylZL_TN8...

Many thanks!!

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

#80

Post by jonnybgood »

leereeves wrote: post #71
baxtr wrote: post #70

Earlier quoted context omitted.

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.

Unfortunately most of the research cited there was in "resistance-trained" individuals (and one in nurses, who are far from sedentary). The meta analysis also included at least some research on active individuals. And the author is a bodybuilder and fitness coach. The one study of overweight individuals mentioned found no adverse side effects but only lasted six months, which may not be long enough for clinical effec…

What convinces you that it’s unsafe?
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