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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

#81

Post by elric »

kilimounjaro wrote: post #78
tapoxi wrote: post #75

Earlier quoted context omitted.

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.

Was put under for minor surgery using propofol some 20 years ago. Doc started injecting the milky white goo into my IV, without so mucy as a hello, there was a clock in the room which seemed to slow down, I couldn't breathe or move or cry out and was sure I was dying.

Then I woke up in a recovery room, with zero awareness of anything that happened in between.

0/10, not an experience I'd recommend.

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

#82

Post by halper »

logifail wrote: post #6
Etheryte wrote: post #5

Earlier quoted context omitted.

To start, the article gives a few good examples: > children sometimes wake up from anesthesia with a set of side effects including lack of eye contact, inconsolability, unawareness of surroundings, restlessness, and non-purposeful movements In general, a very simple mental model for general anesthesia is that it's an unnatural state for your body and your body will do its best to get rid of it, similar to say alcohol…

> In other words, general anesthesia is rough on you Can confirm having watched our kids recover from general anesthesia multiple times. Full disclosure: have three kids, eldest child at lifetime total of 4x general anesthesia so far (1x for endoscopy, 3x for surgery), youngest child lifetime total of two (1x endoscopy, 1x dental work). Middle child seems to have escaped so far... he asked recently what it was like,…

Interesting. My adventurous child (soon 10) has been under thrice and generally remembers nothing unpleasant, despite it being a bit worrying for the parents. She has been a bit confused and weird upon waking up, but whatever they have given her to ease her transition into waking life appears to have made her forget it. She tends to remember talking to me (or watching Bluey) in the OR and then she is talking to some doctor in another room, wondering why they are not putting her to sleep. The experience has been quite smooth despite one of the times taking place in more of an emergency setting after an accident.

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

#83

Post by bobowzki »

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…

Always nice to see another anesthesiologist on hackernews, we're quite a few it seems. I have done research in this area and also worked a bit with Emery. Which/what brand EEG monitor do you use?

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

#84

Post by dr_dshiv »

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…

I was surprised when my 7 year old son received a minor eye surgery (he had a random fleck of metal on the sclera) and they gave him a large dose of ketamine.

He remained conscious but was immobilized. I asked him what it was like afterwards and he said “dad, everything turned into legos!!”

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

#85

Post by slicerdicer2 »

bobowzki wrote: post #83
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…

Always nice to see another anesthesiologist on hackernews, we're quite a few it seems. I have done research in this area and also worked a bit with Emery. Which/what brand EEG monitor do you use?

Hi :) Yes I think the combination of quite a bit of phone time during the work day and also being frustrated tech people makes HN good for us.

I use SedLine but have used entropy and BIS in the past.

Interestingly the study uses 1mg/kg roc in 40% of the patients and a lot of sugammadex, as well as a pretty decent dose 0.5mcg/kg/min remifent infusion.

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

#86

Post by Etheryte »

louthy wrote: post #66
aziaziazi wrote: post #28

Earlier quoted context omitted.

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 w…

First off, glad it worked out nicely for you and there were no complications.

I'm gonna stretch the alcohol analogy a bit here, because that's most likely to be relatable to everyone, but of course the situation is a bit more nuanced with anesthesia. If you're a healthy adult, you could probably down a bottle of vodka. You might not enjoy it nor have a good time, but you'd most likely make it out the other end with a wicked hangover and some questions about life choices. If you're a small child, you might leave with permanent brain damage. If you have an underlying condition, you might have a kidney fail. Etc. Anesthesia is the same way. The fact that you, I'm assuming a healthy adult, walked away with few issues, doesn't make it any less risky.

Most healthy adults walk away from general anesthesia without longlasting effects. But for everyone else, you can already find a number of unfortunate experiences in this comment section alone. A large portion of people who go under do so because they're already in some dire state and need emergency help. Adding general anesthesia on top of that is a large source of risk.

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

#87

Post by mapt »

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 don't think this has been debunked.

I think it's an omnipresent concern in people with 10-20% kidney function left, and outside that cohort, it's a concern if you're getting a supermajority of your calories from protein for a prolonged period of time (which is quite rare/expensive for most of us)

https://en.wikipedia.org/wiki/Protein_toxicity

Most people who eat "high protein diets" are not actually eating all that much protein, because their food is laced with lots of fat and some carbs. The guy eating burgers and sausage all day long is actually on a high-fat diet. This fools people because fat is so nutritionally dense, and because lean protein is basically always chock-full of bulky water. The soy "protein" I'm eating still has fat and carbs.

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

#88

Post by baxtr »

mapt wrote: post #87
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 don't think this has been debunked. I think it's an omnipresent concern in people with 10-20% kidney function left, and outside that cohort, it's a concern if you're getting a supermajority of your calories from protein for a prolonged period of time (which is quite rare/expensive for most of us) https://en.wikipedia.org/wiki/Protein_toxicity Most people who eat "high protein diets" are not actually eating all that…

I don’t think it’s relevant what we think on this matter. The studies have debunked this. See the link in my other comment for actual studies.

Re your link: Yes, most things are toxic if consumed in vast amounts, even water.

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

#89

Post by sawjet »

dr_dshiv wrote: post #84
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…

I was surprised when my 7 year old son received a minor eye surgery (he had a random fleck of metal on the sclera) and they gave him a large dose of ketamine. He remained conscious but was immobilized. I asked him what it was like afterwards and he said “dad, everything turned into legos!!”

I was given ketamine as a 15 year old for a broken ankle that needed to be re-set. The nurse didn't tell what it was but I could read the label when she was filling up the syringe. It definitely didn't put me to sleep.

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

#90

Post by leereeves »

jonnybgood wrote: post #80
leereeves wrote: post #71

Earlier quoted context omitted.

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?

I'm not convinced that it's unsafe either, but I'd like to see stronger evidence than a blog post citing selected research.
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