Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference
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BIS monitoring is a processed electroencephalogram (EEG) technology that is designed to follow the effects that anesthetics and sedatives have on cerebral function. Much is know about the technology, it's utility and limitations. The economic case for widespread utilization of this technology is weak. ⋯ Total cost to the heath care system would approach one billion US dollars per year, just for use during general anesthetics. More appropriate use of already available drugs and technology would most likely decrease the incidence of IR as effectively, although individual patients who are at high risk for IR may benefit from this technology. However, based on current health care economic standards general use of BIS monitoring does not seem warranted and appears not to be cost-effective.
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Conf Proc IEEE Eng Med Biol Soc · Jan 2008
Clinical TrialValidation of the Index of Consciousness (IoC) during sedation/analgesia for ultrasonographic endoscopy.
The level of consciousness of patients undergoing surgery evolves continuously as the effect of the anesthetic agents is counteracted by the surgical stimuli. The monitors of depth of anesthesia, based on the analysis of the electroencephalogram (EEG), have been progressively introduced into the daily practice to provide additional information about the state of the patient. ⋯ A good correlation is found between both indexes. Furthermore, IoC presents a significantly higher prediction probability Pk of the level of sedation than BIS, and can thus be considered as an interesting measure of the level of consciousness.
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Conf Proc IEEE Eng Med Biol Soc · Jan 2008
Fetal distress diagnosis using heart rate variability analysis: design of a high frequency variability index.
Routine monitoring of Fetal Heart Rate (FHR) during labor enables diagnosis of fetal distress and appropriate management by the medical staff. Diagnosis of fetal distress relies mainly on a subjective visual assessment of FHR variations using baseline level, oscillations magnitude, decelerations and their time-relation to the parturient uterine contractions. Strong intra and inter-observer discrepancies exist with this widely used technique, and sometimes requires fetal scalp blood sample pH measurement, which is not fully reliable either. ⋯ We tested this new index on 21 fetuses where FHR was recorded during labor for an observational clinical trial. FHR recordings were separated in two groups given the fetal arterial pH obtained after birth: group 1 - no distress, pH >= 7.15, N=16 and group 2 - fetal distress, pH 7.15, N=5. The new index was significantly higher in group 1 than in group 2 (non parametric Mann Whitney U-test, p=0.01).
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Conf Proc IEEE Eng Med Biol Soc · Jan 2008
EEG spectral changes and onset of burst suppression pattern in propofol/remifentanil anesthesia.
This paper studies how remifentanil, a commonly used intraoperative opioid, affects the relation of the onset of burst suppression pattern (BSP) and the spectral changes of EEG during anesthesia. The onsets of BSP were detected using both manual and the automatic method proposed from the EEGs of twenty-seven patients who had received different amount of remifentanil with the anesthetic. ⋯ The results showed that remifentanil significantly affects the relation of EEG spectral changes and the onset of BSP. The finding is important since the current EEG-based assessment of the depth of anesthesia basically relies on the analysis of the spectral features and BSP.
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Conf Proc IEEE Eng Med Biol Soc · Jan 2008
A target control Infusion method for neuromuscular blockade based on hybrid parameter estimation.
The paper presents a new method for target control infusion (TCI) for neuromuscular blockade (NMB) level control of patients subject to general anaesthesia. The method combines an inversion of the pharmacokinetic/pharmacodynamic (PK/PD) model with a hybrid parameter estimation method that uses on-line data from the initial bolus response to estimate the model parameters. Although atracurium is considered as relaxant, the newly proposed method may be applied to other drugs for which the PK/PD model is available. Simulation results on a bank of 100 patient models are presented to demonstrate the achievable performance.