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Titolo:
CRANIOFACIAL ELECTROMYOGRAM ACTIVATION RESPONSE - ANOTHER INDICATOR OF ANESTHETIC DEPTH
Autore:
DUTTON RC; SMITH WD; BENNETT HL; ARCHER S; SMITH NT;
Indirizzi:
KAISER PERMANENTE MED CTR,DEPT ANESTHESIA,27400 HESPERIAN BLVD HAYWARD CA 94545 CALIF STATE UNIV SACRAMENTO,BIOMED ENGN PROGRAM SACRAMENTO CA 95819 PENN STATE UNIV,DEPT ANESTHESIA HERSHEY PA 00000 VENTRITREX CORP SUNNYVALE CA 00000 UNIV CALIF SAN DIEGO,VET AFFAIRS MED CTR,DEPT ANESTHESIA SAN DIEGO CA92161
Titolo Testata:
JOURNAL OF CLINICAL MONITORING AND COMPUTING
fascicolo: 1, volume: 14, anno: 1998,
pagine: 5 - 17
SICI:
1387-1307(1998)14:1<5:CEAR-A>2.0.ZU;2-O
Fonte:
ISI
Lingua:
ENG
Soggetto:
GENERAL-ANESTHESIA; WAKEFUL RESPONSE; MULTIPLE MODEL; STARTLE REFLEX; NITROUS-OXIDE; ISOFLURANE; EEG; PROPOFOL; COMMAND; EMG;
Keywords:
ANESTHESIA, GENERAL, DEPTH, ISOFLURANE, COMPUTER SIMULATION; AROUSAL; MONITORING, ANESTHETIC DEPTH, ELECTROMYOGRAM, EMG; MEMORY, AWARENESS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
32
Recensione:
Indirizzi per estratti:
Citazione:
R.C. Dutton et al., "CRANIOFACIAL ELECTROMYOGRAM ACTIVATION RESPONSE - ANOTHER INDICATOR OF ANESTHETIC DEPTH", JOURNAL OF CLINICAL MONITORING AND COMPUTING, 14(1), 1998, pp. 5-17

Abstract

Objective. After finding that craniofacial EMG preceding a stimulus was a poor predictor of movement response to that stimulus, we evaluated an alternative relation between EMG and movement: the difference in anesthetic depth between the endpoint of EMG responsiveness to a stimulus and endpoint of movement responsiveness to that stimulus. We expressed this relation as the increment of isoflurane between the two endpoints. Methods. We measured EMG over the frontalis muscle, over the corrugator muscle, and between the F-p2 and the mastoid process as patients emerged from general anesthesia during suture dosing of the surgical incision. Anesthesia was decreased by controlled washout of isoflurane while maintaining 70% N2O, and brain isoflurane concentrations (C-isoBrain) were calculated. We studied a control group of 10 patients who received only surgical stimulation, and 30 experimental patients who intermittently received test stimuli in addition to the surgical stimulation. Patients were observed for movement responses and EMG records were evaluated for EMG activation responses. We defined an EMG activation response to be a rapid voltage increase of at least 1.0 mu V RMSabove baseline, with a duration of at least 30 s, in at least one of the three EMG channels. Patient responses to stimuli were classified as either an EMG activation response without a move response (EMG(+)), a move response without an EMG activation response (MV+), both an EMG activation response and a move response (EMG(+)MV(+)), or no response. We defined the EMG(+) endpoint to be the threshold between EMG(+) response and nonresponse to a stimulus, and estimated C-isoBrain at this endpoint. We similarly defined the move endpoint and estimated the move endpoint C-isoBrain. We then calculated the increment of C-isoBrain at the EMG(+) endpoint relative to the move endpoint. Main results. For the 30 experimental patients, the initial response to a test stimulus was an EMG(+) in 14 patients (47%), an EMG(+)MV(+) in 12 patients (40%), and a MV+ in 1 patient (3%); no response occurred by the time surgery was completed in 3 patients (10%). No response occurred in 7 of the control patients (70%). Of the 14 patients with an initial EMG(+) response to a test stimulus, 9 patients later had a move response. For these 9 patients, the increment of C-isoBrain between the EMG(+) endpoint and move endpoint was 0.11 +/- 0.04 vol% (mean +/- SD). Conclusions. Our results suggest that, given the circumstances of our study an EMG activation response by a nonmoving patient indicates that the patient is at an anesthetic level close to that at which movement could occur. However, because the first EMG activation response map occur simultaneously with movement, the EMG activation response cannot be relied upon to always herald a move response before it occurs. Our results also suggest that EMG responsiveness to a test stimulus may be used to estimate the anesthetic depth of an individual patient.

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Documento generato il 31/03/20 alle ore 10:21:31