Method for assessing adequate general anaesthesia in children aged from 4 to 14 years old by long-latency auditory evoked potentials

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to anaesthesiology, and may be used in assessing an adequate general anaesthesia in the children aged from 4 to 14 years old. That is ensured by pre-anaesthetic and intra-anaesthetic intraoperative recording of long-latency auditory evoked potentials. That is followed by summing up initial latencies of first three pre-anaesthetic peaks (P1, N1, P2) to calculate sum A, subtracting the sum of the latencies of the first three intraoperative peaks (P1, N1, P2) to calculate sum B. The A to B relation is multiplied by 100. A percentage of the latencies of the intra-anaesthetic peaks P1, N1, P2 to the pre-anaesthetic values is considered as the adequate general anaesthesia. For the children of the first age group of 4-6 years old, the general anaesthesia is considered to be adequate, if the percentage is 140-253%; for the children of the second age group of 7-9 years old, the adequate general anaesthesia is shown by the percentage of 133-253%; for the children of the third age group of 10-12 years old, the adequate anaesthesia is shown by the percentage of 159-190%; and the percentage of 125-271% provides the adequate general anaesthesia for the children of the fourth age group of 13-14 years old.

EFFECT: method provides the adequate and easy assessment of the anaesthesia ensured by reducing a time of examination and simplicity of data interpretation in the form of one three-peak wave.

1 ex, 6 tbl

 

The invention relates to medicine, namely to anesthesiology. Known measure of the hypnotic component of anesthesia is electroencephalography (EEG). The method consists in the registration of spontaneous brain activity with at least 8 electrodes placed on the surface of the head of the patient in the form of waves of different frequency and amplitude, which in the stage of surgical anesthesia, the amplitude of the waves increases and the frequency decreases. The disadvantage of this method is the complexity of registration in the form of a superposition of a large number of electrodes and the complexity of interpreting the results in the form of reading native EEG doctor, not a neurophysiologist or neurologist. Methods of computer processing of native EEG require temporary registration of EEG for at least 20 minutes, the choice of the epochs of analysis manually or automatically, which also increases the time of receipt of important information (Epuni S.N. Electroencephalography in clinical anesthesiology. - M., 1961; the Greedy mathematical SCIENCES. Biophysical mechanisms of the EEG. M.: Nauka, 1984; Zenkov LR Clinical electroencephalography with elements of epilepsy. - Taganrog, 1996; Ivanov LB Applied computational electroencephalography. - M: medical Research firm NMG, 2004; Ivanov LB Recognition of artifacts and some problems of practical Ana who studied computer EEG. - M., 2007; Mori, K. et al.: Factors modifying anestheticinduced EEG activities. In Stoeckel H (ed), Quantitation, Modeling and Control in Anesthesia. Georg Thime Verglag, Stutgard, New York. - 1985). Evoked potentials are generated by the same neuronal structures that spontaneous rhythm (Halliday A.M. the Standards of clinical practice registration EAP recommendations of the International society of EEG and clinical neurophysiology. - Amsterdam: El - sevier. - 1983; Gazdecki CENTURIES Inverse problem of EEG and clinical electroencephalography - Taganrog, 2000). Currently, the more common opinion about the availability in different parts of the CNS complexes (ensembles), columns of neurons" individual microstructures, in which the circulation of excitation that causes regular EEG. Among ensembles of neurons distinguish synchronization system (inhibitory), localized in the nonspecific nuclei of the thalamus, the hypothalamus and the reticular formation of the lower sections of the brain stem. They carry out the integration of separate neuronal columns in smoothly working group on EEG occur low-frequency, high-amplitude oscillations, showing slower intracerebral processes. Activity synchronization systems appears brighter while you sleep, anesthesia, mental peace and children. Desynchronizers (trigger) system are located in the cortex, the reticular form the AI at the level of the mid-brain and peoplechecking nuclei of the forebrain. Excitation reticulocytopenia systems leads to increased level of functional activity of the brain, manifested in the EEG high-frequency, low-amplitude rhythms, demonstrating the process of processing the incoming of information into the brain. Common to these systems is the reticular organization with bilateral cortical connections that determine bilateral symmetry, homogeneity EEG and involvement of all departments in the Central nervous system even in case of local intracerebral process (the Greedy mathematical SCIENCES. Biophysical mechanisms of the EEG. - M.: Nauka, 1984; cutin, VA Functional and ultrasonic methods in practical medicine edited by Novikov AU - Ivanov, 2009). A special contribution in the generation of evoked potentials contribute to the so-called gradually potentials ITSP and TPSP (excitatory and inhibitory postsynaptic potentials) dendritic fibres of bark or different nuclei of the brain. Summation of synaptic gradually potentials gives the basic response of the brain when registering on the scalp. A smaller contribution to the registration of evoked potentials make the actual action potentials (experience in the use of evoked potentials in clinical practice edited by Gnezdilova CENTURIES, Shamshinova A.M. - M.: JSC "Antidoron", 2001; Sebel P.S., Glass P. Do evokeds potentials measure depth of anesthesia // J. Clin. Monit. - 1988. - Vol.5; Sadowski R. Evocierte potenciale in kliik und praxis. Eine Einfiirung in VEP, SEP, AEP, MEASURES, P 300 AND PAP. - Springer-Verlag. - 1993; Jorg J., H. Hielscher Evozierte potentiale in klinik und praxis. Eine Einfiirung in VEP, SEP, AEP, MEASURES, P 300 AND PAP - Springer-Verlag. - 1993). According to existing theories of anaesthesia and mechanism of action of anesthetics under the action of the latter is the reflex inhibition of the processes at the level of the reticular substance of the brain, it eliminates its activating effect on the above-lying structures of the brain, leading to their deafferentation. Loss of consciousness and amnesia, usually associated with the direct influence of the anesthetic on the cerebral cortex of the brain (Zaitsev, A. and et estimation Method analgesia - nociceptive evoked potentials. The first clinical observations // Anesti reanim., 2008; Jessop J., Jones J.G. Evaluation of the actions of general anaesthetics in the human brain // Gen Pharmacol - 1992. - Vol.23. - N 6, 1992; Concurrent recording of AEP, SSEP and EEG parameters during anaesthesia: a factor analysis / H.Schwilden, E.Kochs, M.Daunderer et al. // The British Journal of Anaesthesia. - 2005. - Vol.95. - N 2; Quantifying cortical activity during general anesthesia using wavelet analysis / T.Zikov, S.Bibian, G.A.Dumont / IEEE Trans. Bio-med. Eng. - 2006. - Vol.53. - N 4). Conducting registration of evoked potential near-field, we receive information from generators located in the cortex, the location of the electrode in the immediate vicinity of the generator. In this case, auditory cortex and the electrode is located at the point where the recorded maximum amplitude of the response - Cz vertex international scheme (experience in the use of you who bathrooms potentials in clinical practice edited by Gnezdilova CENTURIES, Shamshinova A.M. - M.: JSC "Antidoron", 2001).

To assess the adequacy of anesthesia we used a method of registration of long-latency auditory evoked potentials (DSVP). The survey was carried out in the operating room until the anesthesia and during anaesthesia, surgical stage, the onset of which was determined only clinical signs - lack of reflexes of the eyeball, the fixation of the pupil clearly in a neutral position, pupil diameter is narrow, the absence of pharyngeal reflex in the formulation of the duct, reduced muscle tone and the absence of motor responses to external stimulus.

Identification and designation of components of the response

DSIT dates back to the late components of the auditory response and occurs after 40 MS from the moment of stimulation. The result of the inquiry was a negative-positive complex of peaks, each of which has its origin time, called latency, msec. The first peak, facing down - P1, the second peak, facing up - N1, the third peak, facing down - P2, the fourth peak, facing up - N2. Before anesthesia, the most well-registered so-called V - wave: complex with peak latencies of N1 - from 70 to 90 MS and P2 is from 150 to 200 MS. Under the action of anesthetics change the shape of the response is better identified complex - N1-P2 and uvelichenie the camping latency of each peak (experience in the use of evoked potentials in clinical practice edited by Gnezdilova CENTURIES, Shamshinova A.M. - M.: JSC "Antidoron", 2001).

The closest analogue of the invention is a method of assessing the adequacy of anesthesia in children from 4 to 14 years by registering during anaesthesia, in the phase of its surgical stage, long-latency auditory evoked potentials (Evdokimov RV and other New method of determining the depth of General anesthesia method long-latency auditory evoked potentials (DSWP), proceedings of the 91st annual scientific-practical conference of students and young scientists Yugma "Week of science - 2011", Ivanovo, 2011).

The technical result of the proposed method lies in the fact that children in four age groups conducting registration DSWP to anesthesia and during anaesthesia, in the phase of its surgical stage, evaluating the adequacy of anesthesia on the ratio of the sum of the latencies of the first three peaks (P1, N1, P2) in anaesthesia, to the data before anaesthesia, expressed in percent. The effect of the use of the method consists in a significant simplification of the registration parameters (overlay only 4 electrodes), the reduction of the time of the survey is on average 2-3 minutes, which is necessary for stimulation, ease of interpretation of the survey data in the form of a single wave, having three peaks. As the active electrode is used Cz - vertex international circuit, supplied the th to the first amplifier input (-). Reference electrode - earflap or mastoid connected to the second amplifier input (+) lead Cz-A2 (A1). The grounding electrode on the frontal pole (Gazdecki CENTURIES, 2001). Headphones beaurline signal-clicking the capacity of 126 decibels, which is on average 20% above the lower hearing threshold. The duration of the stimulus is not more than 50 MS, with a frequency no more than once per second. Highly sensitive amplifiers and digital devices allow you to register a response to an auditory stimulus by averaging, accumulation and filtering a large number of weak responses of the brain. The responses of the brain to stimuli and their variances are estimated by the change of basic parameters - the amplitude and latency of the recorded peaks.

The method is as follows. Calculates the sum And source indicators P1, N1, P2 to anesthesia. Calculates the sum of the latencies of the peaks P1, N1, P2 in anaesthesia. Then the ratio of the sum In the sum And multiply by 100, so the result will be the percentage of indicators the latencies of the peaks P1, N1, P2 in anaesthesia to the indicators before anaesthesia. When children first age group 4-6 years the percentage was 140-253%, for children the second age group 7-9 years 133-253%, for the third age group 10-12 years 159-190%, for children-fourth age group 13-14 years - 125-271%, the addict is C evaluate adequate.

To ensure the validity of a study, it was necessary that before anesthesia patients in groups according to the main indicators: sex, age, nosological forms, did not differ from each other, that is statistically fair for them was the null hypothesis. The proposed method, an evaluation of the adequacy of anesthesia in 51 children (39 boys and 12 girls) aged 4 to 14 years, operated in a planned manner about hernias of different locations and varicocele. At the time of the survey, all children were healthy.

As the sedation was used atropine and seduxen in the age dosages. The first group consisted of 20 children, in whom anesthesia was used inhalation anesthetic halothane and nitrous oxide. The second group consisted of 21 children, in whom anesthesia was used in the preparation and nitrous oxide. The third group consisted of 10 children for anesthesia was used intravenous anesthetic propofol and narcotic analgesic fentanyl.

In tables (see Appendix) used the following notation:

M - medium, m is the standard error, σ - standard deviation, p is the probability of the null hypothesis. As can be seen from tables 1 and 2, the performance of the latencies of the main peaks correspond to the normal increase in latency and amplitude of all components DSWP in surgical stage n is rcosa has a statistically significant and does not depend on the type of anesthetic. Statistically significant differences in the analysis of components DSIT during anaesthesia by age groups were not found (table 3-6). You can talk about the trend is quite stable and uniform increase in the latencies of the first three peaks in all age groups for surgery under anaesthesia. Latency component N2 is more variable and surgery under anaesthesia its increase is less pronounced in relation to the increase in the latencies of the first three peaks.

Clinical example

The patient P. Smirnova, 7 years registration DSIT before surgical intervention (see examination report). Indicators of the latencies of the first three peaks amounted to P1 - 79 MS, N1 - 111 MS, P2 - 144 MS. Premedication for 30 minutes before anesthesia was administered intramuscularly atropine and dormicum in dosages of 20 mg/kg and 0.3 mg/kg, respectively. Held mask anesthesia for semi-loop. As an inhalation anesthetic used a combination of preparation and nitrous oxide. The onset of surgery under anaesthesia defined clinical criteria - absence of reflexes of the eyeball, the fixation of the pupil clearly in a neutral position, pupil diameter is narrow, the absence of pharyngeal reflex in the formulation of the duct, reduced muscle tone and the absence of motor responses to external will raskazhite the ü. After 5 minutes after skin incision was registered DSWP. Indicators of the latencies of the first three peaks amounted to P1 - 175 MS, N1 - 194 MS, P2 : 246 MS. Perform the calculation of the percentage of latency is calculated by the ratio of the sum of the latencies in anaesthesia to the sum of the latencies to anesthesia and expressed in percent- ((175+194+246)/(79+111+144))*100=184%. We have calculated the index corresponds to surgery under anaesthesia in children in the age group 7-9 years (table 4).

The method of assessing the adequacy of anesthesia in children from 4 to 14 years by registering during anaesthesia, in the phase of its surgical stage, long-latency auditory evoked potentials, characterized in that the registration DSIT conducted additionally to General anesthesia, with subsequent calculation of the sum of the baseline latencies of the first three peaks (P1, N1, P2) to anesthesia - the amount And calculation of the sum of the indices of the latencies of the first three peaks (P1, N1, P2) in the surgical stage of anaesthesia amount, then the ratio of the sum to be multiplied by 100, assessing the adequacy of anaesthesia for the percentage ratio of the latencies of the peaks P1, N1, P2 anesthesia to the indicators before anaesthesia, while the percentage for children in the first age group of 4-6 years - 140-253%, for children the second age group 7-9 years 133-253%, for the third age group 10-12 Le is - 159-190%, for children-fourth age group 13-14 years - 125-271%, anaesthesia assess adequate.



 

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1 ex, 1 tbl

FIELD: medicine, neurophysiology.

SUBSTANCE: one should carry out EEG survey to detect spectrometrically the index of full range if alpha-rhythm both before and after therapy. Moreover, power index of full range of alpha-rhythm and the index of 9-10 Hz-strip's spectral power should be detected in occipital cerebral areas. One should calculate the value of the ratio of the index of 9-10 Hz-strip's spectral power to the index of full range of alpha-rhythm and at the increase of this value by 20% against the background it is possible to evaluate positive result of therapy. The method increases the number of diagnostic means applied in evaluating therapeutic efficiency in the field of neurophysiology.

EFFECT: higher efficiency of evaluation.

1 ex

FIELD: medicine, neurology.

SUBSTANCE: method involves carrying out the standard vascular and nootropic therapy. Diazepam is administrated under EEG control with the infusion rate that is calculated by the following formula: y = 0.0015x - 0.025 wherein y is the rate of diazepam administration, mg/h; x is an average EEG amplitude, mcV. Method provides enhancing the effectiveness of treatment of patients. Invention can be used for treatment of patients in critical severe period of ischemic insult.

EFFECT: enhanced effectiveness of treatment.

2 tbl, 1 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: method involves selecting signals showing patient consciousness level and following evoked auditory potentials as responses to repeating acoustic stimuli, applying autoregression model with exogenous input signal and calculating AAI index showing anesthesia depth next to it.

EFFECT: quick tracing of unconscious to conscious state and vice versa; high accuracy of measurements.

9 cl, 3 dwg

FIELD: medicine; experimental and medicinal physiology.

SUBSTANCE: device can be used for controlling changes in functional condition of central nervous system. Device has receiving electrodes, unit for reading electroencephalograms out, analog-to-digital converter and inductor. Low noise amplifier, narrow band filter linear array which can be program-tuned, sample and store unit, online memory, microcontroller provided with controlled permanent storage, liquid-crystal indicator provided with external control unit are introduced into device additionally. Receiving electrodes are fastened to top part of patient's head. Outputs of electrodes are connected with narrow band filters linear array through electroencephalograph. Output of linear array is connected with input of input unit which has output connected with input of analog-to-digital converter. First bus of analog-to-digital converter is connected with online storage. Recording/reading bus of microcontroller is connected with control input of input unit and its starting bus is connected with address input of online storage. Third control bus is connected with narrow band filters linear array. Second control bus is connected with liquid-crystal indicator. Output bus is connected with inductor. External control (keyboard) of first control bus is connected with microcontroller. Output of online storage is connected with data input of microcontroller through 12-digit second data bus. Efficiency of influence is improved due to getting specific directed influence being based onto general technological transparency of processing of human brain's signals and strictly specific influence based on the condition of better stimulation.

EFFECT: increased efficiency.

3 cl, 1 dwg, 1 tbl

FIELD: medicine, neurology, professional pathology.

SUBSTANCE: one should carry out either biochemical blood testing and electroencephalography or SMIL test, or ultrasound dopplerography of the main cranial arteries, rheoencephalography (REG) to detect the volume of cerebral circulation and hypercapnic loading and their digital values. Then it is necessary to calculate diagnostic coefficients F by the following formulas: Fb/e=6.3-0.16·a1+0.12·a2-1·a3+0.2·a4, or FSMIL=9.6+0.16·a5-0.11·a6-0.14·a7+0.07·a8, or Fhem=48.6-0.04·a9+0.15·a10+13.7·a11-0.02·a12+24.7·a13, where Fb/e -diagnostic coefficient for biochemical blood testings and EEG; FSMIL - diagnostic coefficient for SMIL test; Fhem - diagnostic coefficient for hemodynamic testing; 6.3; 9.6 and 48.6 - constants; a1 - the level of vitamin C in blood; a2 - δ-index by EEG; a3 - atherogenicity index; a4 - the level of α-proteides in blood; a5 - scale 3 value by SMIL; a6 - scale K value by SMIL; a7 - scale 5 value by SMIL; a8 - scale 7 value by SMIL; a9 - the level of volumetric cerebral circulation; a10 - the value of linear circulatory rate along total carotid artery, a11 - the value of resistive index along total carotid artery; a12 - the value for the tonicity of cerebral vessels at carrying out hypercapnic sampling by REG; a13 - the value for the intensity of cerebral circulation in frontal-mastoid deviation by REG. At F value being above the constant one should diagnose toxic encephalopathy, at F value being below the constant - discirculatory encephalopathy due to applying informative values.

EFFECT: higher accuracy of diagnostics.

6 ex, 1 tbl

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