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Case Studies Using the Electroencephalogram to Monitor Anesthesia-Induced Brain States in Children

For this child, at this particular moment, how much anesthesia should I give? Determining the drug requirements of a specific patient is a fundamental problem in medicine. Our current approach uses population-based pharmacological models to establish dosing. However, individual patients, and childre...

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Autores principales: Brandt, Steven P., Walsh, Elisa C., Cornelissen, Laura, Lee, Johanna M., Berde, Charles, Shank, Erik S., Purdon, Patrick L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkin 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467151/
https://www.ncbi.nlm.nih.gov/pubmed/32925322
http://dx.doi.org/10.1213/ANE.0000000000004817
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author Brandt, Steven P.
Walsh, Elisa C.
Cornelissen, Laura
Lee, Johanna M.
Berde, Charles
Shank, Erik S.
Purdon, Patrick L.
author_facet Brandt, Steven P.
Walsh, Elisa C.
Cornelissen, Laura
Lee, Johanna M.
Berde, Charles
Shank, Erik S.
Purdon, Patrick L.
author_sort Brandt, Steven P.
collection PubMed
description For this child, at this particular moment, how much anesthesia should I give? Determining the drug requirements of a specific patient is a fundamental problem in medicine. Our current approach uses population-based pharmacological models to establish dosing. However, individual patients, and children in particular, may respond to drugs differently. In anesthesiology, we have the advantage that we can monitor our patients in real time and titrate drugs to the desired effect. Examples include blood pressure management or muscle relaxation. Although the brain is the primary site of action for sedative-hypnotic drugs, the brain is not routinely monitored during general anesthesia or sedation, a fact that would surprise many patients. One reason for this is that, until recently, physiologically principled approaches for anesthetic brain monitoring have not been articulated. In the past few years, our knowledge of anesthetic brain mechanisms has developed rapidly. We now know that anesthetic drug effects are clearly visible in the electroencephalogram (EEG) of adults and reflect underlying anesthetic pharmacology and brain mechanisms. Most recently, similar effects have been characterized in children. In this article, we describe how EEG monitoring could be used to guide anesthetic management in pediatric patients. We review previous evidence and present multiple case studies showing how drug-specific and dose-dependent EEG signatures seen in adults are visible in children and infants, including those with neurological disorders. We propose that the EEG can be used in the anesthetic care of children to enable anesthesiologists to better assess the drug requirements of individual patients in real time and improve patient safety and experience.
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spelling pubmed-74671512020-09-16 Case Studies Using the Electroencephalogram to Monitor Anesthesia-Induced Brain States in Children Brandt, Steven P. Walsh, Elisa C. Cornelissen, Laura Lee, Johanna M. Berde, Charles Shank, Erik S. Purdon, Patrick L. Anesth Analg Featured Articles For this child, at this particular moment, how much anesthesia should I give? Determining the drug requirements of a specific patient is a fundamental problem in medicine. Our current approach uses population-based pharmacological models to establish dosing. However, individual patients, and children in particular, may respond to drugs differently. In anesthesiology, we have the advantage that we can monitor our patients in real time and titrate drugs to the desired effect. Examples include blood pressure management or muscle relaxation. Although the brain is the primary site of action for sedative-hypnotic drugs, the brain is not routinely monitored during general anesthesia or sedation, a fact that would surprise many patients. One reason for this is that, until recently, physiologically principled approaches for anesthetic brain monitoring have not been articulated. In the past few years, our knowledge of anesthetic brain mechanisms has developed rapidly. We now know that anesthetic drug effects are clearly visible in the electroencephalogram (EEG) of adults and reflect underlying anesthetic pharmacology and brain mechanisms. Most recently, similar effects have been characterized in children. In this article, we describe how EEG monitoring could be used to guide anesthetic management in pediatric patients. We review previous evidence and present multiple case studies showing how drug-specific and dose-dependent EEG signatures seen in adults are visible in children and infants, including those with neurological disorders. We propose that the EEG can be used in the anesthetic care of children to enable anesthesiologists to better assess the drug requirements of individual patients in real time and improve patient safety and experience. Lippincott Williams & Wilkin 2020-08-17 2020-10 /pmc/articles/PMC7467151/ /pubmed/32925322 http://dx.doi.org/10.1213/ANE.0000000000004817 Text en Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Anesthesia Research Society. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Featured Articles
Brandt, Steven P.
Walsh, Elisa C.
Cornelissen, Laura
Lee, Johanna M.
Berde, Charles
Shank, Erik S.
Purdon, Patrick L.
Case Studies Using the Electroencephalogram to Monitor Anesthesia-Induced Brain States in Children
title Case Studies Using the Electroencephalogram to Monitor Anesthesia-Induced Brain States in Children
title_full Case Studies Using the Electroencephalogram to Monitor Anesthesia-Induced Brain States in Children
title_fullStr Case Studies Using the Electroencephalogram to Monitor Anesthesia-Induced Brain States in Children
title_full_unstemmed Case Studies Using the Electroencephalogram to Monitor Anesthesia-Induced Brain States in Children
title_short Case Studies Using the Electroencephalogram to Monitor Anesthesia-Induced Brain States in Children
title_sort case studies using the electroencephalogram to monitor anesthesia-induced brain states in children
topic Featured Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467151/
https://www.ncbi.nlm.nih.gov/pubmed/32925322
http://dx.doi.org/10.1213/ANE.0000000000004817
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