The study BIS and other electrophysiologic and clinical variables has enabled construction and cross-validation of a model relating BIS(max) to the probability of recovery of consciousness in patients in a coma state due to a severe brain injury, after sedation has been withdrawn.

The effectiveness of lecture and case/problem-based learning discussion differed little in terms of improving participants' immediate knowledge of 'pre-anaesthetic assessment'.

Background: Functional stereotactic surgery requires careful titration of sedation since patients with Parkinson disease need to be rapidly awakened for testing. This study reports a population pharmacodynamic model of propofol sedation and airway obstruction in the Parkinson disease population.Methods: Twenty-one patients with advanced Parkinson disease undergoing functional stereotactic surgery were included in the study and received propofol via target-controlled infusion to achieve an initial steady state concentration of 1 g/ml. Sedation was measured using the Ramsay Sedation Scale. Airway obstruction was measured using a four-category score. Blood samples were drawn for propofol measurement. Individual pharmacokinetic profiles were constructed nonparametrically using linear interpolation. Time course of sedation and respiratory effects were described with population pharmacodynamic models using NONMEM. The probability (P) of a given level of sedation or airway obstruction was related to the estimated effect-site concentration of propofol (Ce) using a logistic regression model. Results:The concentrations predicted by the target-controlled infusion system generally exceeded the measured concentrations. The estimates of C 50 for Ramsay scores 3, 4, and 5 were 0.1, 1.02, and 2.28 g/ml, respectively. For airway obstruction scores 2 and 3, the estimates of C 50 were 0.32 and 2.98 g/ml, respectively. Estimates of k e0 were 0.24 and 0.5 1/min for the sedation and respiratory effects, respectively.Conclusions: The pharmacokinetic behavior of propofol in patients with Parkinson disease differs with respect to the population from which the model used by the target-controlled infusion device was developed. Based on the results from the final models, a typical steady state plasma propofol concentration of 0.35 g/ml eliciting a sedation score of 3 with only minimal, if any, airway obstruction has been defined as the therapeutic target.

Post delivery trigeminal and facial nerve palsy in a 38 yr old woman recovered spontaneously with conservative therapy.

Intermittent high peak pressure values inside the endoscope during neuroendoscopic surgical procedures are associated with postoperative morbidity. Unexpected delay in awakening is the complication most frequently observed by the anesthesiologist as a result of high peak pressure values inside the endoscope. During eight neuroendoscopic procedures the authors continuously monitored cerebral hemodynamic function, using a transcranial doppler (TCD) probe fixed on patients' temporal window. We observed that episodes of high peak pressure values inside the endoscope during neuroendoscopic navigation rinsing periods resulted in changes in the TCD wave profile consistent with "near intracranial circulatory arrestlike" wave. No systemic hemodynamic warning signs accompanied these intermittent episodes of severe decrease in cerebral perfusion pressure. When the rinsing liquid was allowed to escape, the pressure inside the endoscope decreased and the TCD wave immediately returned to its previous value. Neuroendoscopic procedures, although classified as minimally invasive surgery, warrant special monitoring that could alert us to a decrease in cerebral perfusion pressure. Middle cerebral artery TCD recording is a reliable and accurate tool for this purpose.