We undertook a prospective, randomised study using a non-invasive transcranial Doppler device to evaluate cranial embolisation in computer-assisted navigated total knee arthroplasty (n = 14) and compared this with a standard conventional surgical technique using intramedullary alignment guides (n = 10). All patients were selected randomly without the knowledge of the patient, anaesthetists (before the onset of the procedure) and ward staff. The operations were performed by a single surgeon at one hospital using a uniform surgical approach, instrumentation, technique and release sequence. The only variable in the two groups of patients was the use of single tracker pins of the imageless navigation system in the tibia and femur of the navigated group and intramedullary femoral and tibial alignment jigs in the non-navigated group. Acetabular Doppler signals were obtained in 14 patients in the computer-assisted group and nine (90%) in the conventional group, in whom high-intensity signals were detected in seven computer-assisted patients (50%) and in all of the non-navigated patients. In the computer-assisted group no patient had more than two detectable emboli, with a mean of 0.64 (SD 0.74). In the non-navigated group the number of emboli ranged from one to 43 and six patients had more than two detectable emboli, with a mean of 10.7 (sd 13.5). The difference between the two groups was highly significant using the Wilcoxon non-parametric test (p = 0.0003).Our findings show that computer-assisted total knee arthroplasty, when compared with conventional jig-based surgery, significantly reduces systemic emboli as detected by transcranial Doppler ultrasonography.

Commonly used general anaesthetics cause a decrease in the spectral entropy of the electroencephalogram as the patient transits from the conscious to the unconscious state. Although the spectral entropy is a configurational entropy, it is plausible that the spectral entropy may be acting as a reliable indicator of real changes in cortical neuronal interactions. Using a mean field theory, the activity of the cerebral cortex may be modelled as fluctuations in mean soma potential around equilibrium states. In the adiabatic limit, the stochastic differential equations take the form of an Ornstein-Uhlenbeck process. It can be shown that spectral entropy is a logarithmic measure of the rate of synaptic interaction. This model predicts that the spectral entropy should decrease abruptly from values approximately 1.0 to values of approximately 0.7 as the patient becomes unconscious during induction of general anaesthesia, and then not decrease significantly on further deepening of anaesthesia. These predictions were compared with experimental results in which electrocorticograms and brain concentrations of propofol were recorded in seven sheep during induction of anaesthesia with intravenous propofol. The observed changes in spectral entropy agreed with the theoretical predictions. We conclude that spectral entropy may be a sensitive monitor of the consciousness-unconsciousness transition, rather than a progressive indicator of anaesthetic drug effect.

Patients receiving intraoperative ANI-guided fentanyl administration during sevoflurane anesthesia for lumbar discectomy and laminectomy demonstrated decreased pain in the recovery room, likely as a result of more objective intraoperative fentanyl administration.