For the assessment of sedation, several scoring systems have been introduced into clinical practice, but the differentiation of deeper sedation levels, especially, remains poor. In this study we compared auditory evoked potentials, as an objective method with which to assess the level of sedation, with five different sedation scoring systems. In comparison with changes in latency of the midlatency component N(b), Ramsay's sedation score showed the closest correlation. Objective electrophysiological monitoring is desirable during long-term sedation.

Background Acute coronary syndrome patients receiving dual antiplatelet therapy who need emergent or urgent cardiac surgery are at high risk of major bleeding, which can impair postoperative outcomes. CytoSorb ® , a blood purification technology based on adsorbent polymer, has been demonstrated to remove ticagrelor from blood during on-pump cardiac surgery. Objective The aim of this study was to evaluate the cost utility of intraoperative removal of ticagrelor using CytoSorb versus usual care among patients requiring emergent or urgent cardiac surgery in the UK. Methods A de novo decision analytic model, based on current treatment pathways, was developed to estimate the short-and long-term costs and outcomes. Results from randomised clinical trials and national standard sources such as National Health Service (NHS) reference costs were used to inform the model. Costs were estimated from the NHS and Personal Social Services perspective. Deterministic and probabilistic sensitivity analyses (PSAs) explored the uncertainty surrounding the input parameters. Results In emergent cardiac surgery, intraoperative removal of ticagrelor using CytoSorb was less costly (£12,933 vs. £16,874) and more effective (0.06201vs. 0.06091 quality-adjusted life-years) than cardiac surgery without physiologic clearance of ticagrelor over a 30-day time horizon. For urgent cardiac surgery, the use of CytoSorb was less costly than any of the three comparators-delaying surgery for natural washout without adjunctive therapy, adjunctive therapy with short-acting antiplatelet agents, or adjunctive therapy with low-molecular-weight heparin. Results from the PSAs showed that CytoSorb has a high probability of being cost saving (99% in emergent cardiac surgery and 53-77% in urgent cardiac surgery, depending on the comparators). Cost savings derive from fewer transfusions of blood products and re-thoracotomies, and shorter stay in the hospital/intensive care unit. Conclusions The implementation of CytoSorb as an intraoperative intervention for patients receiving ticagrelor undergoing emergent or urgent cardiac surgery is a cost-saving strategy, yielding improvement in perioperative and postoperative outcomes and decreased health resource use.

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survival model. The model was based on the survival data from published literature, extrapolated to 10 years (results were based on the restricted mean survival time). In BIA, the number of patients was based on data on MIS-SU-AVR in other countries. The patients using MIS-SU-AVR in the new scenario recruit from cSAVR or TAVI; the proportion was based on current diagnosis-related groups statistics. The cost of the procedure was based on current cSAVR cost, adjusting for the device cost; other costs were based of the National Health Fund data. Results: In the CEA, MIS-SU-AVR offers clinical benefits vs cSAVR and TAVI (0.1 and 1.1 life years gained, respectively) and is cost saving vs TAVI (hence, dominant). The incremental cost effectiveness ratio vs cSAVR amounts to 32,544 EUR (below the official threshold). In the BIA, there would be 102, 182, 429, and 560 MIS-SU-AVR patients in consecutive years. Introducing MIS-SU-AVR would result in net savings ('000s EUR): 73, 131, 305, and 403, respectively. Conclusions: MIS-SU-AVR is cost-effective vs cSAVR and TAVI and its reimbursement would result in net savings in Poland.