Studies on the assessment of the adequacy of anesthesia

Several hypnosis monitoring systems based on the processed electroencephalogram (EEG) have been developed for use during general anesthesia. The assessment of the analgesic component (antinociception) of general anesthesia is an emerging field of research. This study investigated the interaction of hypnosis and antinociception, the association of several physiological variables with the degree of intraoperative nociception, and aspects of EEG Bispectral Index Scale (BIS) monitoring during general anesthesia. In addition, EEG features and heart rate (HR) responses during desflurane and sevoflurane anesthesia were compared. A propofol bolus of 0.7 mg/kg was more effective than an alfentanil bolus of 0.5 mg in preventing the recurrence of movement responses during uterine dilatation and curettage (D C) after a propofol-alfentanil induction, combined with nitrous oxide (N2O). HR and several HR variability-, frontal electromyography (fEMG)-, pulse plethysmography (PPG)-, and EEG-derived variables were associated with surgery-induced movement responses. Movers were discriminated from non-movers mostly by the post-stimulus values per se or normalized with respect to the pre-stimulus values. In logistic regression analysis, the best classification performance was achieved with the combination of normalized fEMG power and HR during D C (overall accuracy 81%, sensitivity 53%, specificity 95%), and with the combination of normalized fEMG-related response entropy, electrocardiography (ECG) R-to-R interval (RRI), and PPG dicrotic notch amplitude during sevoflurane anesthesia (overall accuracy 96%, sensitivity 90%, specificity 100%). ECG electrode impedances after alcohol swab skin pretreatment alone were higher than impedances of designated EEG electrodes. The BIS values registered with ECG electrodes were higher than those registered simultaneously with EEG electrodes. No significant difference in the time to home-readiness after isoflurane-N2O or sevoflurane-N2O anesthesia was found, when the administration of the volatile agent was guided by BIS monitoring. All other early and intermediate recovery parameters were also similar. Transient epileptiform EEG activity was detected in eight of 15 sevoflurane patients during a rapid increase in the inspired volatile concentration, and in none of the 16 desflurane patients. The observed transient EEG changes did not adversely affect the recovery of the patients. Following the rapid increase in the inhaled desflurane concentration, HR increased transiently, reaching its maximum in two minutes. In the sevoflurane group, the increase was slower and more subtle. In conclusion, desflurane may be a safer volatile agent than sevoflurane in patients with a lowered seizure threshold. The tachycardia induced by a rapid increase in the inspired desflurane concentration may present a risk for patients with heart disease. Designated EEG electrodes may be superior to ECG electrodes in EEG BIS monitoring. When the administration of isoflurane or sevoflurane is adjusted to maintain BIS values at 50-60 in healthy ambulatory surgery patients, the speed and quality of recovery are similar after both isoflurane-N2O and sevoflurane-N2O anesthesia. When anesthesia is maintained by the inhalation of N2O and bolus doses of propofol and alfentanil in healthy unparalyzed patients, movement responses may be best avoided by ensuring a relatively deep hypnotic level with propofol. HR/RRI, fEMG, and PPG dicrotic notch amplitude are potential indicators of nociception during anesthesia, but their performance needs to be validated in future studies. Combining information from different sources may improve the discrimination of the level of nociception.

Measurements of adequacy of anesthesia and level of consciousness during surgery and intensive care

The adequacy of anesthesia has been studied since the introduction of balanced general anesthesia. Commercial monitors based on electroencephalographic (EEG) signal analysis have been available for monitoring the hypnotic component of anesthesia from the beginning of the 1990s. Monitors measuring the depth of anesthesia assess the cortical function of the brain, and have gained acceptance during surgical anesthesia with most of the anesthetic agents used. However, due to frequent artifacts, they are considered unsuitable for monitoring consciousness in intensive care patients. The assessment of analgesia is one of the cornerstones of general anesthesia. Prolonged surgical stress may lead to increased morbidity and delayed postoperative recovery. However, no validated monitoring method is currently available for evaluating analgesia during general anesthesia. Awareness during anesthesia is caused by an inadequate level of hypnosis. This rare but severe complication of general anesthesia may lead to marked emotional stress and possibly posttraumatic stress disorder. In the present series of studies, the incidence of awareness and recall during outpatient anesthesia was evaluated and compared with that of in inpatient anesthesia. A total of 1500 outpatients and 2343 inpatients underwent a structured interview. Clear intraoperative recollections were rare the incidence being 0.07% in outpatients and 0.13% in inpatients. No significant differences emerged between outpatients and inpatients. However, significantly smaller doses of sevoflurane were administered to outpatients with awareness than those without recollections (p<0.05). EEG artifacts in 16 brain-dead organ donors were evaluated during organ harvest surgery in a prospective, open, nonselective study. The source of the frontotemporal biosignals in brain-dead subjects was studied, and the resistance of bispectral index (BIS) and Entropy to the signal artifacts was compared. The hypothesis was that in brain-dead subjects, most of the biosignals recorded from the forehead would consist of artifacts. The original EEG was recorded and State Entropy (SE), Response Entropy (RE), and BIS were calculated and monitored during solid organ harvest. SE differed from zero (inactive EEG) in 28%, RE in 29%, and BIS in 68% of the total recording time (p<0.0001 for all). The median values during the operation were SE 0.0, RE 0.0, and BIS 3.0. In four of the 16 organ donors, EEG was not inactive, and unphysiologically distributed, nonreactive rhythmic theta activity was present in the original EEG signal. After the results from subjects with persistent residual EEG activity were excluded, SE, RE, and BIS differed from zero in 17%, 18%, and 62% of the recorded time, respectively (p<0.0001 for all). Due to various artifacts, the highest readings in all indices were recorded without neuromuscular blockade. The main sources of artifacts were electrocauterization, electromyography (EMG), 50-Hz artifact, handling of the donor, ballistocardiography, and electrocardiography. In a prospective, randomized study of 26 patients, the ability of Surgical Stress Index (SSI) to differentiate patients with two clinically different analgesic levels during shoulder surgery was evaluated. SSI values were lower in patients with an interscalene brachial plexus block than in patients without an additional plexus block. In all patients, anesthesia was maintained with desflurane, the concentration of which was targeted to maintain SE at 50. Increased blood pressure or heart rate (HR), movement, and coughing were considered signs of intraoperative nociception and treated with alfentanil. Photoplethysmographic waveforms were collected from the contralateral arm to the operated side, and SSI was calculated offline. Two minutes after skin incision, SSI was not increased in the brachial plexus block group and was lower (38 ± 13) than in the control group (58 ± 13, p<0.005). Among the controls, one minute prior to alfentanil administration, SSI value was higher than during periods of adequate antinociception, 59 ± 11 vs. 39 ± 12 (p<0.01). The total cumulative need for alfentanil was higher in controls (2.7 ± 1.2 mg) than in the brachial plexus block group (1.6 ± 0.5 mg, p=0.008). Tetanic stimulation to the ulnar region of the hand increased SSI significantly only among patients with a brachial plexus block not covering the site of stimulation. Prognostic value of EEG-derived indices was evaluated and compared with Transcranial Doppler Ultrasonography (TCD), serum neuron-specific enolase (NSE) and S-100B after cardiac arrest. Thirty patients resuscitated from out-of-hospital arrest and treated with induced mild hypothermia for 24 h were included. Original EEG signal was recorded, and burst suppression ratio (BSR), RE, SE, and wavelet subband entropy (WSE) were calculated. Neurological outcome during the six-month period after arrest was assessed with the Glasgow-Pittsburgh Cerebral Performance Categories (CPC). Twenty patients had a CPC of 1-2, one patient had a CPC of 3, and nine patients died (CPC 5). BSR, RE, and SE differed between good (CPC 1-2) and poor (CPC 3-5) outcome groups (p=0.011, p=0.011, p=0.008, respectively) during the first 24 h after arrest. WSE was borderline higher in the good outcome group between 24 and 48 h after arrest (p=0.050). All patients with status epilepticus died, and their WSE values were lower (p=0.022). S-100B was lower in the good outcome group upon arrival at the intensive care unit (p=0.010). After hypothermia treatment, NSE and S-100B values were lower (p=0.002 for both) in the good outcome group. The pulsatile index was also lower in the good outcome group (p=0.004). In conclusion, the incidence of awareness in outpatient anesthesia did not differ from that in inpatient anesthesia. Outpatients are not at increased risk for intraoperative awareness relative to inpatients undergoing general anesthesia. SE, RE, and BIS showed non-zero values that normally indicate cortical neuronal function, but were in these subjects mostly due to artifacts after clinical brain death diagnosis. Entropy was more resistant to artifacts than BIS. During general anesthesia and surgery, SSI values were lower in patients with interscalene brachial plexus block covering the sites of nociceptive stimuli. In detecting nociceptive stimuli, SSI performed better than HR, blood pressure, or RE. BSR, RE, and SE differed between the good and poor neurological outcome groups during the first 24 h after cardiac arrest, and they may be an aid in differentiating patients with good neurological outcomes from those with poor outcomes after out-of-hospital cardiac arrest.

An electron spectroscopic study of the adsorption of nitrogen on a Ni/TiO2 catalyst prepared in situ in the spectrometer: evidence for dissociative adsorption in the strong-metal-support-interaction (SMSI) state

Nitrogen is dissociatively adsorbed on an annealed Ni/TiO2 surface just as on a Ti–Ni alloy surface while it is molecularly adsorbed on a Ni/Al2O3 surface.

Case studies on the formation of chalcogenide self-assembled monolayers on surfaces and dissociative processes

This report examines the assembly of chalcogenide organic molecules on various surfaces, focusing on cases when chemisorption is accompanied by carbon-chalcogen atom-bond scission. In the case of alkane and benzyl chalcogenides, this induces formation of a chalcogenized interface layer. This process can occur during the initial stages of adsorption and then, after passivation of the surface, molecular adsorption can proceed. The characteristics of the chalcogenized interface layer can be significantly different from the metal layer and can affect various properties such as electron conduction. For chalcogenophenes, the carbon-chalcogen atombond breaking can lead to opening of the ring and adsorption of an alkene chalcogenide. Such a disruption of the pi-electron system affects charge transport along the chains. Awareness about these effects is of importance from the point of view of molecular electronics. We discuss some recent studies based on X-ray photoelectron spectroscopy that shed light on these aspects for a series of such organic molecules.

Kinetics of dissociative water adsorption on stepped Si(001), on Si(115), Si(113), Si(5,5,12) and Si(112)

We present photoelectron spectroscopic and low energy electron diffraction measurements of water adsorption on flat Si samples of the orientations (001), (115), (113), (5,5,12) and (112) as well as on curved samples covering continuously the ranges (001)-(117) and (113)-(5,5,12)-(112). On all orientations, water adsorption is dissociative (OH and H) and non-destructive. On Si(001) the sticking coefficient S and the saturation coverage Theta(sat) are largest. On Si(001) and for small miscuts in the [110]-azimuth, S is constant nearly up to saturation which proves that the kinetics involves a weakly bound mobile precursor state. For (001)-vicinals with high miscut angles (9-13 degrees), the step structure breaks down, the precursor mobility is affected and the adsorption kinetics changed. On (115), (113), (5,5,12) and (112), the values of S and Theta(sat) are smaller which indicates that not all sites are able to dissociate and bind water. For (113) the shape of the adsorption curves Theta versus exposure shows the existence of two adsorption processes, one with mobile precursor kinetics and one with Langmuir-like kinetics. On (5,5,12), two processes with mobile precursor kinetics are observed which are ascribed to adsorption on different surface regions within the large surface unit cell. From the corresponding values of S and Theta(sat), data for structure models are deduced. (C) 1997 Elsevier Science B.V.

Quantum-mechanical calculations of vibrationally resolved cross sections for non-dissociative charge transfer of O3+ with H-2

Charge transfer due to collisions of ground state O3+ (2s(2)2p P-2) ions with molecular hydrogen is investigated using the quantum-mechanical molecular-orbital close-coupling (MOCC) method, and electronic and vibrational state-selective cross sections along with the corresponding differential cross sections are calculated for projectile energies of 100, 500, 1000 and 5000 eV/u at the orientation angles of 25 degrees,45 degrees and 89 degrees. The adiabatic potentials and radial coupling matrix elements utilized in the QMOCC calculations were obtained with the spin-coupled valence-bond approach. The infinite order sudden approximation (IOSA) and the vibrational sudden approximation (VSA) are utilized to deal with the rotation of H-2 and the coupling between the electron and the vibration of H-2. It is found that the distribution of vibrationally resolved cross sections with the vibrational quantum number upsilon' of H-2(+) (upsilon') varies with the increment of the projectile energy; and the electronic and vibrational stateselective differential cross sections show similar behaviors: there is a highest platform within a very small scattering angle, beyond which the differential cross sections decrease as the scattering angle increases and lots of oscillating structures appear, where the scattering angle of the first structure decreases as E-P(-1/2) with the increment of the projectile energy E-P; and the structure and amplitude of the differential cross sections are sensitive to the orientation of molecule H-2, which provides a possibility to identify the orientations of molecule H-2 by the vibrational state-selective differential scattering processes.

利用HIRFL-CSR开展分子离子复合离解研究的可行性分析；Feasibility Analysis of Studying Dissociative Recombination Processes of Molecular Ions at HIRFL-CSR

介绍了储存环高精度分子谱学研究的科学意义、国内外研究现状和利用HIRFL-CSR开展该项研究的优势,着重论证了HIRFL-CSR分子离子注入实验环的总体设计方案和技术方案。通过在HIRFL-CSR实验环上增建一条分子离子注入线,将实验环改造成能兼顾现有物理实验和大分子物理研究的综合性研究平台,为分子离子复合离解研究提供良好的技术支撑。特别是质量数大于70的分子离子,能显著提高其能量分辨。

Dissociative recombination of the acetaldehyde cation, CH3CHO+

The dissociative recombination of the acetaldehyde cation, CH3CHO+, has been investigated at the heavy ion storage ring CRYRING at the Manne Siegbahn Laboratory in Stockholm, Sweden. The dependence of the absolute cross section of the reaction on the relative kinetic energy has been determined and a thermal rate coefficient of k(T) = (1.5 +/- 0.2) x 10(-6) (T/300)(-0.70 +/- 0.02) cm(3) s(-1) has been deduced, which is valid for electron temperatures between similar to 10 and 1000 K. The branching fractions of the reaction were studied at similar to 0 eV relative kinetic energy and we found that breaking one of the bonds between two of the heavy atoms occurs in 72 +/- 2% of the reactions. In the remaining events the three heavy atoms stay in the same product fragment. While the branching fractions are fairly similar to the results from an earlier investigation into the dissociative recombination of the fully deuterated acetaldehyde cation, CD3CDO+, the thermal rate coefficient is somewhat larger for CH3CHO+. Astrochemical implications of the results are discussed.

DISSOCIATIVE RECOMBINATION OF PROTONATED PROPIONITRILE, CH3CH2CNH+: IMPLICATIONS FOR TITAN'S UPPER ATMOSPHERE

The dissociative recombination of protonated propionitrile, CH3CH2CNH+, has been investigated at the heavy ion storage ring, CRYRING, at the Manne Siegbahn Laboratory, Stockholm University, Sweden. The thermal rate coefficient has been deduced to follow k(T) = (1.5 +/- 0.2) x 10(-6) (T/300)(-0.76) (+/-) (0.02) cm(3) s(-1) for electron temperatures ranging from similar to 10 to similar to 1000 K. Measurements of the branching fractions were performed at similar to 0 eV relative kinetic energy. It has been found that in 43% +/- 2% of the reactions the four heavy atoms remain in the same product fragment. An equal portion of the reactions leads to products where one of the heavy atoms is split off from the other three and 14% +/- 1% result in a breakup into two heavy fragments containing two heavy atoms each. We discuss the significance of the data to Titan's upper atmosphere.

Experimental studies of the dissociative recombination of CD3CDOD+ and CH3CH2OH2+

Aims. We determine branching fractions, cross sections and thermal rate constants for the dissociative recombination of CD3CDOD+ and CH3CH2OH2+ at the low relative kinetic energies encountered in the interstellar medium. Methods. The experiments were carried out by merging an ion and electron beam at the heavy ion storage ring CRYRING, Stockholm, Sweden. Results. Break-up of the CCO structure into three heavy fragments is not found for either of the ions. Instead the CCO structure is retained in 23 +/- 3% of the DR reactions of CD3CDOD+ and 7 +/- 3% in the DR of CH3CH2OH2+, whereas rupture into two heavy fragments occurs in 77 +/- 3% and 93 +/- 3% of the DR events of the respective ions. The measured cross sections were fitted between 1-200 meV yielding the following thermal rate constants and cross-section dependencies on the relative kinetic energy: sigma(E-cm[eV]) = 1.7 +/- 0.3 x 10(-15)(Ecm[eV])(-1.23 +/- 0.02) cm(2) and k(T) = 1.9 +/- 0.4 x 10(-6)(T/300)-0.73 +/- 0.02 cm(3) s(-1) for CH3CH2OH2+ as well as k(T) = 1.1 +/- 0.4 x 10(-6)(T/300)(-0.74 +/- 0.05) cm(3) s(-1) and s(Ecm[eV]) = 9.2 +/- 4 x 10(-16)(Ecm[eV])-1.24 +/- 0.05 cm(2) for CD3CDOD+

Femtosecond pump-probe mass spectra on the dissociative photoionization of CF3I

The multi-photon dissociative photoionization dynamics of CF3I has been studied with femtosecond two-color pump-probe time-of-flight mass spectra at a pump pulse of 265 nm and a probe pulse of 398 nn. This enables the A band and 5ppi(3)7ssigma((2)Pi(1/2)) Rydberg state to be accessed with the pump beam. The observed fast and slow decay components of CF3+ and I+ reflect the fast repulsive A band and some higher lying ion-pair states may be responsible for the decay of the 5ppi(3)7ssigma((2)Pi(1/2)) Rydberg state. The results provide information on the different multi-photon pathways producing these ions and the de-excitation mechanism of the 5ppi(3)7ssigma((2)Pi(1/2)) Rydberg state. (C) 2003 Elsevier Science B.V. All rights reserved.