The work presents recent contributions in the field of computational neuroscience and sketches possible research perspectives.

Inför en operation med generell anestesi upplever en stor del av patienterna oro som uttrycker sig på olika sätt. För att patienten ska kunna uppleva trygghet och delaktighet i sin vård är en god vårdrelation mellan anestesisjukskörskan och patienten centralt. Genom information kan patientens oro minska samt upplevelse av trygghet öka. Syftet med studien var att belysa patientens upplevelse av patientinformationen. Studien utfördes med kvalitativ ansats med hjälp av semistrukturerade intervjuer. Studien inkluderade fyra patienter som var klassificerade enligt ASA 1-2 och var mellan 18 och 65 år. Akuta operationer exkluderades. Materialet analyserades med hjälp av en kvalitativ innehållsanalys och två kategorier, upplevelse av information och anhörigas på verkan framkom. Resultatet visade att patienter upplevde att god information angående anestesin skapade trygghet hos patienter och därigenom mindre oro inför operation. Anhörigas stöd bidrog också till ökad trygghet men kunde också vara en källa till oro beroende på anhörigas tidigare erfarenheter. På grund av varierande upplevelser hos olika patienter angående information finns ett behov av vidare fördjupningar i ämnet. / Before a surgical procedure with general anaesthesia, it is common for a variety of patients to experience anxiety and fear. Establishing a professional relationship between the nurse anaesthetic and the patient is essential in order for the patient to feel safe and involved in his or her own care. Keeping the patient informed helps reducing anxiety and fear and increases the patients’ experience of feeling safe. The aim of this thesis was to illuminate patients’ experiences of the information before a surgical intervention. The thesis was designed with a qualitative design, thus qualitative content analysis was used for the data analysis. Four patients classified as ASA-class 1-2, and between the ages of 18 and 65 were included. Urgent surgeries were excluded. Semi structured interviews were used to obtain the data, where two categories emerged, the experience of information and the effect of relatives and close acquaintances. The results showed the patients experienced a feeling of being safe and thereby experienced a reduced amount of anxiety and fear before the surgical procedure. Relatives and close acquaintances could enforce the patients’ feeling of being safe but could also be a source of anxiety and fear depending on their experience prior to the patients care. Due to different patients’ experiences the need involving the information there is a need for further studies.

O presente estudo teve como objetivo avaliar os efeitos do halotano, isofluorano e sevofluorano sobre o índice biespectral, parâmetros cardiorrespiratórios e hemogasométricos em cadelas submetidas a ovariosalpingohisterectomia. Foram utilizadas 48 cadelas, sem raça definida, com peso médio de 15,09±4,29 kg, com idade média de 3,9±1,23 anos, encaminhadas para realização do procedimento de orivariosalpingohisterectomia. Os animais foram distribuídos aleatoriamente em seis grupos de oito animais, sendo designados como AH, AMH, AI, AMI, AS e AMS. Os animais dos grupos AH, AI e AS receberam acepromazina na medicação pré-anestésica na dose de 0,1 mg.kg-1 por via intramuscular. Já os animais dos grupos AMH, AMI e AMS receberam na medicação pré-anestésica acepromazina, na dose de 0,05 mg.kg-1, associada a meperidina, na dose de 3 mg.kg-1, administrados por via intramuscular. A indução da anestesia foi realizada com o auxílio de propofol, na dose de 5 mg.kg-1, lentamente por meio da via intravenosa. Uma vez que os animais apresentaram relaxamento mandibular foi realizada a entubação orotraqueal, sendo em seguida conectada ao circuito valvular circular do aparelho de anestesia, e mantidas em respiração espontânea com halotano (grupos AH e AMH), isofluorano (grupos AI e AMI) ou sevofluorano (grupos AS e AMS), diluídos em oxigênio a 100%. Foram mensurados o índice biespectral (BIS), eletromiografia (EMG), freqüência cardíaca (FC), pressão arterial sistólica (PAS), pressão arterial diastólica (PAD), pressão arterial média (PAM), temperatura retal, freqüência respiratória (FR), tensão de dióxido de carbono no final da expiração (ETCO2), saturação periférica de oxigênio na oxi-hemoglobina (SpO2), relação entra a pressão parcial de oxigênio no sangue arterial e a fração inspirada de oxigênio hemogasometria arterial (pH, PaCO<2, PaO2, HCO3- e DB). Os parâmetros verificados e registrados em todos os grupos desde M0 até M5, sendo estes: M0; 15 minutos após a administração da medicação pré-anestésica, M1; 10 minutos de manutenção anestésica, M2; ligadura do pedículo ovariano direito, M3; sutura da musculatura, M4; sutura de pele, M5; 10 minutos após o fim da administração do anestésico. Em todos os grupos houve forte correlação do índice biespectral e a fração expirada de anestésico. Quanto ao índice biespectral, o grupo AMH apresentou índices inferiores em M2 quando comparado com AI, AMI e AS; neste mesmo momento AI apresentou índices superiores em relação a AMS. Não houve diferença entre os grupos estudados em relação aos parâmetros cardiovasculares. Todos os agentes causaram depressão respiratória, evidenciado pelo incremento na PaCO2, e a ocorrência de acidemia. Conclui-se que os três agentes avaliados possuíram correlação inversa com o índice biespectral, o grupo AMS apresentou valores inferiores de BIS, todos os agentes promoveram estabilidade cardiovascular e de maneira semelhante, desencadearam depressão respiratória e acidemia. / The objective of this study was evaluation effects of the halothane, isoflurane and sevoflurane on bispectral index, cardiopulmonary and hemogasometrics parameters in bitches undergoing ovariohysterectomy. Fourth-eight mongrel bitches (weight: 15,09±4,29 kg) with 3,9±1,23 years old, send to HOVET-USP for surgical procedure of ovariohysterectomy. The animals were randomly allocated in six grupos of eight animals, designed with AH, AMH, AI, AMI, AS e AMS. The animals of the AH, AI and AS group were premedicated with acepromazine (0,1 mg.kg-1, i.m.) and the animals of the AMH, AMI and AMS groups receive acepromazine (0,05 mg.kg-1, i.m.) and meperidine (3 mg.kg-1, i.m.). Fifteen minutes later, propofol was titrated to allow endotracheal intubation and connected in valvular circuit of anesthesia machine and was maintained in spontaneously breathing with halotane (groups AH and AMH), isoflurane (AI and AMI) and sevoflurane (AS and AMS) in 100% oxygen delivery. Bispectral index (BIS), heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), rectal temperature (RT), respiratory rate (RR), end-tidal of carbon dioxide (ETCO2), peripheral oxihemoglobin saturation, relationship of the arterial oxygen pressure and inspiration fraction of oxygen, inspiration fraction of anesthetics, end-tidal anesthetics, and gasometrical parameters (pH, PaCO2, PaO2, HCO3- and BD) was evaluated. The parameters was evaluated in all groups in moments M0 to M5, M0 fifteen minutes after de pre-medication administration; M1, ten minutes of anesthetic maintains; M2, transfixation of left ovarian; M3 muscle suture; M4, skin suture, M5, ten minutes of the end of anesthetic. All groups were having strong correlation of the bispectral index and end-tidal anesthetic. The AMH group has minor values of bispectral index in M2 when compare with AI, AMI and AS groups; in this moment AI group present to values when compare with AMS. The cardiovascular parameters havent difference between groups. All agents caused reduction of respiratory function, evidenced for increase in PaCO2 and acidemia. The tree agents has inverse correlation with bispectral index, the AMS group, present minor values of BIS, all agents promoted cardiovascular stability and decrease of respiratory function.

Please read the abstract in the dissertation. / Dissertation (MSc)--University of Pretoria, 2013. / gm2014 / Clinical Epidemiology / unrestricted

The role of CEA for stroke prevention in the presence of symptomatic carotid artery stenosis is well established. In order to maximize the benefit of surgery, several perioperative processes of care have been under scrutiny, of which one is the choice of anaesthetic method. The differing effects of GA vs. LA on the cerebral circulation after CEA may be of significance, since changes in the cerebral circulation post-CEA may give rise to cerebral hyperperfusion and intracerebral haemorrhage. This work assessed the effect of GA vs. LA on cerebral haemodynamic control after CEA using transcranial Doppler (TCD) techniques, and correlated these changes with serum markers of cerebral injury. Subjects undergoing CEA had perioperative TCD monitoring of middle cerebral artery blood flow velocity (MCAV). Pre- and postoperative (within 48 hours of surgery) testing of cerebral autoregulation [CA] (tilt-testing) and cerebral vasoreactivity to CO2 [CVR] (rebreathing expired air) was conducted. Cerebral haemodynamic parameters and clinical outcome were correlated with changes in jugular venous and peripheral levels of protein S100β and neurone-specific enolase (NSE).The change in CA and CVR was not different between GA (n=16) and LA (n=20). Overall, CA and CVR improved significantly within 48 hours of CEA for patients with preoperative impairment of these parameters, although some patients with normal baseline CA and CVR exhibited postoperative impairment. Increase of MCAV >100% from baseline after restoration of carotid blood flow was observed in patients with impaired CVR, but resolved by the first postoperative day. Transient elevation in jugular venous (but not peripheral) S100β during surgery was seen. Both jugular and peripheral NSE levels dropped during surgery. Neither anaesthetic method nor CA or CVR status had any effect on changes in serum S100β or NSE. Cerebral autoregulatory parameters thus improve rapidly after CEA, but appear unaffected by anaesthetic technique. This supports the concept that cerebral hyperperfusion is dependent on factors in addition to impaired CA or CVR. Changes in serum S100β or NSE do not reflect cerebral haemodynamic changes. However, the variability encountered between patients warrants further investigation. The implications for clinical practice and directions for further research are discussed.

<p>Post-operative sore throat is a common minor complication following general anaesthesia via endotracheal intubation. Pharyngeal packing has often been implicated in this minor anaesthetic complication. In maxillo-facial and oral surgery, two types of throat packs are commonly used namely ribbon gauze and tampons. In order to establish the efficacy of these two types of throat packs a prospective, randomised, clinical study was conducted. The objectives of the study were threefold: to investigate the effect of the two different types of throat packs on the incidence of post-operative sore throat, to determine the quality of seal provided by the two different types of throat packs and finally, to formulate a faculty protocol. The study consisted of 70 patients undergoing third molar surgery. All the patients were intubated via endotracheal intubation and had a throat pack placed. Patients were also randomly selected and allocated to two groups. One group had ribbon gauze while the other group had a tampon as a throat pack. The study reflected no statistically significant difference in the incidence of postoperative sore throat between the two groups. It was interesting to note that the symptoms of sore throat resolved quicker with the use of tampons. On the other hand, the ribbon gauze provided a better pharyngeal seal.</p>

<p>Post-operative sore throat is a common minor complication following general anaesthesia via endotracheal intubation. Pharyngeal packing has often been implicated in this minor anaesthetic complication. In maxillo-facial and oral surgery, two types of throat packs are commonly used namely ribbon gauze and tampons. In order to establish the efficacy of these two types of throat packs a prospective, randomised, clinical study was conducted. The objectives of the study were threefold: to investigate the effect of the two different types of throat packs on the incidence of post-operative sore throat, to determine the quality of seal provided by the two different types of throat packs and finally, to formulate a faculty protocol. The study consisted of 70 patients undergoing third molar surgery. All the patients were intubated via endotracheal intubation and had a throat pack placed. Patients were also randomly selected and allocated to two groups. One group had ribbon gauze while the other group had a tampon as a throat pack. The study reflected no statistically significant difference in the incidence of postoperative sore throat between the two groups. It was interesting to note that the symptoms of sore throat resolved quicker with the use of tampons. On the other hand, the ribbon gauze provided a better pharyngeal seal.</p>

Magister Chirurgiae Dentium - MChD / Post-operative sore throat is a common minor complication following general anaesthesia via endotracheal intubation. Pharyngeal packing has often been implicated in this minor anaesthetic complication. In maxillo-facial and oral surgery, two types of throat packs are commonly used namely ribbon gauze and tampons. In order to establish the efficacy of these two types of throat packs a prospective, randomised, clinical study was conducted. The objectives of the study were threefold: to investigate the effect of the two different types of throat packs on the incidence of post-operative sore throat, to determine the quality of seal provided by the two different types of throat packs and finally, to formulate a faculty protocol. The study consisted of 70 patients undergoing third molar surgery. All the patients were intubated via endotracheal intubation and had a throat pack placed. Patients were also randomly selected and allocated to two groups. One group had ribbon gauze while the other group had a tampon as a throat pack. The study reflected no statistically significant difference in the incidence of postoperative sore throat between the two groups. It was interesting to note that the symptoms of sore throat resolved quicker with the use of tampons. On the other hand, the ribbon gauze provided a better pharyngeal seal. / South Africa

Abstract General anaesthesia (GA) is a widely used sedation method in dentistry. It is usually used for patients with an extensive dental treatment need, most often related to dental caries, and limited coping skills to consider conventional dental care. These patients are often small children or persons with dental fear. Using dental general anaesthesia (DGA) is expensive, special equipment and trained staff are needed, and it is not without risks for patients. The aim of this study was to investigate factors associated with children’s DGA. In addition to dental caries and dental fear, general health status, oral health behaviours, family-related factors, as well as dental attendance after DGA were in focus. The thesis is composed of five independent studies. There were three different study populations ‒ one in specialised and two in primary health care. There was also an age- and gender-matched comparison group for one of the study populations. Questionnaires were used in three of the studies, and two of the studies were based on patient files. According to the results, DGA is more common among medically compromised children than among healthy children. Medically compromised children have more often a history of DGA treatments compared with their healthy peers. Dental caries and dental fear were the main reasons for DGA in all of the studies. Dietary and drinking habits, as well as oral hygiene behaviours were distinctly poorer among children undergoing DGA than among those treated in a normal dental setting. A history of DGA in the family, a large number of siblings and male gender were important background factors associated with DGA. Patients treated under DGA were prone to miss or cancel their upcoming appointments. In conclusion, DGA is necessary in some cases, but it could be avoided if factors associated with DGA were taken into account in treatment plans. DGA in itself does not have an enhancing effect on oral health over the long term. / Tiivistelmä Yleisanestesia on hammashoidossa yleisesti käytetty sedaatiomenetelmä vaikeahoitoisille potilaille. He ovat usein pieniä lapsia, hammashoitopelkoisia tai sellaisia potilaita, joiden hoidontarve on liian laaja ja haastava tavanomaiseen hammashoitoon. Tämän tutkimuksen tavoitteena oli selvittää lasten nukutushammashoitoon liittyviä tekijöitä. Karieksen ja hammashoitopelon lisäksi tutkimuksen kohteena oli yleisterveydellisiä seikkoja, suunterveystottumuksia, perheeseen liittyviä tekijöitä sekä hammashoitopalvelujen käyttö nukutushammashoidon jälkeen. Tämä väitöskirja koostuu viidestä erillisestä osajulkaisusta. Tutkimusjoukkoja oli kolme: yksi erikoissairaanhoidosta ja kaksi perusterveydenhuollosta. Yhdelle tutkimusjoukolle oli ikä- ja sukupuolivakioitu vertailuryhmä. Kyselylomakkeita käytettiin kolmessa osajulkaisussa ja kaksi osajulkaisua perustui potilaspapereihin. Nukutushammashoito oli yleisempää yleissairailla kuin terveillä lapsilla. Yleissairailla lapsilla oli myös useammin nukutushammashoitohistoriaa kuin terveillä lapsilla. Karies ja hammashoitopelko olivat pääsyyt nukutushammashoitoon kaikissa tutkimuksissa. Juoma- ja ruokatottumukset, kuten myös suuterveystottumukset, olivat selkeästi huonommat nukutushammashoidossa hoidetuilla lapsilla kuin niillä lapsilla, jotka hoidettiin normaalisti hereillä. Perheen nukutushammashoitohistoria, suuri määrä sisaruksia ja miessukupuoli olivat merkittäviä nukutushammashoitoon yhteydessä olevia tekijöitä. Nukutushammashoidossa hoidetut potilaat jättivät usein tulematta nukutushammashoidon jälkeisille hammashoitokäynneilleen tai peruivat aikansa. Nukutushammashoito on välttämätön tietyissä tilanteissa, mutta se voitaisiin välttää, jos siihen liittyviä tekijöitä huomioitaisiin paremmin hoitosuunnitelmissa. Nukutushammashoidolla sinänsä ei ole suunterveyttä parantavaa pitkäaikaisvaikutusta.

Made available in DSpace on 2016-12-08T16:24:17Z (GMT). No. of bitstreams: 1 PGCA14MA134.pdf: 1248046 bytes, checksum: af3ac6b025f01fe9a2d5a20f8a4685e3 (MD5) Previous issue date: 2014-02-28 / The aim of this study was to compare the efficacy and safety of premedication with detomidine and morphine in sheep kept under inhalation anesthesia with isoflurane or total intravenous anesthesia with propofol, both associated with lumbosacral spinal anesthesia. Fourteen adult, female, sheep, mean weight 27,2±2,4 Kg were used. All animals were pre medicated with 0,3 mg.Kg-1 of morphine IM, and 5 minutes later received 20 mcg.Kg-1 of detomidine IV. Subsequently were assigned into two groups: GISO (n=7), which were induced with 0,5mg.Kg-1 of diazepam associated with 5 mg.Kg-1 of ketamine IV, and maintenance of anesthesia was through isoflurane diluted in 100 % oxygen; the GPRO (n=7), animals were induced with 4 mg.Kg-1 propofol and maintained with continuous infusion of propofol in the initial rate of 0,3 mg.Kg-1.min-1 and subsequently adjusted to maintain adequate depth of anesthesia. Mechanical ventilation was iniciated to maintain normocapnia during the anesthesia. All animals underwent bilateral tibial osteotomy, therefore, received 0,5mg.Kg-1 0,75% ropivacaine associated with 0,1 mg.Kg-1 morphine by the intrathecal route, and diluting to a final volume of 1 mL/7,5 Kg bodyweight with NaCl0,9% solution. The parameters were evaluated at baseline (M0), after instrumentation of the animals while held in right lateral recumbeny; 5 minutes after administration of detomidine (M1); 5 minutes after anesthetic induction (M2); 10 minutes after performing spinal anesthesia and positioning of the animal into dorsal recumbency (M3); immediately after osteotomy of the right hindlimb (M4); 30 minutes after the spinal anesthesia and positioning of the animal into dorsal recumbency (M5); immediately after osteotomy of the left hindlimb (M6); and at the end of surgery/anesthesia (M7). There was a 40% reduction in heart rate in M1 in both groups, remaining on average 23% reduced to M7. Mean arterial pressure rose in 16% in GISO at M2, 12 but decreasing from M3 to M7, like at in the GPRO. The average EtISO was 0,57 V% and average infusion rate of propofol was 0,24 mg.Kg-1.min-1. Spinal block was 100% effective in all animals. We registered a respiratory acidosis in M2, and a posterior metabolic alkalosis in M3 to M7, in both groups. Reduction of potassium levels and sustained hyperglycemia were observed in M2 to M7 in both groups. A 20% decrease ocurred in hematocrit and hemoglobin were observed in both groups from M1. The total time of surgery, anesthesia and extubation were 66±9,8, 92±7,0 and 13,8±1,5 minutes in GISO and 56±2,4, 82,9±4,6 and 5,4±1,5 minutes in GPRO. We conclude that sedation provided with the association of morphine and detomidine promoted adequate sedation depth, quality of induction promoted by propofol or ketamine diazepam was excellent and the protocol of spinal anesthesia was effective in preventing the nociception during surgical stimulation, not requiring rescue analgesia. The maintenance anesthesia with propofol or isoflurane produced similar depth of anesthesia with minimal cardiovascular and hemogasometric alterations, which are well tolerated in healthy animals / O objetivo deste estudo foi comparar a eficácia e segurança da pré medicação com detomidia e morfina em ovinos mantidos sob anestesia geral inalatória com isofluorano ou anestesia total intravenosa com propofol, ambas associadas à anestesia subaracnóidea lombo-sacra. Foram utilizados 14 ovinos, fêmeas, adultas, com peso médio 27,2±2,4 Kg. Todos os animais foram pré medicados com 0,3 mg.Kg-1 de morfina pela via IM, e 5 minutos após receberam 20 mcg.Kg-1 de detomidina pela via IV. Posteriormente foram alocados em dois grupos: GISO (n=7), onde foram induzidos com 0,5 mg.Kg-1 de diazepam e 5 mg.Kg-1 de cetamina IV, e manutenção anestésica realizada através de isofluorano diluído em 100% de oxigênio; no GPRO (n=7), os animais foram induzidos com 4 mg.Kg-1 de propofol, e a manutenção foi realizada com infusão contínua de propofol na taxa inicial de 0,3 mg.Kg-1.min-1 sendo posteriormente ajustada de acordo com o plano anestésico. Todos os animais foram mantidos sob ventilação mecânica ajustada para manter normocapnia. Todos os animais foram submetidos à osteotomia bilateral de tíbia, para tanto, receberam 0,5 mg.Kg-1 de ropivacaína 0,75% associado a 0,1 mg.Kg-1 de morfina pela via subaracnóidea, diluindo-se para um volume final de 1 mL/7,5 Kg com solução NaCl 0,9%. Os parâmetros foram avaliados no momento basal (M0), este ocorrido após a instrumentação dos animais, enquanto mantidos em decúbito lateral direito; 5 minutos após a administração da detomidina (M1); 5 minutos após a indução anestésica (M2); 10 minutos após a realização da anestesia subaracnóidea e posicionamento do animal em decúbito dorsal (M3); imediatamente após a realização da osteotomia do membro pélvico direito (perfuração da cortical) (M4); 30 minutos após a realização da anestesia subaracnóidea e posicionamento do animal em decúbito dorsal (M5); imediatamente após a realização da osteotomia do membro pélvico esquerdo (perfuração da cortical) (M6); e ao término da 10 cirurgia/anestesia (M7). Houve redução de 40% nos valores médios de frequência cardíaca em M1 em ambos os grupos, permanecendo em média 23% reduzidos até M7. A pressão arterial média elevou-se 16% em M2 no GISO, mas reduzindo-se de M3 até M7, assim como no GPRO. A EtISO média foi de 0,57V% e a taxa média de infusão do propofol foi de 0,24 mg.Kg-1.min-1. O bloqueio subaracnóideo foi 100% eficaz em todos os animais. Registrou-se acidose respiratória em M2, e posterior alcalose metabólica de M3 à M7, em ambos os grupos. Redução dos valores de potássio e hiperglicemia sustentada ocorreram de M2 a M7, em ambos os grupos. Decréscimo significativo de 20% nos valores de hematócrito e hemoglobina foram observados nos dois grupos a partir de M1. Os tempos totais de cirurgia, anestesia e para extubação foram de 66±9,8, 92±13,8 e 7,0±1,5 minutos no GISO e 56±2,4, 82,9±4,6 e 5,4±1,5 minutos no GPRO. Conclui-se que a sedação promovida pela associação de morfina e detomidina promoveu sedação adequada, a qualidade de indução promovida pelo propofol ou associação de cetamina diazepam foi excelente, o protocolo de anestesia subaracnóidea foi eficaz em prevenir a nocicepção durante o estímulo cirúrgico, não requerendo resgate analgésico trans operatório. A manutenção anestésica com isofluorano ou propofol promoveu plano anestésico similar com mínimos efeitos cardiovasculares ou hemogasométricos, os quais são bem tolerados em animais hígidos