RESUMEN
OBJECTIVES: Electroconvulsive therapy (ECT) has dramatically reduced musculoskeletal complications when carried out with muscle relaxants under general anesthesia. However, seizure quality can be affected by the depth of anesthesia and choice of anesthetic agent. The purpose of this study was to describe a general anesthetic technique for ECT by using laryngeal mask, bispectral index (BIS), and muscle relaxant monitoring. METHODS: Twenty-one patients, between ages 18 and 70 years (American Society of Anesthesiologists physical status I-III), who underwent a total of 89 sessions of ECT were examined in a retrospective study. Anesthesia was induced by use of propofol (1.0 mg/kg) followed by cisatracurium (0.2 mg/kg). The BIS, train-of-four, and end-tidal carbon dioxide were all monitored continuously. A laryngeal mask airway was used to maintain and protect the airway during the procedure. Electroconvulsive therapy stimuli were applied bilaterally when the train-of-four was assessed as being zero and BIS scores were 70. All patients then received 5 µg sufentanil and 2 mg midazolam, while titrated to maintain the BIS value at 40 to 50, before the muscle relaxation exhibited complete recovery. RESULTS: The mean duration of treatment process takes approximately 82.5 minutes. Mean (SD) seizure length was 58.8 (28.3) seconds, with 4.5% incidence of restimulation per treatment. Incidence of awareness was 0%. No patients exhibited delirium, nausea, vomiting, or myalgia in the postseizure phase. CONCLUSIONS: Bispectral index monitoring of the depth of anesthesia may have improved seizure quality, and awareness did not occur.
Asunto(s)
Anestesia General , Atracurio/análogos & derivados , Monitores de Conciencia , Terapia Electroconvulsiva/métodos , Máscaras Laríngeas , Fármacos Neuromusculares no Despolarizantes , Adolescente , Adulto , Anciano , Anestesia General/efectos adversos , Atracurio/efectos adversos , Dióxido de Carbono/sangre , Terapia Electroconvulsiva/efectos adversos , Femenino , Humanos , Despertar Intraoperatorio , Masculino , Persona de Mediana Edad , Fármacos Neuromusculares no Despolarizantes/efectos adversos , Seguridad del Paciente , Estudios Retrospectivos , Convulsiones/fisiopatología , Adulto JovenRESUMEN
To identify the specificity of base substitutions, a novel experimental system was established based on rifampicin-resistant (Rif r) mutant screening and sequencing of the defined region of the rpoB gene in E. coli. We focused on comparing mutational spectra of base substitutions induced by either low energy nitrogen ion beam implantation or 60Co-gamma rays. The most significant difference in the frequency of specific kinds of mutations induced by low energy nitrogen ion beam was that CG -> TA transitions were significantly increased from 32 to 46, AT -> TA transversions were doubled from 7 to 15 in 50 mutants, respectively. The preferential base substitutions induced by nitrogen ion beam implantation were CG -> TA transitions, AT -> GC transitions, AT -> TA transversions, which account for 92.13 percent (82/89) of the total. The mutations induced by 60Co-gamma rays were preferentially GC -> AT and AT -> GC transitions, which totaled 84.31 percent (43/51).