Carotid angioplasty and stenting (CAS) was developed to be a less invasive and complex procedure compared to carotid endarterectomy (CEA). It has emerged as an alternative for patients who are considered to have high ...Carotid angioplasty and stenting (CAS) was developed to be a less invasive and complex procedure compared to carotid endarterectomy (CEA). It has emerged as an alternative for patients who are considered to have high surgical risks due to medical comorbidities or anatomical high-risk features [1]. The procedure is usually done under local anesthesia with light sedation, with the subsequent expectation of less neurologic injury, venous thromboembolisms, and myocardial infarctions—all well-known clinical risks of undergoing surgical procedures under general anesthesia. CAS, however, carries some increased risks of arterial dissection, dislocation of atherothrombotic debris and embolization to the brain or eye, late embolization due to thrombus formation on the damaged plaque, and bradycardia and hypotension as a result of carotid sinus stimulation. Electroencephalography can detect cerebral ischemia and hypoxia along with measuring hypnotic effects, but has not been reported to be used during CAS to signal impending neurological deficit and allow for intervention to prevent stroke. We report on the use of patient state index (PSI), an electroencephalographic (EEG) derived variable used by SEDLine monitor (Masimo Inc., San Diego, CA) to monitor changes in cerebral blood flow during carotid angioplasty and stenting in an awake patient under local anesthesia. PSI was developed to measure the level of hypnosis and sedation during anesthesia and in the ICU. The PSI is based on quantitative electroencephalogram features, recorded from anterior and posterior scalp sites, as input to a multivariate algorithm that quantifies the most probable level of anesthesia or sedation. The PSI is reported as a range from 0 to 100, with decreasing values indicating increasing levels of anesthesia or sedation. Adequate depth of anesthesia is reflected by PSI value of 25 - 50, and a fully awake state by a PSI of 100 [2]. Other EEG analysis techniques have been explored to detect changes in cerebral blood flow during carotid surgery [3], such as entropy described by Khan and Ozcan in his recent work entitled Disagreement in Bilateral State Entropy Values in Carotid Artery Disease [4], but there are no previous reports of the use of PSI during procedural sedation in carotid angioplasty and stenting in an awake patient.展开更多
Since October 2007, we have been conducting rigorous scientific research on the unexplained “power” of a pyramidal structure (PS). From our research results so far, we could classify the pyramid effects by the PS in...Since October 2007, we have been conducting rigorous scientific research on the unexplained “power” of a pyramidal structure (PS). From our research results so far, we could classify the pyramid effects by the PS into the following two types. (i) The pyramid effects in which the PS converted the test subject’s unexplained energy to affect biosensors when the test subject entered the PS and meditated. (ii) The pyramid effects in which the potential power of the PS affect</span><span style="font-family:Verdana;">ed</span><span style="font-family:Verdana;"> biosensors if the test subject ha</span><span style="font-family:Verdana;">d</span><span style="font-family:Verdana;"> not been inside the PS for at least 20 days and the test subject’s unexplained energy was excluded. In this paper, we report new results regarding (ii). As a result of dividing a year according to the four seasons of winter, spring, summer, and autumn and analyzing the pyramid effect of each period, the following points were found. 1) There was a pyramid effect without seasonal variation. The pyramid effect on the lower and upper layers was different throughout the year for the biosensors placed at the PS apex in two layers, regardless of the season. 2) There was a pyramid effect with seasonal variation. The value of the psi index, which indicates the magnitude of the pyramid effect, changed as the seasons changed, while different pyramid effects were maintained on the lower and upper layers. Regarding the change in the pyramid effect depending on the season, the psi index in summer was larger than that in winter in both the lower and upper layers. From these results, we found that there are two types of potential power at the PS apex: seasonal potential power and non-seasonal potential power.展开更多
文摘Carotid angioplasty and stenting (CAS) was developed to be a less invasive and complex procedure compared to carotid endarterectomy (CEA). It has emerged as an alternative for patients who are considered to have high surgical risks due to medical comorbidities or anatomical high-risk features [1]. The procedure is usually done under local anesthesia with light sedation, with the subsequent expectation of less neurologic injury, venous thromboembolisms, and myocardial infarctions—all well-known clinical risks of undergoing surgical procedures under general anesthesia. CAS, however, carries some increased risks of arterial dissection, dislocation of atherothrombotic debris and embolization to the brain or eye, late embolization due to thrombus formation on the damaged plaque, and bradycardia and hypotension as a result of carotid sinus stimulation. Electroencephalography can detect cerebral ischemia and hypoxia along with measuring hypnotic effects, but has not been reported to be used during CAS to signal impending neurological deficit and allow for intervention to prevent stroke. We report on the use of patient state index (PSI), an electroencephalographic (EEG) derived variable used by SEDLine monitor (Masimo Inc., San Diego, CA) to monitor changes in cerebral blood flow during carotid angioplasty and stenting in an awake patient under local anesthesia. PSI was developed to measure the level of hypnosis and sedation during anesthesia and in the ICU. The PSI is based on quantitative electroencephalogram features, recorded from anterior and posterior scalp sites, as input to a multivariate algorithm that quantifies the most probable level of anesthesia or sedation. The PSI is reported as a range from 0 to 100, with decreasing values indicating increasing levels of anesthesia or sedation. Adequate depth of anesthesia is reflected by PSI value of 25 - 50, and a fully awake state by a PSI of 100 [2]. Other EEG analysis techniques have been explored to detect changes in cerebral blood flow during carotid surgery [3], such as entropy described by Khan and Ozcan in his recent work entitled Disagreement in Bilateral State Entropy Values in Carotid Artery Disease [4], but there are no previous reports of the use of PSI during procedural sedation in carotid angioplasty and stenting in an awake patient.
文摘Since October 2007, we have been conducting rigorous scientific research on the unexplained “power” of a pyramidal structure (PS). From our research results so far, we could classify the pyramid effects by the PS into the following two types. (i) The pyramid effects in which the PS converted the test subject’s unexplained energy to affect biosensors when the test subject entered the PS and meditated. (ii) The pyramid effects in which the potential power of the PS affect</span><span style="font-family:Verdana;">ed</span><span style="font-family:Verdana;"> biosensors if the test subject ha</span><span style="font-family:Verdana;">d</span><span style="font-family:Verdana;"> not been inside the PS for at least 20 days and the test subject’s unexplained energy was excluded. In this paper, we report new results regarding (ii). As a result of dividing a year according to the four seasons of winter, spring, summer, and autumn and analyzing the pyramid effect of each period, the following points were found. 1) There was a pyramid effect without seasonal variation. The pyramid effect on the lower and upper layers was different throughout the year for the biosensors placed at the PS apex in two layers, regardless of the season. 2) There was a pyramid effect with seasonal variation. The value of the psi index, which indicates the magnitude of the pyramid effect, changed as the seasons changed, while different pyramid effects were maintained on the lower and upper layers. Regarding the change in the pyramid effect depending on the season, the psi index in summer was larger than that in winter in both the lower and upper layers. From these results, we found that there are two types of potential power at the PS apex: seasonal potential power and non-seasonal potential power.
