BACKGROUND: Rapid sequence induction and intubation(RSII) is a medical procedure involving a prompt induction of general anesthesia by using cricoid pressure that prevents regurgitation of gastric contents. The factor...BACKGROUND: Rapid sequence induction and intubation(RSII) is a medical procedure involving a prompt induction of general anesthesia by using cricoid pressure that prevents regurgitation of gastric contents. The factors affecting RSII are prophylaxis for aspiration, preoxygenation, drug and equipment preparation for RSII, ventilation after induction till intubation and patient condition. We sometimes saw diffi culties with the practice of this technique in our hospital operation theatres. The aim of this study was to assess the techniques of rapid sequence induction and intubation.METHODS: Hospital based observational study was conducted with a standardized checklist. All patients who were operated upon under general anesthesia during the study period were included. The techniques of RSII were observed during the induction of anesthesia by trained anesthetists.RESULTS: Altogether 140 patients were included in this study with a response rate of 95.2%. Prophylaxis was not given to 130 patients(92.2%), and appropriate drugs were not used for RSII in 73 patients(52.1%), equipments for diffi cult intubation in 21(15%), suction machines with catheter not connected and turned on in 122(87.1%), ventilation for patients after induction and before intubation in 41(29.3%), cricoid pressure released before cuff inflation in 12(12.1%), and difficult intubation in 8(5.7%), respectively. RSII with cricoid pressure was applied appropriately in 94(67.1%) patients, but cricoid pressure was not used in 46(32.9%) patients.CONCLUSIONS: The techniques of rapid sequence induction and intubation was low. Training should be given for anesthetists about the techniques of RSII.展开更多
Ketamine, a dissociative anesthetic with distinct sedative and analgesic properties, is receiving renewed attention in critical care owing toits unique pharmacological profile. Although historically limited by concern...Ketamine, a dissociative anesthetic with distinct sedative and analgesic properties, is receiving renewed attention in critical care owing toits unique pharmacological profile. Although historically limited by concerns over psychoactive side effects, its ability to maintain hemody-namicstability has prompted growing interest in its use in intensive care settings. This narrative review synthesizes emerging evidence on10 potential applications of ketamine in the intensive care unit (ICU), including opioid-sparing analgesia, sedation during mechanical ven-tilation,rapid sequence intubation, and management of sepsis, postcardiac surgery states, acute brain injury, super-refractory status ep-ilepticus,acute severe asthma, delirium, and psychiatric disorders. Although ketamine shows promising advantages—such as reducedopioid use and improved cardiovascular stability—the quality of supporting evidence remains low, with limitations including small samplesizes, study heterogeneity, and methodological concerns. Evidence regarding its impact on long-term outcomes, such as mortality, cog-nitivefunction, and length of ICU stay remains inconclusive. Some data suggest that ketamine may reduce the incidence of ICU deliriumand aid in managing refractory psychiatric conditions;however, concerns about adverse effects—including cardiovascular strain, emer-gencereactions, and potential neurotoxicity—require cautious application. Despite these challenges, the utility of ketamine in patients withhemodynamic instability, particularly in sepsis and during tracheal intubation, highlights its potential as a versatile agent in critical care phar-macotherapy.Currentguidelines recommend restrained, adjunctive use pending further high-quality evidence. This review emphasizes theneed for large-scale, multicenter randomized controlled trials to define the role of ketamine, refine dosing strategies, and assess safetyacross diverse ICU populations. As clinical interest expands, the integration of ketamine into ICU practice must be guided by both inno-vationand vigilant safety monitoring.展开更多
Artificial neural networks(ANNs)have made great strides in the field of remote sensing image object detection.However,low detection efficiency and high power consumption have always been significant bottlenecks in rem...Artificial neural networks(ANNs)have made great strides in the field of remote sensing image object detection.However,low detection efficiency and high power consumption have always been significant bottlenecks in remote sensing.Spiking neural networks(SNNs)process information in the form of sparse spikes,creating the advantage of high energy efficiency for computer vision tasks.However,most studies have focused on simple classification tasks,and only a few researchers have applied SNNs to object detection in natural images.In this study,we consider the parsimonious nature of biological brains and propose a fast ANN-to-SNN conversion method for remote sensing image detection.We establish a fast sparse model for pulse sequence perception based on group sparse features and conduct transform-domain sparse resampling of the original images to enable fast perception of image features and encoded pulse sequences.In addition,to meet accuracy requirements in relevant remote sensing scenarios,we theoretically analyze the transformation error and propose channel self-decaying weighted normalization(CSWN)to eliminate neuron overactivation.We propose S3Det,a remote sensing image object detection model.Our experiments,based on a large publicly available remote sensing dataset,show that S3Det achieves an accuracy performance similar to that of the ANN.Meanwhile,our transformed network is only 24.32%as sparse as the benchmark and consumes only 1.46 W,which is 1/122 of the original algorithm’s power consumption.展开更多
文摘BACKGROUND: Rapid sequence induction and intubation(RSII) is a medical procedure involving a prompt induction of general anesthesia by using cricoid pressure that prevents regurgitation of gastric contents. The factors affecting RSII are prophylaxis for aspiration, preoxygenation, drug and equipment preparation for RSII, ventilation after induction till intubation and patient condition. We sometimes saw diffi culties with the practice of this technique in our hospital operation theatres. The aim of this study was to assess the techniques of rapid sequence induction and intubation.METHODS: Hospital based observational study was conducted with a standardized checklist. All patients who were operated upon under general anesthesia during the study period were included. The techniques of RSII were observed during the induction of anesthesia by trained anesthetists.RESULTS: Altogether 140 patients were included in this study with a response rate of 95.2%. Prophylaxis was not given to 130 patients(92.2%), and appropriate drugs were not used for RSII in 73 patients(52.1%), equipments for diffi cult intubation in 21(15%), suction machines with catheter not connected and turned on in 122(87.1%), ventilation for patients after induction and before intubation in 41(29.3%), cricoid pressure released before cuff inflation in 12(12.1%), and difficult intubation in 8(5.7%), respectively. RSII with cricoid pressure was applied appropriately in 94(67.1%) patients, but cricoid pressure was not used in 46(32.9%) patients.CONCLUSIONS: The techniques of rapid sequence induction and intubation was low. Training should be given for anesthetists about the techniques of RSII.
基金funded by the National Key Research and Develop-ment Program of China(No.2021YFC2501800)the National Natural Science Foundation of China(No.82472184)+4 种基金the Out-standing Youth Project of Heilongjiang Natural Science Foundation(No.JQ2021H002)the Key R&D Plan Project in Heilongjiang Prov-ince(No.GY2023ZB0075)the HarbinMedical University Foundation Youth Project(No.PYQN2023-9)the Wu Jieping Medical Foundation(No.320.6750.2021-4-60)the Research Project of Heilongjiang Provincial Health Commission(No.20241717010028).
文摘Ketamine, a dissociative anesthetic with distinct sedative and analgesic properties, is receiving renewed attention in critical care owing toits unique pharmacological profile. Although historically limited by concerns over psychoactive side effects, its ability to maintain hemody-namicstability has prompted growing interest in its use in intensive care settings. This narrative review synthesizes emerging evidence on10 potential applications of ketamine in the intensive care unit (ICU), including opioid-sparing analgesia, sedation during mechanical ven-tilation,rapid sequence intubation, and management of sepsis, postcardiac surgery states, acute brain injury, super-refractory status ep-ilepticus,acute severe asthma, delirium, and psychiatric disorders. Although ketamine shows promising advantages—such as reducedopioid use and improved cardiovascular stability—the quality of supporting evidence remains low, with limitations including small samplesizes, study heterogeneity, and methodological concerns. Evidence regarding its impact on long-term outcomes, such as mortality, cog-nitivefunction, and length of ICU stay remains inconclusive. Some data suggest that ketamine may reduce the incidence of ICU deliriumand aid in managing refractory psychiatric conditions;however, concerns about adverse effects—including cardiovascular strain, emer-gencereactions, and potential neurotoxicity—require cautious application. Despite these challenges, the utility of ketamine in patients withhemodynamic instability, particularly in sepsis and during tracheal intubation, highlights its potential as a versatile agent in critical care phar-macotherapy.Currentguidelines recommend restrained, adjunctive use pending further high-quality evidence. This review emphasizes theneed for large-scale, multicenter randomized controlled trials to define the role of ketamine, refine dosing strategies, and assess safetyacross diverse ICU populations. As clinical interest expands, the integration of ketamine into ICU practice must be guided by both inno-vationand vigilant safety monitoring.
基金Project supported by the National Key Research and Development Program of China(No.2022YFB4500900)。
文摘Artificial neural networks(ANNs)have made great strides in the field of remote sensing image object detection.However,low detection efficiency and high power consumption have always been significant bottlenecks in remote sensing.Spiking neural networks(SNNs)process information in the form of sparse spikes,creating the advantage of high energy efficiency for computer vision tasks.However,most studies have focused on simple classification tasks,and only a few researchers have applied SNNs to object detection in natural images.In this study,we consider the parsimonious nature of biological brains and propose a fast ANN-to-SNN conversion method for remote sensing image detection.We establish a fast sparse model for pulse sequence perception based on group sparse features and conduct transform-domain sparse resampling of the original images to enable fast perception of image features and encoded pulse sequences.In addition,to meet accuracy requirements in relevant remote sensing scenarios,we theoretically analyze the transformation error and propose channel self-decaying weighted normalization(CSWN)to eliminate neuron overactivation.We propose S3Det,a remote sensing image object detection model.Our experiments,based on a large publicly available remote sensing dataset,show that S3Det achieves an accuracy performance similar to that of the ANN.Meanwhile,our transformed network is only 24.32%as sparse as the benchmark and consumes only 1.46 W,which is 1/122 of the original algorithm’s power consumption.
