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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "7" "paginaFinal" => "8" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Pedro L. Gambús, José F. Valencia" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Pedro L." "apellidos" => "Gambús" "email" => array:1 [ 0 => "plgambus@hospitalclinic.org" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "José F." "apellidos" => "Valencia" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Systems Pharmacology Effect Control & Modeling (SPEC-M) Research Group, Anesthesiology Department, Hospital CLINIC de Barcelona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Adjunct Associate Professor, Department of Anesthesia and Perioperative Care, University of California San Francisco (UCSF), San Francisco, CA, USA" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Electronic Engineering, School of Engineering, Universidad de San Buenaventura, Cali, Colombia" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Monitorización de la actividad cerebral: ¿Dónde estamos y hacia dónde debemos dirigirnos?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Anesthesiology is a medical specialty in which quantification—the capacity to measure—is of major importance. The basic principle of our interventions as anesthesiologists is based on the administration of drugs, the observation of the effect that these drugs have on the patient, and the adjustment of drug delivery depending on the response that is observed. The magnitude of this response depends on: 1. Factors directly related to the patient such as their age, physical state, and the medication he/she is taking and, 2. Contextual factors such as the type of surgical procedure, its urgency, the point of time within the procedure, and the complications that can appear (bleeding, hypothermia, state of shock) to cite just a few of the most relevant aspects. Observing, adjusting, and magnitude—they are concepts that imply the possibility of measuring to precisely evaluate how the patient reacts in each and every moment of anesthetic drug delivery process.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Technological developments over the last 30 or 40 years and digitalization at all levels have favored the creation of more exact and portable measuring systems. These systems are applicable to the dynamic study of the function of practically all the organs that make up the human body. In the operating room we have access to non-invasive systems that are capable of continually assessing the degree of blockage of the neuromuscular junction, cardiac function, breathing and the efficiency of mechanical ventilation, hemoglobin levels in the blood… We can also assess the effect that the drugs used in anesthesia have on the brain by studying the electroencephalogram.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The electroencephalogram (EEG) is a register of the changes in voltage of the pyramidal neurons in the cerebral cortex. It is a non-invasive, continuous process and sensitive to the effect of anesthetics. Nevertheless, its signal is also susceptible to interference from other, more powerful, electrical currents, it is difficult to understand when one observes the wave trains exclusively, it can change if there is a pathological situation in the brain and, depending on where and how the electrodes are placed, the wave changes can vary.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Intravenous hypnotic drugs, benzodiazepines, opiates, and inhalation agents can all induce consistent changes in the form of the electroencephalogram (EEG). Although the signal has small amplitude—approximately 100 times smaller than the amplitude of an electrocardiogram—it can be detected and stored. Despite its chaotic appearance, it can be analyzed by applying mathematical and statistical methods.</p><p id="par0020" class="elsevierStylePara elsevierViewall">EEGs have been used to analyze the effect of drugs that act on the nervous system since the early 20th century. In the last quarter of the last century analysis methods began to be applied to study and quantify the changes brought about by the anesthetics. In this way, pharmacokinetic and pharmacodynamic models capable of defining the relationships between dosage, plasma concentration, and effect could be constructed. The way that we administer propofol,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> remifentanil,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> benzodiazepines,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and other drugs today has its origins in the pioneering work of researchers like Stanski and Shafer, who used this methodology. Their vision of the EEG as a source of information exclusively about the pharmacological effect functioned as a starting point for defining a method for measuring the depth of the anesthetic state.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Since then, multiple indicators of the effect of anesthetics have been used to individualize the delivery in response to each patient. With a basis in the concept of the individualization or personalization based on quantification of response, the consequences of hypnotic underdosing—such as intraoperative waking—have been studied<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> along with the consequences of overdosing, which is manifested not only as a tendency toward hemodynamic depression or a delay in waking but, as some authors have proposed, as an increase in the long-term perioperative death rate.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">However, the cortex is only one part of the brain and probably what we observe from the changes in the EEG is a reflection of the pharmacological effects that appear at a subcortical level, in areas like the locus ceruleus, the thalamus or other nuclei.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The great development in neuroscience based above all on in-laboratory studies in animals has allowed for significant advances in our knowledge of brain function. Diverse research groups have been able to study the phenomenon of the transition between consciousness and unconsciousness by using imaging techniques in volunteers under anesthesia.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Other research groups have tried to join—using a vision of systems analysis—the findings at the experimental level with what has been observed in volunteers and patients, using changes in the EEG as a link. The work of Dr. E. Brown in this field area has established how the effect of propofol, dexmedetomidine, and other anesthetic agents is produced. This explains changes in the EEG in light of what is observed in the clinic and what is known based on basic research. The anteriorization and appearance of activity in the frontal alpha waves can be considered a sufficiently sensitive and specific indicator of unconsciousness induced by propofol.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Currently, we are at a highly interesting point of convergence for our specialty. The resources, both from Europe and the USA, dedicated to neuroscience research to unravel the workings of the brain as a key for understanding so many diseases is increasing significantly. Furthermore, anesthesiologists have integrated the EEG as part of their monitoring arsenal. At our disposal we have the tools that allow us to contribute, via our every day work, to widening our knowledge about the brain: patients, continuous measuring systems and pharmaceuticals that induce unconsciousness quickly and quantifiably.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Moreover, we have a vast experience of more than twenty years in the personalization of anesthetics delivery according to the response of each patient by considering the changes in indicators extracted from the EEG as an information source. We can find out what the state of the patient's brain is by assessing the changes that the induction dose of hypnotic drugs has caused in the EEG form in a specific patient. We can predict when he/she will regain consciousness by observing the indicator value.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In which direction, then, should we move in the future? The choice is clear. It is not a question of adopting any single one of the trends that we have commented here. The rewarding solution is to adopt both. As anesthesiologists, we are experts in quantification. We are familiar with the use of the EEG and we know best how to induce the anesthetic state in our patients by using systems based in EEG analysis. Additionally, we have the necessary tools—the EEG, as well as a basis in physiology, pharmacology, and clinical analysis—to contribute, through our work and our ideas, to the knowledge of the workings of the brain. This—improving our knowledge of the brain—is one of the great challenges of neuroscience research, and we could not be in a better clinical and research position to rise to it.</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0205" class="elsevierStylePara elsevierViewall">None.</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">This editorial is based on the conference “Brain Monitoring Function: Where are we now and where do we go from here?” at the Roundtable sponsored by Masimo Corp, which took place at the ESA Congress, Stockholm June 2, 2014.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Gambús PL, Valencia JF. Monitorización de la actividad cerebral: ¿Dónde estamos y hacia dónde debemos dirigirnos?. Rev Colomb Anestesiol. 2015;43:7–8.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A primer for EEG signal processing in anesthesia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "I.J. 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Year/Month | Html | Total | |
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2024 November | 6 | 1 | 7 |
2024 October | 10 | 2 | 12 |
2024 September | 16 | 0 | 16 |
2024 August | 9 | 4 | 13 |
2024 July | 10 | 0 | 10 |
2024 June | 12 | 3 | 15 |
2024 May | 17 | 4 | 21 |
2024 April | 14 | 5 | 19 |
2024 March | 18 | 4 | 22 |
2024 February | 20 | 4 | 24 |
2024 January | 9 | 4 | 13 |
2023 December | 14 | 8 | 22 |
2023 November | 10 | 11 | 21 |
2023 October | 18 | 10 | 28 |
2023 September | 9 | 0 | 9 |
2023 August | 15 | 3 | 18 |
2023 July | 5 | 5 | 10 |
2023 June | 11 | 1 | 12 |
2023 May | 23 | 2 | 25 |
2023 April | 27 | 3 | 30 |
2023 March | 13 | 1 | 14 |
2023 February | 12 | 4 | 16 |
2023 January | 5 | 5 | 10 |
2022 December | 13 | 8 | 21 |
2022 November | 34 | 5 | 39 |
2022 October | 11 | 3 | 14 |
2022 September | 9 | 15 | 24 |
2022 August | 15 | 5 | 20 |
2022 July | 8 | 5 | 13 |
2022 June | 7 | 6 | 13 |
2022 May | 11 | 8 | 19 |
2022 April | 6 | 12 | 18 |
2022 March | 5 | 7 | 12 |
2022 February | 4 | 3 | 7 |
2022 January | 6 | 5 | 11 |
2021 December | 8 | 6 | 14 |
2021 November | 5 | 8 | 13 |
2021 October | 4 | 7 | 11 |
2021 September | 10 | 12 | 22 |
2021 August | 5 | 3 | 8 |
2021 July | 8 | 7 | 15 |
2021 June | 6 | 7 | 13 |
2021 May | 3 | 4 | 7 |
2021 April | 12 | 21 | 33 |
2021 March | 12 | 18 | 30 |
2021 February | 3 | 15 | 18 |
2021 January | 5 | 8 | 13 |
2020 December | 7 | 5 | 12 |
2020 November | 2 | 5 | 7 |
2020 October | 5 | 6 | 11 |
2020 September | 5 | 6 | 11 |
2020 August | 5 | 9 | 14 |
2020 July | 7 | 4 | 11 |
2020 June | 2 | 1 | 3 |
2020 May | 7 | 5 | 12 |
2020 April | 4 | 1 | 5 |
2020 March | 3 | 4 | 7 |
2020 February | 5 | 2 | 7 |
2020 January | 8 | 3 | 11 |
2019 December | 7 | 8 | 15 |
2019 November | 1 | 1 | 2 |
2019 October | 0 | 1 | 1 |
2019 September | 3 | 2 | 5 |
2019 August | 1 | 0 | 1 |
2019 July | 5 | 6 | 11 |
2019 June | 0 | 1 | 1 |
2019 May | 1 | 8 | 9 |
2019 April | 1 | 0 | 1 |
2018 September | 1 | 0 | 1 |
2018 June | 4 | 3 | 7 |
2018 May | 26 | 5 | 31 |
2018 April | 32 | 11 | 43 |
2018 March | 33 | 12 | 45 |
2018 February | 20 | 8 | 28 |
2018 January | 29 | 8 | 37 |
2017 December | 26 | 7 | 33 |
2017 November | 24 | 7 | 31 |
2017 October | 22 | 11 | 33 |
2017 September | 32 | 9 | 41 |
2017 August | 40 | 9 | 49 |
2017 July | 56 | 7 | 63 |
2017 June | 40 | 11 | 51 |
2017 May | 34 | 10 | 44 |
2017 April | 42 | 12 | 54 |
2017 March | 22 | 9 | 31 |
2017 February | 28 | 7 | 35 |
2017 January | 13 | 10 | 23 |
2016 December | 36 | 15 | 51 |
2016 November | 27 | 6 | 33 |
2016 October | 38 | 10 | 48 |
2016 September | 35 | 8 | 43 |
2016 August | 39 | 6 | 45 |
2016 July | 28 | 13 | 41 |
2016 June | 0 | 18 | 18 |
2016 May | 4 | 23 | 27 |
2016 March | 3 | 0 | 3 |
2016 February | 0 | 15 | 15 |
2016 January | 0 | 18 | 18 |
2015 December | 11 | 9 | 20 |
2015 November | 23 | 14 | 37 |
2015 October | 33 | 16 | 49 |
2015 September | 28 | 10 | 38 |
2015 August | 27 | 22 | 49 |
2015 July | 27 | 17 | 44 |
2015 June | 24 | 4 | 28 |
2015 May | 31 | 5 | 36 |
2015 April | 42 | 13 | 55 |
2015 March | 71 | 21 | 92 |
2015 February | 46 | 18 | 64 |
2015 January | 29 | 7 | 36 |