Effect of BIS-guided anesthesia on emergence delirium following general anesthesia in children: A prospective randomized controlled trial.

OBJECTIVE: Emergence delirium (ED) is a postoperative complication in pediatric anesthesia characterized by a perception and psychomotor disorder, with a negative impact on postoperative recovery. As the use of inhalation anesthesia is associated with a higher incidence of ED, we investigated whether titrating the depth of general anesthesia with BIS monitor can reduce the incidence of ED. DESIGN: Randomized, prospective, and double-blind. SETTING: Patients undergoing endoscopic adenoidectomy under general anesthesia according to a uniform protocol. PATIENTS: A total of 163 patients of both sexes aged 3-8 years were enrolled over 18 months. INTERVENTIONS: Immediately after the induction of general anesthesia, a bispectral index (BIS) electrode was placed on the patient's forehead. In the study group, the depth of general anesthesia was monitored with the aim of achieving BIS values of 40-60. In the control group, the dose of sevoflurane was determined by the anaesthesiologist based on MAC (minimum alveolar concentration) and the end-tidal concentration. MEASUREMENTS: The primary objective was to compare the occurrence of ED during the PACU (post-anesthesia care unit) stay in both arms of the study. The secondary objective was to determine the PAED score at 10 and 30 min in the PACU and the need for rescue treatment of ED. MAIN RESULTS: 86 children were randomized in the intervention group and 77 children in the control group. During the entire PACU stay, 23.3% (38/163) of patients developed ED with PAED score >10: 35.1% (27/77) in the control group and 12.8% (11/86) in the intervention group (p = 0.001). Lower PAED scores were also found in the intervention group at 10 (p < 0.001) and 30 (p < 0.001) minutes compared to the control group. The need for rescue treatment did not differ between groups (p = 0.067). CONCLUSION: Individualization of the depth of general anesthesia with BIS monitoring is an effective method of preventing ED in children. CLINICAL TRIAL REGISTRATION: NCT04466579.

Distributed Gram-Schmidt orthogonalization with simultaneous elements refinement.

We present a novel distributed QR factorization algorithm for orthogonalizing a set of vectors in a decentralized wireless sensor network. The algorithm is based on the classical Gram-Schmidt orthogonalization with all projections and inner products reformulated in a recursive manner. In contrast to existing distributed orthogonalization algorithms, all elements of the resulting matrices Q and R are computed simultaneously and refined iteratively after each transmission. Thus, the algorithm allows a trade-off between run time and accuracy. Moreover, the number of transmitted messages is considerably smaller in comparison to state-of-the-art algorithms. We thoroughly study its numerical properties and performance from various aspects. We also investigate the algorithm's robustness to link failures and provide a comparison with existing distributed QR factorization algorithms in terms of communication cost and memory requirements.

Scalable and fault tolerant orthogonalization based on randomized distributed data aggregation.

The construction of distributed algorithms for matrix computations built on top of distributed data aggregation algorithms with randomized communication schedules is investigated. For this purpose, a new aggregation algorithm for summing or averaging distributed values, the push-flow algorithm, is developed, which achieves superior resilience properties with respect to failures compared to existing aggregation methods. It is illustrated that on a hypercube topology it asymptotically requires the same number of iterations as the optimal all-to-all reduction operation and that it scales well with the number of nodes. Orthogonalization is studied as a prototypical matrix computation task. A new fault tolerant distributed orthogonalization method rdmGS, which can produce accurate results even in the presence of node failures, is built on top of distributed data aggregation algorithms.

Transplantation of bone marrow derived progenitor cells in acute myocardial infarction. The first results.

The intracoronary administration of autologous bone marrow cells (BMCs) has been shown to improve the left ventricle function in the course of acute myocardial infarction. Therefore we have started a clinical trial using transplantation of BMCs in the acute phase of myocardial infarction. The aim of our study is to assess the feasibility and safety of this procedure, and effect on the left ventricle function of these patients. We describe the first experience in two patients with acute myocardial infarction reperfused using direct stenting. The aspiration of bone marrow from the sternum provided sufficient amount of the cells for transplantation. No serious ischemia and no changes in coronary artery patency were detected after intracoronary infusion. The left ventricle ejection fraction was increasing throughout the time of three-month follow-up. No other complications (ventricular arrhythmias, reinfarction, thrombus formation) were detected.