Convergent validity of video-based observer rating of drowsiness, against subjective, behavioral, and physiological measures.

Driver drowsiness is a widely recognized cause of motor vehicle accidents. Therefore, a reduction in drowsy driving crashes is required. Many studies evaluating the crash risk of drowsy driving and developing drowsiness detection systems, have used observer rating of drowsiness (ORD) as a reference standard (i.e. ground truth) of drowsiness. ORD is a method of human raters evaluating the levels of driver drowsiness, by visually observing a driver. Despite the widespread use of ORD, concerns remain regarding its convergent validity, which is supported by the relationship between ORD and other drowsiness measures. The objective of the present study was to validate video-based ORD, by examining correlations between ORD levels and other drowsiness measures. Seventeen participants performed eight sessions of a simulated driving task, verbally responding to Karolinska sleepiness scale (KSS), while infra-red face video, lateral position of the participant's car, eye closure, electrooculography (EOG), and electroencephalography (EEG) were recorded. Three experienced raters evaluated the ORD levels by observing facial videos. The results showed significant positive correlations between the ORD levels and all other drowsiness measures (i.e., KSS, standard deviation of the lateral position of the car, percentage of time occupied by slow eye movement calculated from EOG, EEG alpha power, and EEG theta power). The results support the convergent validity of video-based ORD as a measure of driver drowsiness. This suggests that ORD might be suitable as a ground truth for drowsiness.

The Additive Effect of Atropine Sulfate during Cardiopulmonary Resuscitation in Out-of-hospital Non-traumatic Cardiac Arrest Patients with Non-shockable Rhythm.

Objective The updated guidelines of 2015 for cardiopulmonary resuscitation (CPR) do not recommend the routine use of atropine for cardiopulmonary arrest. Methods The study population included out-of-hospital cardiac arrest (OHCA) patients with non-shockable rhythm who were encountered at a Japanese community hospital between October 1, 2012 and April 30, 2017. Results At the outcome, the epinephrine with atropine and epinephrine-only groups had a similar survival rate to that at hospital admission (28.7% vs. 26.7%: p=0.723). The odds ratio (OR) for the survival to hospital admission after the administration of atropine with epinephrine was 1.33 (95% CI 1.09-1.62; p<0.01), while that after the administration of epinephrine was 0.64 (95% CI: 0.55-0.74, p<0.01). The ORs for the survival to hospital admission for patients with pulseless electrical activity in the epinephrine-alone group and the atropine with epinephrine group were 0.62 (95% CI 0.49-0.78; p<0.01) and 1.35 (95% CI 0.99-1.83; p=0.06), respectively, and those for such patients with asystole in the epinephrine-alone group and the atropine with epinephrine group were 0.64 (95% CI 0.53-0.76; p<0.01) and 1.39 (95% CI 1.10-1.77; p<0.01), respectively. The OR for the survival to hospital admission after the administration of atropine sulfate (1 mg) was 2.91 (95% CI 1.49-5.67; p<0.01), while that for the survival to hospital admission after the administration of 0, 2 and ≥3 mg atropine sulfate was 0.38 (95% CI 0.29-0.50; p<0.01), 1.54 (95% CI 0.58-4.08; p=0.38) and 0.23 (95% CI 0.09-0.60; p<0.01), respectively. Conclusion The addition of atropine (within 2 mg) following epinephrine was a comprehensive independent predictor of the survival to hospital admission for non-shockable (especially asystole) OHCA adults.

Effects of intravenous low-dose recombinant human atrial natriuretic peptide on renal function in the perioperative management for gastrointestinal perforation or ileus: a retrospective single-center study.

PURPOSE: We studied the effectiveness of human atrial natriuretic peptide (hANP) on management of acute kidney injury. METHODS: This retrospective single-center study included 43 patients from January 2007 to February 2010 who had undergone non-elective abdominal surgery for gastrointestinal perforation and ileus. Patients were separated into 2 groups according to whether hANP was administered or not, and 4 subgroups according to whether or not baseline serum creatinine <1.2 mg/dL; normal cre/hANP (-) (n = 22), high cre/hANP (-) (n = 10), normal cre/hANP (+) (n = 4), and high cre/hANP (+) (n = 7). The administration of hANP was started during operation. RESULTS: The administration rate of hANP ranged between 0.02 and 0.05 µg/kg per minute, except for one patient and the average postoperative administration time of hANP was 167 ± 237 h (range, 8-888 h). There were no significant differences in characteristics of patients within four subgroups, except for patient's weight. Serum creatinine in high cre/hANP (+) got to decrease more than high cre/hANP (-). Outcomes such as 28-day mortality were not significantly different among four subgroups. No patients required renal replacement therapy in each subgroup. CONCLUSION: Intravenous low dose of hANP was useful as acute kidney injury management in gastrointestinal perforation and ileus patients undergoing non-elective surgery.

[Anesthesia and perioperative management in a patient with acquired angioedema].

We experienced anesthesia and perioperative management for hysterectomy in a patient with acquired angioedema. Angioedema due to C1 esterase inhibitor (C1-INH) deficiency (loss or dysfunction of C1-INH) is one of the rarest diseases, and is characterized by recurrent episodes of regional hard edema and ascites induced by mechanical stimuli or mental stress. Edema spreads to the subcutaneous and submucosal layer, and laryngeal edema may cause the upper airway obstruction. Tranexamic acid and C1-INH concentrates were administered perioperatively for prophylaxis of attacks, and combined spinal and epidural anesthesia was performed for hysterectomy. We could manage perioperative care without causing edema.