Tailor-made Anesthesia

Dr. Ilkka Kalli, MD, PhD, MBA Editor-in-chief, Clinical Window Web Journal See the editor-in-chief working and his Curriculum Vitae

The September 2003 issue of Clinical Window Web Journal (CWWJ) has just appeared, and our new topic is tailor-made anesthesia. Focusing on maintenance of general anesthesia we have two targets: monitoring of entropy and low flow anesthesia.

Entropy measurement analysis of EEG

We start with an interesting clinical communication from Germany. I wish to thank the author Dr. B. Rehberg-Klug (Humboldt University Hospital, Campus Charité Mitte, Berlin) for his article Interpretation of Anesthetic Adequacy - A Clinical Experience with Spectral Entropy. Both theoretical and practical, it shares with us the first clinical observations from using entropy measurement in a large university hospital.

"Although the primary target of anesthetic drugs is the CNS, most anesthesiologists confine monitoring during anesthesia to cardiocirculatory and respiratory parameters. Among other reasons, this is because the measurable signals coming from the CNS such as the electroencephalogram (EEG) or evoked potentials are difficult to interpret." After that introduction he gives us an insight into new mathematical developments and approaches now available for EEG analysis, especially those derived from information theory. His list of references provides the key articles in the field. I welcome you to visit CWWJ on the WEB to learn about his findings and conclusions.

On the WEB, take a look too at other educational support material available, like the paper Deepen Your Understanding about Adequacy of Anesthesia by Ms. Ulla Rankamo RN, Datex-Ohmeda's Senior Product Manager.

Low flow anesthesia

Administration of inhalation anesthetics is a fundamental element of general anesthesia, and we have received two excellent articles from the USA on this subject. Last spring CWWJ started a tradition of publishing educational articles provided for us by GASNet. We now continue that co-operation, for which my thanks to the GASNet team – it’s great communicating with you.

I am grateful also to Dr. Paul H Ting, MD (Dept. Anesth. Univ. Virginia, Charlottesville, USA) for his outstanding contribution. It is important for anesthesia clinicians to have a solid understanding of the technique of low flow anesthesia, particularly as we have to balance clinical benefits with our busy schedules and the cost-conscious approach to healthcare today.

• Low flow anesthesia: Advantages and disadvantages (Part I)
• Low flow anesthesia: Technical requirements and other considerations for low flow anesthesia (Part II)

Dr. Ting’s topics I list above, but do not refer to them here in detail. They are clearly worth thorough study. To access them, just click the link to CWWJ.

Our previous issues

Tailor-made anesthesia, the current topic, continues our series of anesthesiology issues. I list here some of our previously published topics which are worth re-visiting if you’d like to deepen your knowledge.

• Neuromuscular block in anesthesia (July 2003)
• Adequacy of anesthesia (January 2002)
• Low flow anesthesia (January 2001)

On our web journal’s main page you’ll find on the left the “previous issues” link. There, you can review all our fourteen issues published since we started three years ago.

Your comments are welcome

My idea was give wide coverage to general anesthesia in two consecutive issues, publishing articles from relaxation to low flow and monitoring. I found it convenient to have these issues appear in between the major international anesthesia congresses, one in Europe in June (ESA) and the other in America in October (ASA).

Next time, however, it is time once again to publish material on critical care. Hence our next issue will appear in the middle of autumn, soon after the 16th annual ESICM congress in Amsterdam in October 2003.

Keep sending me your comments. I appreciate all your feedback and suggestions.

Ilkka S. Kalli MD, PhD, MBA
Anesthesiologist, Editor-in-Chief
Clinical Window Web Journal

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Last updated: 1 September 2003Created
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