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R C Watt

Publications and source records attributed to R C Watt.

16 recordsLinked to original sources

Phase space electroencephalography (EEG): a new mode of intraoperative EEG analysis.

Intraoperative monitoring of electroencephalography (EEG) data can help assess brain integrity and/or depth of anesthesia. We demonstrate a computer generated technique which provides a visually robust display of EEG data plotted as 'phase space trajectories' and a mathematically derived parameter ('dimensionality') which may correlate with depth of anesthesia. Application of nonlinear mathematical analysis, used to describe complex dynamical systems, can characterize 'phase space' EEG patterns by identifying attractors (geometrical patterns in phase space corresponding to specific ordered EEG data subjects) and by quantifying the degree of order and chaos (calculation of dimensionality). Dimensionality calculations describe the degree of complexity in a signal and may generate a clinically useful univariate EEG descriptor of anesthetic depth. In this paper we describe and demonstrate phase space trajectories generated for sine waves, mixtures of sine waves, and white noise (random chaotic events). We also present EEG phase space trajectories and dimensionality calculations from a patient undergoing surgery and general anesthesia in 3 recognizable states: awake, anesthetized, and burst suppression. Phase space trajectories of the three states are visually distinguishable, and dimensionality calculations indicate that EEG progresses from 'chaos' (awake) to progressively more 'ordered' attractors (anesthetized and burst suppression).

Electroencephalography

Effects of pulse duration on neuromuscular blockade monitoring: implications for supramaximal stimulation.

Questions have been raised concerning the reliability of surface electrodes in achieving supramaximal stimulation during the monitoring of neuromuscular blockade; needle electrodes are considered reliable in this respect. This study compares interelectrode impedances of needle and surface electrodes during neuromuscular blockade monitoring and suggests those characteristics of the stimulation pulse that can ensure reliable supramaximal stimulation with either type of electrode. Interelectrode voltage and current for surface and needle electrodes were measured by using 1.0-ms pulses at low, medium, and high stimulation levels on 22 surgical patients during anesthesia. Data were collected immediately after electrode application, and again at 10 minutes after application. Stimulation with surface electrodes produced an initial, transient surge of current, followed by a lower steady-state value. At high stimulation levels, the peak transient current was 87% higher than the steady-state current. Needle electrodes produced a constant high-current response. At high stimulation levels the transient impedance of the surface electrode and the impedance of the needle electrode were essentially equal (0.7 k omega and 0.75 k omega, respectively). The transient impedance was significantly lower (P less than 0.001) and was associated with less interpatient variation (P less than 0.001) and less sensitivity to the duration of electrode application than was the steady-state impedance of the surface electrode. These data suggest that high-current pulses with widths of less than 0.2 ms could provide reliable supramaximal stimulation with either type of electrode.

Electric Conductivity

Urinary diversion.

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Colon, Sigmoid

Karaya reconsidered.

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Colostomy

Monitoring the anesthetized patient in the operating room.

In general, monitors used by the anesthesiologist in the operating room provide three basic functions: assessment of machine and patient status to ensure safety; assessment of depth of anesthesia; and determination of physiologic variables. Improved monitoring should reduce risk and improve patient care. Some monitoring techniques are used in only a few specialized procedures, particularly in high-risk patients or for prolonged or difficult surgery. However, many less-sophisticated techniques are used in routine daily practice and require similar philosophies of monitoring. The status of the cardiovascular system is assessed primarily by monitoring the electrocardiogram and blood pressure waveforms. Although desired effects of anesthesia impact the central nervous system, this vital organ system is not routinely monitored. Likewise, widespread monitoring of the respiratory system is not routinely accomplished. Monitoring for anesthesia in the operating room has evolved to some extent in response to what can be accomplished rather than what needs to be done. While the potential for an integrated monitoring system--including all patient and delivery system variables--clearly exists, numerous difficulties preclude its becoming a reality. What is required is the development of an integrated system that can augment the anesthesiologist's sixth sense. Initial efforts toward device interface standardization, configurability, and flexibility must be encouraged to pave the way for the integrated, automated anesthesia delivery system of the future.

Anesthesia