摘要：The incidence of accidental injection or catheterization of the subdural space during performance of a neuroaxial block has recently increased. It can occur even when an experienced practitioner performs the neuraxial procedure. The presentation of numerous unexplainable clinical signs in the process of continuous epidural anesthesia, which do not fit the clinical picture of subarachnoid or intravascular injection, should envoke a high suspicion for unintentional subdural block. We report two cases of patients who achieved prolonged labor analgesia via epidural technique with only half the initial loading dose of local anesthetic. Both patients also had short episodes of hypotension. Additionally, one patient presented with severe hypoxemia and mild motor block of both upper and lower extremities. The other patient presented with transit unresponsiveness without motor block. Both patients rapidly responded to vasopressors. Desaturation in one patient, however, was persistent lasting for more than four hours. Her bedside chest X-ray was inconclusive “possible pulmonary edema” and the follow up Chest CT Scan on the second day revealed aspiration pneumonia. Based on the clinical findings, these two cases were suggestive of subdural block with cranial nerve involvement.

摘要：This paper presents the automatic drug administration for the regulation of bispectral (BIS) index in the anesthesia process during the clinical surgery by controlling the concentration target of two drugs, namely, propofol and remifentanil. To realize the automatic drug administration, real clinical data are collected for 42 patients for the construction of patients’ models consisting of pharmacokinetic and pharmacodynamic models describing the dynamics reacting to the input drugs. A nominal anesthesia model is obtained by taking the average of 42 patients’ models for the design of control scheme. Three PID controllers are employed, namely linear PID controller, type-1 (T1) fuzzy PID controller and interval type-2 (IT2) fuzzy PID controller, to regulate the BIS index using the nominal patient’s model. The PID gains and membership functions are obtained using genetic algorithm (GA) by minimizing a cost function measuring the control performance. The best trained PID controllers are tested under different scenarios and compared in terms of control performance. Simulation results show that the IT2 fuzzy PID controller offers the best control strategy regulating the BIS index while the T1 fuzzy PID controller comes the second.

摘要：The lateral hypothalamic area(LHA)plays a pivotal role in regulating consciousness transition,in which orexinergic neurons,GABAergic neurons,and melanin-concentrating hormone neurons are *** neurons have a large population in the LHA,but their anesthesia-related effect has not been ***,we found that genetic ablation of LHA glutamatergic neurons shortened the induction time and prolonged the recovery time of isoflurane anesthesia in *** contrast,chemogenetic activation of LHA glutamatergic neurons increased the time to anesthesia and decreased the time to *** activation of LHA glutamatergic neurons during the maintenance of anesthesia reduced the burst suppression pattern of the electroencephalogram(EEG)and shifted EEG features to an arousal *** of LHA glutamatergic projections to the lateral habenula(LHb)also facilitated the emergence from anesthesia and the transition of anesthesia depth to a lighter ***,LHA glutamatergic neurons and their projections to the LHb regulate anesthetic potency and EEG features.