Thread by @OBsleepmerchant

@Chronotrope presents on using pEEG for sedation at #RAUK23

Now it only took the first slide (next tweet) to draw my full attention, and mean that I will be catching up with recordings later. This raises VERY important questions for #OBAnes in light of recent #SOAPAM2023 chats

Neuraxial anesthesia as a sedative…

Sensory deafferentation dependent sedation - an example of a full stomach being sedated that #OBAnes do routinely @VeenaGraffMD (oh wait it gets better)
#RAUK23 #SOAPAM2023

@GongGasGirl have you heard of this? Anyone at #ASM23SYD?

Patient age and sensory block level significantly affect relationship between propofol Ce and sedation (I added the graphs from Roh et al’s study). Regional techniques dynamically reduce neural traffic. #RAUK23 #SOAPAM2023

Regional techniques including neuraxial reduce neural traffic such that the brain stem SLOWS DOWN, which in turn has a knock on effect on the effects of sedatives like propofol. (@Chronotrope feel free to contribute - it was 330am and 🤯 as new information to me at least) #RAUK23… twitter.com/i/web/status/1…

Decreasing neural traffic and decreasing hypnotic dose. When walking a tightrope of consciousness, sedatives can add a light wind. In the setting of regional/ neuraxial, it’s a thunder storm - more likely to fall off! @VeenaGraffMD @HofkampMichael @emilysharpe #RAUK23 #SOAPAM2023

pEEG calibration is more complex than we like to think. There is NO distinct number separating conscious from unconscious. Significant overlap exists! #RAUK23

Different drugs do different things. Classic EEG changes with anesthesia and sedation. Some familiar patterns. #RAUK23

BIS number and EEG morphology disconnect. pEEG identifies anesthesia and suppression. Have you ever had a patient SO suppressed that EEG on reads ECG? (@AnaSjaus and I have seen this at TIVA GA section). pEEG can reduce unintended anesthesia.

Argument for its use in sedating a… twitter.com/i/web/status/1…

How about adding a safety net? Patient Managed Propfol sedation, a study found definite advantages - particularly applicable to #OBAnes perhaps?

@Chronotrope does this program exist widely in TCI pumps? (And yes, limited TCI in North America, if any)

#RAUK23 #SOAPAM2023

Of note (especially with recent #OBAnes discussions @VeenaGraffMD) other agents do different things. The anesthesiologist is the integration engine. #RAUK23

Great summary slide from @Chronotrope. Lots of food for thought at #RAUK23 and #SOAPAM2023