• Journal of the korean academy of Pediatric Dentistry
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• v.34 no.1
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• pp.91-98
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• 2007

The aim of this study was to examine the difference of the depth of sedation using the Bispectral index assessment with and without the added submucosal Midazolam to oral Chloral hydrate and Hydroxyzine for pediatric patients. Twenty seven sedation cases were performed in this study Selection criteria included good health(ASA I), 2 to 6 years of age, the need for sedation to receive dental treatment including anesthesia, and restorative procedure over at least two teeth. Patients were randomly classified into one group taking oral Chloral hydrate(60 mg/kg) and Hydroxyzine(1 mg/kg) and the other group recieving Chloral hydrate(60 mg/kg), Hydroxyzine(1 mg/kg) and submucosal Midazolam(0.1 mg/kg). Nitrous Oxide(50%) was used for both group during sedation. Patients were monitored using a pulse oximeter and a Bispectral monitor. A behavior scale was rated as quiet(Q), crying(C), movement(M), or struggling(S) every 2 minutes watching a recorded videotape. Analysis showed a significant difference in mean Bispectral index and SD during sedation across two groups(P<0.001). The group of patients injected with submucosal Midazolam in addition to oral Chloral hydrate and Hydroxyzine showed a lower mean Bispectral index and a narrower SD. PR and SpO2 for both groups remained within the normal values. Submucosal Midazolam improved the sedation quality by deepening sedation depth without compromising safety and enabled the sedation pattern to be kept more stable.

• Journal of the Korean Society for Nondestructive Testing
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• v.19 no.2
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• pp.85-92
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• 1999

The fact that material degradation can be evaluated by measuring nonlinear acoustic effect has been proposed by previous studies. The most conventional method to measure nonlinear acoustic effect is to measure the absolute magnitude of fundamental and $2^{nd}$ order harmonic frequency component in the propagated ultrasonic wave. For this aim, power spectral analysis technique has been used widely. However, the power spectral analysis has fatal disadvantage that the gaussian additive noise superimposed in the wave signal remains in the power spectrum domain. Moreover, the magnitude of $2^{nd}$ order harmonic frequency component generated by nonlinear effect is so small that it may be suppressed by the noise remained in the power spectrum. In order to overcome this problem, this paper proposes an alternative method using bispectrum analysis, which can reduce the effect of addictive gaussian noise and. the nonlinear parameter can be obtained more stably. Simulations showed that the proposed method can obtain the value of nonlinear parameter near to the true value in the case of low SNR signal. Also, in order to confirm the usefulness of our method in actual case, we compared the nonlinear parameter obtained by using both of power spectral and bispectral analysis for several specimen intentionally degraded by fatigue load.

• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.4
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• pp.235-244
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• 2018

Background: Patients with intellectual disability (ID) often require general anesthesia during oral procedures. Anesthetic depth monitoring in these patients can be difficult due to their already altered mental state prior to anesthesia. In this study, the utility of electroencephalographic indexes to reflect anesthetic depth was evaluated in pediatric patients with ID. Methods: Seventeen patients (mean age, $9.6{\pm}2.9years$) scheduled for dental procedures were enrolled in this study. After anesthesia induction with propofol or sevoflurane, a bilateral sensor was placed on the patient's forehead and the bispectral index (BIS) was recorded. Anesthesia was maintained with sevoflurane, which was adjusted according to the clinical signs by an anesthesiologist blinded to the BIS value. The index performance was accessed by correlation (with the end-tidal sevoflurane [EtSevo] concentration) and prediction probability (with a clinical scale of anesthesia). The asymmetry of the electroencephalogram between the left and right sides was also analyzed. Results: The BIS had good correlation and prediction probabilities (above 0.5) in the majority of patients; however, BIS was not correlated with EtSevo or the clinical scale of anesthesia in patients with Lennox-Gastaut, West syndrome, cerebral palsy, and epilepsy. BIS showed better correlations than SEF95 and TP. No significant differences were observed between the left- and right-side indexes. Conclusion: BIS may be able to reflect sevoflurane anesthetic depth in patients with some types of ID; however, more research is required to better define the neurological conditions and/or degrees of disability that may allow anesthesiologists to use the BIS.

• Journal of Korean Neurosurgical Society
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• v.56 no.1
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• pp.28-33
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• 2014

Objective : Postoperative delirium is a common complication in the elderly after surgery but few papers have reported after spinal surgery. We analyzed various risk factors for postoperative delirium after spine surgery. Methods : Between May 2012 and September 2013, 70 patients over 60 years of age were examined. The patients were divided into two groups : Group A with delirium and Group B without delirium. Cognitive function was examined with the Mini-Mental State Examination-Korea (MMSE-K), Clinical Dementia Rating (CDR) and Global Deterioration Scale (GDS). Information was also obtained on the patients' education level, underlying diseases, duration of hospital stay and laboratory findings. Intraoperative assessment included Bispectral index (BIS), type of surgery or anesthesia, blood pressure, fluid balance, estimated blood loss and duration of surgery. Results : Postoperative delirium developed in 17 patients. The preoperative scores for the MMSE, CDR, and GDS in Group A were $19.1{\pm}5.4$, $0.9{\pm}0.6$, and $3.3{\pm}1.1$. These were significantly lower than those of Group B ($25.6{\pm}3.4$, $0.5{\pm}0.2$, and $2.1{\pm}0.7$) (p<0.05). BIS was lower in Group A ($30.2{\pm}6.8$ compared to $35.4{\pm}5.6$ in group B) (p<0.05). The number of BIS <40 were $5.1{\pm}3.1$ times in Group A, $2.5{\pm}2.2$ times in Group B (p<0.01). In addition, longer operation time and longer hospital stay were risk factors. Conclusion : Precise analysis of risk factors for postoperative delirium seems to be more important in spinal surgery because the surgery is not usually expected to have an effect on brain function. Although no risk factors specific to spinal surgery were identified, the BIS may represent a valuable new intraoperative predictor of the risk of delirium.

• Journal of the Institute of Convergence Signal Processing
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• v.21 no.1
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• pp.7-12
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• 2020

Various parameters are used to measure anesthetic depth during surgery using brain waves, and in actual clinical use, the linear analysis SEF is widely used. However, with recent studies showing that biological signals including EEG, contain nonlinear properties interest in nonlinear analysis of brain signals is increasing and parameters based on these are being developed. In this study, we are going to develop a parameter that can measure EEG using the nonlinear analysis method and extract noise that can be mixed with external electronic equipment and EEG instrumentation by comparing it with the data from the bispectrum analysis of static waves.

• Journal of Biomedical Engineering Research
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• v.7 no.2
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• pp.117-118
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• 1986

It is well known that nonlinear propagation characteristics of the wave in the tissue may give very useful information for the medical diagnoisis. In this paper, a new method to detect nonlinear propagation characteristics of the internal vibration in the tissue for the low frequency mechanical vibration by using bispectral analysis is proposed. In the method, low frequency vibration of f0( = 100Hz) is applied on the surface of the object, and the waveform of the internal vibration x (t) is measured from Doppler frequency modulation of silmultaneously transmitted probing ultrasonic waves. Then, the bispectra of the signal x (t) at the frequencies (f0, f0) and (f0, 2f0) are calculated to estimate the nonlinear propagation characteristics as their magnitude ratio, w here since bispectrum is free from the gaussian additive noise we can get the value with high S/N. Basic experimental system is constructed by using 3.0 MHz probing ultrasonic waves and the several experiments are carried out for some phantoms. Results show the superiority of the proposed method to the conventional method using power spectrum and also its usefulness for the tissue characterization.

• Journal of Hospice and Palliative Care
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• v.25 no.4
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• pp.139-197
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• 2022

Patients with terminal cancer experience very severe symptoms during the end of life, and palliative sedation (PS) may be considered if those symptoms are refractory to any other treatment. This brief report presents ethical considerations, practices, and recent concerns on PS. PS is quite different from euthanasia. There is a lack of consensus and standards on protocols, but its notable effects have been reported in hospice care settings. Most studies to date have reported no difference in survival between patients receiving PS and those not, and PS must be conducted proportionally with the lightest level of sedation. The most common indication for PS is delirium, and midazolam is the main sedative used. It is recommended that information regarding PS should be provided to patients and their caregivers repeatedly as early as possible. Existential suffering alone is not an indication for PS, and there is a lack of evidence on bispectral analysis. Additional research on PS is needed in Korea.

• Smart Structures and Systems
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• v.20 no.6
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• pp.669-682
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• 2017

The normalised version of bispectrum, the so-called bicoherence, has often proved a reliable method of damage detection on engineering applications. Indeed, higher-order spectral analysis (HOSA) has the advantage of being able to detect non-linearity in the structural dynamic response while being insensitive to ambient vibrations. Skewness in the response may be easily spotted and related to damage conditions, as the majority of common faults and cracks shows bilinear effects. The present study tries to extend the application of HOSA to damage localisation, resorting to a neural network based classification algorithm. In order to validate the approach, a non-linear finite element model of a 4-meters-long cantilever beam has been built. This model could be seen as a first generic concept of more complex structural systems, such as aircraft wings, wind turbine blades, etc. The main aim of the study is to train a Neural Network (NN) able to classify different damage locations, when fed with bispectra. These are computed using the dynamic response of the FE nonlinear model to random noise excitation.

• Journal of the korean academy of Pediatric Dentistry
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• v.28 no.3
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• pp.441-446
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• 2001

Flumazenil is a competitive antagonist of benzodiazepines. It is usually administered intravenously. However, if the intravenous route is not available then other routes of drug administration should be considered. This study was designed to evaluate the reversal effects of flumazenil after nasal administration. Twenty-five young, healthy adult volunteers participated in this clinical trial. The dosage of 0.08mg/kg midazolam was administered intravenously to induce deep sedation. Ten minutes after midazolam administration, 0.5mg of flumazenil was dropped nasally, over a period of one minute. Blood samples were taken to measure the concentration of midazolam and flumazenil at 0, 5, 10, and 20min after nasal administration of flumazenil, using High Performance Liquid Chromatography. The degree of sedation was evaluated with sedation score and bispectral index (BIS), Statistical analysis was performed by multivariate ANOVA and correlation analysis (P<0.05). Peak serum flumazenil concentration was reached in 10min. Sedation score decreased after midazolam administration and showed a significant increase after flumazenil administration. However, BIS decreased during the first 10min after midazolam administration and then no significant changes after flumazenil administration. There were two instances representing rapid and complete reversal of midazolam after intranasal administration of flumazenil. In conclusion, intranasal flumazenil administration may be effective in some patients when intravenous route is not available in condition of benzodiazepine overdose.

• Journal of Navigation and Port Research
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• v.41 no.1
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• pp.1-8
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• 2017

The estimation of non-linear ship motion is one of the most important issues in recent studies of ship stability. In this paper, bispectral analysis and bicoherence analysis were introduced in order to analyze the non-linear ship motion. In addition to the previously observed non-linear pitching motion in following seas, this study observed the non-linear phase coupling of pitching motion in following & quartering seas, and starboard beam seas. By comparing phase coupling between each frequency quantitatively via the bicoherence analysis, it was confirmed that non-linear phase coupling was much stronger in frequency regions other than the peak frequencies of a power spectrum. Furthermore, it was found out that the results of bicoherence calculation were analagous to each other, although the different normalization methods were applied.