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How can doctors tell if you wake up during surgery?
Researchers are only just beginning to really understand anaesthesia awareness.
Waking up during surgery – it's terrifying to think about. But it does happen.
There is evidence that around 5 percent of people may experience so-called anaesthesia awareness at some point on the operating table, though not everyone remembers it.
Living through such an event can be traumatic and painful (read our related story, 'This is what it's like waking up during surgery'). So, what can be done to prevent it?
Anaesthetists have a few tools that can open a channel of communication while a patient is paralysed by neuromuscular blocking drugs.
1. The isolated forearm technique
The isolated forearm technique uses a cuff to stem the flow of blood to the hand, preventing the neuromuscular blocking drugs from paralysing the muscles there. This means that if you're still alert when you should be under anaesthetic, you could move your hand to signal to the doctors and nurses.
It is not often possible to stem the blood flow for very long, however, so this technique can only detect awareness straight after the start of the anaesthesia.
2. Looking at intended movement in the muscles
There may be ways to expand the communication possible with the isolated forearm technique. Federico Linassi at the University Hospital of Padova in Italy is investigating whether it may be possible to measure nerve impulses as a patient is trying to move.
Although the paralytic agents prevent these impulses from stimulating the muscles, the intention still produces measurable electrical activity in the nerves, which, he believes, might offer another way for an awake patient to signal their distress. And, rather than looking at the limbs, Linassi suggests you could detect the intention to move facial muscles such as the mouth.
BSIP/Universal Images Group via Getty Images
3. Looking at consciousness in the brain
Some anaesthetists try to measure brain activity during general anaesthesia. The most common method involves attaching electrodes to the skin of the forehead, to measure the firing of neurons in the frontal lobes.
Anaesthetic drugs are supposed to dampen down that activity, with a characteristic pattern of slow waves on the electrode monitor showing that the person really is unconscious. Unfortunately, some recent studies have revealed troubling findings that these brain monitors are unreliable at detecting awareness.
Perhaps they are simply looking in the wrong place? Recent theories of consciousness suggest that our awareness depends on many other brain regions, including the posterior parts.
In the future, researchers may be able to identify a more reliable signature of consciousness, so that an anaesthetist could monitor a patient's level of awareness throughout an operation and adjust the doses according to what they see.
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Construction of the $500 billion dollar tech city-state of the future is moving ahead.
- The futuristic megacity Neom is being built in Saudi Arabia.
- The city will be fully automated, leading in health, education and quality of life.
- It will feature an artificial moon, cloud seeding, robotic gladiators and flying taxis.
The Red Sea area where Neom will be built:
Saudi Arabia Plans Futuristic City, "Neom" (Full Promotional Video)<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="c646d528d230c1bf66c75422bc4ccf6f"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/N53DzL3_BHA?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span>
Many of the most popular apps are about self-improvement.
Emotions are the newest hot commodity, and we can't get enough.
Frequent shopping for single items adds to our carbon footprint.
- A new study shows e-commerce sites like Amazon leave larger greenhouse gas footprints than retail stores.
- Ordering online from retail stores has an even smaller footprint than going to the store yourself.
- Greening efforts by major e-commerce sites won't curb wasteful consumer habits. Consolidating online orders can make a difference.
A pile of recycled cardboard sits on the ground at Recology's Recycle Central on January 4, 2018 in San Francisco, California.
Photo by Justin Sullivan/Getty Images<p>A large part of the reason is speed. In a competitive market, pure players use the equation, <em>speed + convenience</em>, to drive adoption. This is especially relevant to the "last mile" GHG footprint: the distance between the distribution center and the consumer.</p><p>Interestingly, the smallest GHG footprint occurs when you order directly from a physical store—even smaller than going there yourself. Pure players, such as Amazon, are the greatest offenders. Variables like geographic location matter; the team looked at shopping in the UK, the US, China, and the Netherlands. </p><p>Sadegh Shahmohammadi, a PhD student at the Netherlands' Radboud University and corresponding author of the paper, <a href="https://www.cnn.com/2020/02/26/tech/greenhouse-gas-emissions-retail/index.html" target="_blank">says</a> the above "pattern holds true in countries where people mostly drive. It really depends on the country and consumer behavior there."</p><p>The researchers write that this year-and-a-half long study pushes back on previous research that claims online shopping to be better in terms of GHG footprints.</p><p style="margin-left: 20px;">"They have, however, compared the GHG emissions per shopping event and did not consider the link between the retail channels and the basket size, which leads to a different conclusion than that of the current study."</p><p>Online retail is where convenience trumps environment: people tend to order one item at a time when shopping on pure player sites, whereas they stock up on multiple items when visiting a store. Consumers will sometimes order a number of separate items over the course of a week rather than making one trip to purchase everything they need. </p><p>While greening efforts by online retailers are important, until a shift in consumer attitude changes, the current carbon footprint will be a hard obstacle to overcome. Amazon is trying to have it both ways—carbon-free and convenience addicted—and the math isn't adding up. If you need to order things, do it online, but try to consolidate your purchases as much as possible.</p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a>, <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank">Facebook</a> and <a href="https://derekberes.substack.com/" target="_blank">Substack</a>. His next book is</em> "<em>Hero's Dose: The Case For Psychedelics in Ritual and Therapy."</em></p>
Building a personal connection with students can counteract some negative side effects of remote learning.