3 The short story from Poe to Chesterton. 4 French crime fiction. 5 The golden age. 77 stephen knight. 6 The private eye. Of critical anxiety. Sensation novels were often described as 'newspaper nov- els', in which 'the England of today's newspapers crops up at every step'.45. Sea and the Mirror (1944) and The Age of Anxiety (1946). This study is limited to Collected Poems (1976) rather than the edition of 'complete poems” published by Princeton University Press for three reasons: (1) simply because Collected. Poems includes all the poetry Auden wished to preserve, (2) because this edition is.

Methods We enrolled 400 children, ages 1–12 years old, scheduled for dental procedures under general anesthesia. All children were induced with high concentration sevoflurane and BIS monitoring was continuous from induction through recovery in the PACU. A BIS reading. INTRODUCTION Emergence agitation (EA) in pediatric patients is a clinical entity generally defined by behaviors including combativeness, excitation, disorientation and inconsolability (). The incidence of EA is wide ranging in the literature from 10–80% (–). It is usually a self-limited phenomenon, but can be severe and present dangers to both patients and caregivers.

Additionally, the severity and duration of EA may demand additional postoperative care personnel, delay parental presence in the Post Anesthesia Care Unit (PACU), and increase time to discharge. Several factors have been associated with an increased risk of EA including the child’s baseline temperament and anxiety levels (, ), sevoflurane anesthesia (,,, ), young age (,, ) and ENT procedures ().

Pain has also been implicated as a factor in EA, but it can be especially difficult to distinguish between pain and EA in the PACU (,, ). While a multitude of studies have described the incidence and factors associated with EA, its etiology remains unclear. Following discharge to home, another perioperative complication which has been seen in up to 50% of children postoperatively is the development of negative postoperative behavioral changes (NPOBC) (). Saab Tis 2008 Download. These behaviors include generalized anxiety, nighttime crying, enuresis, separation anxiety and temper tantrums. The incidence of these maladaptive behaviors was also seen in one study to be linked to the incidence of EA seen in the PACU ().

As with EA, several factors have been associated with NPOBC including young age, preoperative anxiety in children and parents, and anesthetic agents such as sevoflurane (–). As with EA, the etiology remains unclear. While the pathogenesis of postoperative behavioral disturbances such as EA and NPOBC remains undefined, we know that ENT procedures such as myringotomy and tympanostomy are associated with a higher incidence of EA (). This is usually an ultra-short procedure, but is performed using very deep levels of anesthesia. Within adults, titration of BIS levels improves postoperative () recovery while longer duration of anesthesia has been seen to be related to early postoperative cognitive dysfunction (, ).

To our knowledge, no studies have looked at the relationship between hypnotic depth or duration of anesthesia and the incidence of EA or NPOBC in children. We wished to perform an observational study to investigate whether the length of time under deep hypnosis as measured by a BIS monitor reading of. METHODS Following IRB approval, informed consent/assent was obtained for enrollment of 400 ASA I–III children between the ages of 1 and 12 years old. All patients were scheduled for outpatient dental procedures under general anesthesia. Exclusion criteria included pre-existing neurological disorders (e.g. Seizure history, developmental delay, psychiatric diagnosis), planned use of ketamine and use of total intravenous anesthesia (TIVA). We also excluded non-English speaking patients to prevent difficulty in obtaining follow up results for NPOBC.

All patients scheduled for outpatient dental procedures meeting inclusion/exclusion criteria during the study period were considered for participation. Following enrollment, a designated study nurse administered the modified Yale Preoperative Anxiety Scale (m-YPAS) () prior to the administration of pre-medication. A BIS monitoring strip was then placed on the child’s forehead in the preoperative holding area and data collection was begun. BIS data collection was continuous from the pre-operative period through recovery in the PACU. A BIS range from 40–60 is considered general anesthesia. Studies in children have found BIS to correlate with clinical indicators of anesthesia and with the concentration of inhalational agents similar to that seen in adults (, ). For this study, we considered a BIS reading of less than 45 to be deep hypnosis ().