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Jiang Y, Sleigh J. Consciousness and General Anesthesia: Challenges for Measuring the Depth of Anesthesia. Anesthesiology 2024; 140:313-328. [PMID: 38193734 DOI: 10.1097/aln.0000000000004830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
The optimal consciousness level required for general anesthesia with surgery is unclear, but in existing practice, anesthetic oblivion, may be incomplete. This article discusses the concept of consciousness, how it is altered by anesthetics, the challenges for assessing consciousness, currently used technologies for assessing anesthesia levels, and future research directions. Wakefulness is marked by a subjective experience of existence (consciousness), perception of input from the body or the environment (connectedness), the ability for volitional responsiveness, and a sense of continuity in time. Anesthetic drugs may selectively impair some of these components without complete extinction of the subjective experience of existence. In agreement with Sanders et al. (2012), the authors propose that a state of disconnected consciousness is the optimal level of anesthesia, as it likely avoids both awareness and the possible dangers of oversedation. However, at present, there are no reliably tested indices that can discriminate between connected consciousness, disconnected consciousness, and complete unconsciousness.
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Affiliation(s)
- Yandong Jiang
- Department of Anesthesiology, Critical Care and Pain Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Jamie Sleigh
- Department of Anesthesiology, University of Auckland, Hamilton, New Zealand
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Liang Z, Wang X, Yu Z, Tong Y, Li X, Ma Y, Guo H. Age-dependent neurovascular coupling characteristics in children and adults during general anesthesia. BIOMEDICAL OPTICS EXPRESS 2023; 14:2240-2259. [PMID: 37206124 PMCID: PMC10191645 DOI: 10.1364/boe.482127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 05/21/2023]
Abstract
General anesthesia is an indispensable procedure in clinical practice. Anesthetic drugs induce dramatic changes in neuronal activity and cerebral metabolism. However, the age-related changes in neurophysiology and hemodynamics during general anesthesia remain unclear. Therefore, the objective of this study was to explore the neurovascular coupling between neurophysiology and hemodynamics in children and adults during general anesthesia. We analyzed frontal electroencephalogram (EEG) and functional near-infrared spectroscopy (fNIRS) signals recorded from children (6-12 years old, n = 17) and adults (18-60 years old, n = 25) during propofol-induced and sevoflurane-maintained general anesthesia. The neurovascular coupling was evaluated in wakefulness, maintenance of a surgical state of anesthesia (MOSSA), and recovery by using correlation, coherence and Granger-causality (GC) between the EEG indices [EEG power in different bands and permutation entropy (PE)], and hemodynamic responses the oxyhemoglobin (Δ[HbO]) and deoxy-hemoglobin (Δ[Hb]) from fNIRS in the frequency band in 0.01-0.1 Hz. The PE and Δ[Hb] performed well in distinguishing the anesthesia state (p > 0.001). The correlation between PE and Δ[Hb] was higher than those of other indices in the two age groups. The coherence significantly increased during MOSSA (p < 0.05) compared with wakefulness, and the coherences between theta, alpha and gamma, and hemodynamic activities of children are significantly stronger than that of adults' bands. The GC from neuronal activities to hemodynamic responses decreased during MOSSA, and can better distinguish anesthesia state in adults. Propofol-induced and sevoflurane-maintained combination exhibited age-dependent neuronal activities, hemodynamics, and neurovascular coupling, which suggests the need for separate rules for children's and adults' brain states monitoring during general anesthesia.
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Affiliation(s)
- Zhenhu Liang
- School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, China
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Qinhuangdao 066004, China
| | - Xin Wang
- School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, China
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Qinhuangdao 066004, China
| | - Zhenyang Yu
- School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, China
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Qinhuangdao 066004, China
| | - Yunjie Tong
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Xiaoli Li
- Center for Cognition and Neuroergonomics, Beijing Normal University (Zhuhai), Zhuhai, Guangdong, 519087, China
| | - Yaqun Ma
- Department of Anesthesiology, the Seventh Medical Center to Chinese PLA General Hospital, Beijing, 100700, China
| | - Hang Guo
- Department of Anesthesiology, the Seventh Medical Center to Chinese PLA General Hospital, Beijing, 100700, China
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Tagliabue S, Lindner C, da Prat IC, Sanchez-Guerrero A, Serra I, Kacprzak M, Maruccia F, Silva OM, Weigel UM, de Nadal M, Poca MA, Durduran T. Comparison of cerebral metabolic rate of oxygen, blood flow, and bispectral index under general anesthesia. NEUROPHOTONICS 2023; 10:015006. [PMID: 36911206 PMCID: PMC9993084 DOI: 10.1117/1.nph.10.1.015006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
SIGNIFICANCE The optical measurement of cerebral oxygen metabolism was evaluated. AIM Compare optically derived cerebral signals to the electroencephalographic bispectral index (BIS) sensors to monitor propofol-induced anesthesia during surgery. APPROACH Relative cerebral metabolic rate of oxygen ( rCMRO 2 ) and blood flow (rCBF) were measured by time-resolved and diffuse correlation spectroscopies. Changes were tested against the relative BIS (rBIS) ones. The synchronism in the changes was also assessed by the R-Pearson correlation. RESULTS In 23 measurements, optically derived signals showed significant changes in agreement with rBIS: during propofol induction, rBIS decreased by 67% [interquartile ranges (IQR) 62% to 71%], rCMRO 2 by 33% (IQR 18% to 46%), and rCBF by 28% (IQR 10% to 37%). During recovery, a significant increase was observed for rBIS (48%, IQR 38% to 55%), rCMRO 2 (29%, IQR 17% to 39%), and rCBF (30%, IQR 10% to 44%). The significance and direction of the changes subject-by-subject were tested: the coupling between the rBIS, rCMRO 2 , and rCBF was witnessed in the majority of the cases (14/18 and 12/18 for rCBF and 19/21 and 13/18 for rCMRO 2 in the initial and final part, respectively). These changes were also correlated in time ( R > 0.69 to R = 1 , p - values < 0.05 ). CONCLUSIONS Optics can reliably monitor rCMRO 2 in such conditions.
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Affiliation(s)
- Susanna Tagliabue
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Claus Lindner
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | | | - Angela Sanchez-Guerrero
- Vall d’Hebron University Hospital Research Institute, Neurotraumatology and Neurosurgery Research Unit, Barcelona, Spain
| | - Isabel Serra
- Centre de Recerca Matemàtica, Bellaterra, Spain
- Barcelona Supercomputing Center—Centre Nacional de Supercomputació, Spain
| | - Michał Kacprzak
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
- Nalecz Institute of Biocybernetics and Biomedical Engineering PAS, Warsaw, Poland
| | - Federica Maruccia
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
- Vall d’Hebron University Hospital Research Institute, Neurotraumatology and Neurosurgery Research Unit, Barcelona, Spain
| | - Olga Martinez Silva
- Vall d’Hebron University Hospital, Department of Anesthesiology, Barcelona, Spain
| | - Udo M. Weigel
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
- HemoPhotonics S.L., Mediterranean Technology Park, Barcelona, Spain
| | - Miriam de Nadal
- Vall d’Hebron University Hospital, Department of Anesthesiology, Barcelona, Spain
- Universidad Autònoma de Barcelona, Plaça Cívica, Barcelona, Spain
| | - Maria A. Poca
- Vall d’Hebron University Hospital Research Institute, Neurotraumatology and Neurosurgery Research Unit, Barcelona, Spain
- Universidad Autònoma de Barcelona, Plaça Cívica, Barcelona, Spain
- Vall d’Hebron University Hospital, Department of Neurosurgery, Barcelona, Spain
| | - Turgut Durduran
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
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Gomez A, Sainbhi AS, Froese L, Batson C, Alizadeh A, Mendelson AA, Zeiler FA. Near Infrared Spectroscopy for High-Temporal Resolution Cerebral Physiome Characterization in TBI: A Narrative Review of Techniques, Applications, and Future Directions. Front Pharmacol 2021; 12:719501. [PMID: 34803673 PMCID: PMC8602694 DOI: 10.3389/fphar.2021.719501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/22/2021] [Indexed: 12/31/2022] Open
Abstract
Multimodal monitoring has been gaining traction in the critical care of patients following traumatic brain injury (TBI). Through providing a deeper understanding of the individual patient's comprehensive physiologic state, or "physiome," following injury, these methods hold the promise of improving personalized care and advancing precision medicine. One of the modalities being explored in TBI care is near-infrared spectroscopy (NIRS), given it's non-invasive nature and ability to interrogate microvascular and tissue oxygen metabolism. In this narrative review, we begin by discussing the principles of NIRS technology, including spatially, frequency, and time-resolved variants. Subsequently, the applications of NIRS in various phases of clinical care following TBI are explored. These applications include the pre-hospital, intraoperative, neurocritical care, and outpatient/rehabilitation setting. The utility of NIRS to predict functional outcomes and evaluate dysfunctional cerebrovascular reactivity is also discussed. Finally, future applications and potential advancements in NIRS-based physiologic monitoring of TBI patients are presented, with a description of the potential integration with other omics biomarkers.
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Affiliation(s)
- Alwyn Gomez
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Amanjyot Singh Sainbhi
- Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Logan Froese
- Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Carleen Batson
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Arsalan Alizadeh
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Asher A Mendelson
- Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada.,Section of Critical Care, Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Frederick A Zeiler
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada.,Centre on Aging, University of Manitoba, Winnipeg, MB, Canada.,Division of Anaesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
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Rahman MA, Siddik AB, Ghosh TK, Khanam F, Ahmad M. A Narrative Review on Clinical Applications of fNIRS. J Digit Imaging 2020; 33:1167-1184. [PMID: 32989620 PMCID: PMC7573058 DOI: 10.1007/s10278-020-00387-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 08/06/2020] [Accepted: 09/14/2020] [Indexed: 01/08/2023] Open
Abstract
Functional near-infrared spectroscopy (fNIRS) is a relatively new imaging modality in the functional neuroimaging research arena. The fNIRS modality non-invasively investigates the change of blood oxygenation level in the human brain utilizing the transillumination technique. In the last two decades, the interest in this modality is gradually evolving for its real-time monitoring, relatively low-cost, radiation-less environment, portability, patient-friendliness, etc. Including brain-computer interface and functional neuroimaging research, this technique has some important application of clinical perspectives such as Alzheimer's disease, schizophrenia, dyslexia, Parkinson's disease, childhood disorders, post-neurosurgery dysfunction, attention, functional connectivity, and many more can be diagnosed as well as in some form of assistive modality in clinical approaches. Regarding the issue, this review article presents the current scopes of fNIRS in medical assistance, clinical decision making, and future perspectives. This article also covers a short history of fNIRS, fundamental theories, and significant outcomes reported by a number of scholarly articles. Since this review article is hopefully the first one that comprehensively explores the potential scopes of the fNIRS in a clinical perspective, we hope it will be helpful for the researchers, physicians, practitioners, current students of the functional neuroimaging field, and the related personnel for their further studies and applications.
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Affiliation(s)
- Md. Asadur Rahman
- Department of Biomedical Engineering, Military Institute of Science and Technology (MIST), Dhaka, 1216 Bangladesh
| | - Abu Bakar Siddik
- Department of Biomedical Engineering, Khulna University of Engineering & Technology (KUET), Khulna, 9203 Bangladesh
| | - Tarun Kanti Ghosh
- Department of Biomedical Engineering, Khulna University of Engineering & Technology (KUET), Khulna, 9203 Bangladesh
| | - Farzana Khanam
- Department of Biomedical Engineering, Jashore University of Science and Technology (JUST), Jashore, 7408 Bangladesh
| | - Mohiuddin Ahmad
- Department of Electrical and Electronic Engineering, Khulna University of Engineering & Technology (KUET), Khulna, 9203 Bangladesh
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Wang G, Liu Z, Feng Y, Li J, Dong H, Wang D, Li J, Yan N, Liu T, Yan X. Monitoring the Depth of Anesthesia Through the Use of Cerebral Hemodynamic Measurements Based on Sample Entropy Algorithm. IEEE Trans Biomed Eng 2019; 67:807-816. [PMID: 31180830 DOI: 10.1109/tbme.2019.2921362] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The aim of this study is to explore the relationship between the depth of anesthesia and the cerebral hemodynamic variables during the complete anesthesia process. METHODS In this study, near-infrared spectroscopy signals were used to record eight kinds of cerebral hemodynamic variables, including left, right, proximal, distal deoxygenated (Hb) and oxygenated (HbO2) hemoglobin concentration changes. Then, by measuring the complexity information of cerebral hemodynamic variables, the sample entropy was calculated as a new index of monitoring the depth of anesthesia. RESULTS By means of receiver operating characteristic curve analysis, the sample entropy approach was proved to effectively discriminate anesthesia maintenance and waking phases. The discriminatory ability of HbO2 signals was stronger than that of Hb signals and the distal signals had weaker discrimination capability when compared with the proximal signals. In addition, there was statistical consistency between the bispectral index and sample entropy of cerebral hemodynamic variables during the complete anesthesia process. Moreover, the cerebral hemodynamic signals could not be interfered by clinical electrical devices. CONCLUSION The sample entropy of cerebral hemodynamic variables could be suitable as a new index for monitoring the depth of anesthesia. SIGNIFICANCE This study is very meaningful for developing new modality and decoding methods in perspective of anesthesia surveillance and may result in the anesthesia monitoring system with high performance.
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Spatio-temporal dynamics of multimodal EEG-fNIRS signals in the loss and recovery of consciousness under sedation using midazolam and propofol. PLoS One 2017; 12:e0187743. [PMID: 29121108 PMCID: PMC5679575 DOI: 10.1371/journal.pone.0187743] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 10/25/2017] [Indexed: 12/29/2022] Open
Abstract
On sedation motivated by the clinical needs for safety and reliability, recent studies have attempted to identify brain-specific signatures for tracking patient transition into and out of consciousness, but the differences in neurophysiological effects between 1) the sedative types and 2) the presence/absence of surgical stimulations still remain unclear. Here we used multimodal electroencephalography–functional near-infrared spectroscopy (EEG–fNIRS) measurements to observe electrical and hemodynamic responses during sedation simultaneously. Forty healthy volunteers were instructed to push the button to administer sedatives in response to auditory stimuli every 9–11 s. To generally illustrate brain activity at repetitive transition points at the loss of consciousness (LOC) and the recovery of consciousness (ROC), patient-controlled sedation was performed using two different sedatives (midazolam (MDZ) and propofol (PPF)) under two surgical conditions. Once consciousness was lost via sedatives, we observed gradually increasing EEG power at lower frequencies (<15 Hz) and decreasing power at higher frequencies (>15 Hz), as well as spatially increased EEG powers in the delta and lower alpha bands, and particularly also in the upper alpha rhythm, at the frontal and parieto-occipital areas over time. During ROC from unconsciousness, these spatio-temporal changes were reversed. Interestingly, the level of consciousness was switched on/off at significantly higher effect-site concentrations of sedatives in the brain according to the use of surgical stimuli, but the spatio-temporal EEG patterns were similar, regardless of the sedative used. We also observed sudden phase shifts in fronto-parietal connectivity at the LOC and the ROC as critical points. fNIRS measurement also revealed mild hemodynamic fluctuations. Compared with general anesthesia, our results provide insights into critical hallmarks of sedative-induced (un)consciousness, which have similar spatio-temporal EEG-fNIRS patterns regardless of the stage and the sedative used.
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Liang Z, Gu Y, Duan X, Cheng L, Liang S, Tong Y, Li X. Design of multichannel functional near-infrared spectroscopy system with application to propofol and sevoflurane anesthesia monitoring. NEUROPHOTONICS 2016; 3:045001. [PMID: 27725946 PMCID: PMC5050277 DOI: 10.1117/1.nph.3.4.045001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 09/12/2016] [Indexed: 05/30/2023]
Abstract
Monitoring the changes of cerebral hemodynamics and the state of consciousness during general anesthesia (GA) is clinically important. There is a great need for developing advanced detectors to investigate the physiological processes of the brain during GA. We developed a multichanneled, functional near-infrared spectroscopy (fNIRS) system device and applied it to GA operation monitoring. The cerebral hemodynamic data from the forehead of 11 patients undergoing propofol and sevoflurane anesthesia were analyzed. The concentration changes of oxygenated hemoglobin, deoxygenated hemoglobin, total hemoglobin, and cerebral tissue heart rate were determined from the raw optical information based on the discrete stationary wavelet transform. This custom-made device provides an easy-to-build solution for continuous wave-fNIRS system, with customized specifications. The developed device has a potential value in cerebral monitoring in clinical settings.
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Affiliation(s)
- Zhenhu Liang
- Yanshan University, Institute of Electrical Engineering, No. 438 Hebei Street, Haigang District, Qinhuangdao 066004, China
| | - Yue Gu
- Yanshan University, Institute of Electrical Engineering, No. 438 Hebei Street, Haigang District, Qinhuangdao 066004, China
| | - Xuejing Duan
- Yanshan University, Institute of Electrical Engineering, No. 438 Hebei Street, Haigang District, Qinhuangdao 066004, China
| | - Lei Cheng
- Yanshan University, Institute of Electrical Engineering, No. 438 Hebei Street, Haigang District, Qinhuangdao 066004, China
| | - Shujuan Liang
- Department of Anesthesia, No. 1 Hospital of Qinhuangdao, No. 258 Wenhua Street, Haigang District, Qinhuangdao 066004, China
| | - Yunjie Tong
- McLean Hospital, McLean Imaging Center, 115 Mill Street, Belmont, Massachusetts 02478, United States
| | - Xiaoli Li
- Beijing Normal University, State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, No. 19 Xinjiekou Wai Street, Haidian District, Beijing 100875, China
- Beijing Normal University, Center for Collaboration and Innovation in Brain and Learning Sciences, No. 19 Xinjiekou Wai Street, Haidian District, Beijing 100875, China
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Abstract
Gastrointestinal endoscopic sedation has improved procedural and patient outcomes but is associated with attendant risks of oversedation and hemodynamic compromise. Therefore, close monitoring during endoscopic procedures using sedation is critical. This monitoring begins with appropriate staff trained in visual assessment of patients and analysis of basic physiologic parameters. It also mandates an array of devices widely used in practice to evaluate hemodynamics, oxygenation, ventilation, and depth of sedation. The authors review the evidence behind monitoring practices and current society recommendations and discuss forthcoming technologies and techniques that are poised to improve noninvasive monitoring of patients under endoscopic sedation.
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Affiliation(s)
- Nadim Mahmud
- Department of Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Tyler M Berzin
- Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, USA.
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Hernandez-Meza G, Izzetoglu M, Osbakken M, Green M, Izzetoglu K. Near-infrared spectroscopy for the evaluation of anesthetic depth. BIOMED RESEARCH INTERNATIONAL 2015; 2015:939418. [PMID: 26495317 PMCID: PMC4606411 DOI: 10.1155/2015/939418] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 08/23/2015] [Indexed: 01/30/2023]
Abstract
The standard-of-care guidelines published by the American Society of Anesthesiologists (ASA) recommend monitoring of pulse oximetry, blood pressure, heart rate, and end tidal CO2 during the use of anesthesia and sedation. This information can help to identify adverse events that may occur during procedures. However, these parameters are not specific to the effects of anesthetics or sedatives, and therefore they offer little, to no, real time information regarding the effects of those agents and do not give the clinician the lead-time necessary to prevent patient "awareness." Since no "gold-standard" method is available to continuously, reliably, and effectively monitor the effects of sedatives and anesthetics, such a method is greatly needed. Investigation of the use of functional near-infrared spectroscopy (fNIRS) as a method for anesthesia or sedation monitoring and for the assessment of the effects of various anesthetic drugs on cerebral oxygenation has started to be conducted. The objective of this paper is to provide a thorough review of the currently available published scientific studies regarding the use of fNIRS in the fields of anesthesia and sedation monitoring, comment on their findings, and discuss the future work required for the translation of this technology to the clinical setting.
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Affiliation(s)
- Gabriela Hernandez-Meza
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3508 Market Street, Suite 100, Philadelphia, PA 19104, USA
| | - Meltem Izzetoglu
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3508 Market Street, Suite 100, Philadelphia, PA 19104, USA
| | - Mary Osbakken
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3508 Market Street, Suite 100, Philadelphia, PA 19104, USA
| | - Michael Green
- Department of Anesthesiology, Drexel University College of Medicine, Hahnemann University Hospital, 245 N. 15th Street, MS 310, Philadelphia, PA 19102, USA
| | - Kurtulus Izzetoglu
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3508 Market Street, Suite 100, Philadelphia, PA 19104, USA
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Yücel MA, Selb J, Aasted CM, Petkov MP, Becerra L, Borsook D, Boas DA. Short separation regression improves statistical significance and better localizes the hemodynamic response obtained by near-infrared spectroscopy for tasks with differing autonomic responses. NEUROPHOTONICS 2015; 2:035005. [PMID: 26835480 PMCID: PMC4717232 DOI: 10.1117/1.nph.2.3.035005] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/10/2015] [Indexed: 05/07/2023]
Abstract
Autonomic nervous system response is known to be highly task-dependent. The sensitivity of near-infrared spectroscopy (NIRS) measurements to superficial layers, particularly to the scalp, makes it highly susceptible to systemic physiological changes. Thus, one critical step in NIRS data processing is to remove the contribution of superficial layers to the NIRS signal and to obtain the actual brain response. This can be achieved using short separation channels that are sensitive only to the hemodynamics in the scalp. We investigated the contribution of hemodynamic fluctuations due to autonomous nervous system activation during various tasks. Our results provide clear demonstrations of the critical role of using short separation channels in NIRS measurements to disentangle differing autonomic responses from the brain activation signal of interest.
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Affiliation(s)
- Meryem A. Yücel
- Massachusetts General Hospital, Harvard Medical School, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, 149 13th Street, Charlestown, Massachusetts 02129, United States
- Address all correspondence to: Meryem A. Yücel, E-mail:
| | - Juliette Selb
- Massachusetts General Hospital, Harvard Medical School, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, 149 13th Street, Charlestown, Massachusetts 02129, United States
| | - Christopher M. Aasted
- Boston Children’s Hospital, Center for Pain and the Brain, Departments of Anaesthesia and Radiology, 300 Longwood Avenue, Boston, Massachusetts 02115, United States
| | - Mike P. Petkov
- Boston Children’s Hospital, Center for Pain and the Brain, Departments of Anaesthesia and Radiology, 300 Longwood Avenue, Boston, Massachusetts 02115, United States
| | - Lino Becerra
- Massachusetts General Hospital, Harvard Medical School, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, 149 13th Street, Charlestown, Massachusetts 02129, United States
- Boston Children’s Hospital, Center for Pain and the Brain, Departments of Anaesthesia and Radiology, 300 Longwood Avenue, Boston, Massachusetts 02115, United States
- Harvard Medical School, Department of Anesthesiology, Perioperative, and Pain Medicine, 300 Longwood Avenue, Boston, Massachusetts 02115, United States
| | - David Borsook
- Massachusetts General Hospital, Harvard Medical School, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, 149 13th Street, Charlestown, Massachusetts 02129, United States
- Boston Children’s Hospital, Center for Pain and the Brain, Departments of Anaesthesia and Radiology, 300 Longwood Avenue, Boston, Massachusetts 02115, United States
- Harvard Medical School, Department of Anesthesiology, Perioperative, and Pain Medicine, 300 Longwood Avenue, Boston, Massachusetts 02115, United States
| | - David A. Boas
- Massachusetts General Hospital, Harvard Medical School, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, 149 13th Street, Charlestown, Massachusetts 02129, United States
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Boas DA, Elwell CE, Ferrari M, Taga G. Twenty years of functional near-infrared spectroscopy: introduction for the special issue. Neuroimage 2014; 85 Pt 1:1-5. [PMID: 24321364 DOI: 10.1016/j.neuroimage.2013.11.033] [Citation(s) in RCA: 302] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 06/03/2013] [Indexed: 10/25/2022] Open
Abstract
Papers from four different groups were published in 1993 demonstrating the ability of functional near infrared spectroscopy (fNIRS) to non-invasively measure hemoglobin concentration responses to brain function in humans. This special issue commemorates the first 20years of fNIRS research. The 9 reviews and 49 contributed papers provide a comprehensive survey of the exciting advances driving the field forward and of the myriad of applications that will benefit from fNIRS.
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Affiliation(s)
- David A Boas
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, USA
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