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Aasheim A, Rosseland LA, Leonardsen ACL, Romundstad L. Depth of anesthesia monitoring in Norway-A web-based survey. Acta Anaesthesiol Scand 2024; 68:781-787. [PMID: 38551019 DOI: 10.1111/aas.14420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 01/16/2024] [Accepted: 03/18/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND The bispectral index (BIS) monitor is the most frequently used electroencephalogram (EEG)-based depth of anesthesia (DoA) technology in Norwegian hospitals. However, there is limited knowledge regarding the extent and clinical impact of its use and how anesthesiologists and nurse anesthetists use the information provided by the DoA monitors in their clinical practice. METHODS This cross-sectional survey on the use of DoA monitors in Norway used a web-based questionnaire distributed to anesthesia personnel in all hospitals in Norway. Participation was voluntary and anonymized, and the web form could not track IP sources or respondents' locations. RESULTS Three hundred and ninety-one nurse anesthetists (n = 324) and anesthesiologists (n = 67) responded. Among the EEG-based DoA monitoring tools, BIS was most often used to observe and assess patients' DoA (98%). Raw EEG waveform analysis (10%), EEG-spectrogram (9%), and suppression rate (10%) were seldom used. Twenty-seven percent of the anesthesia personnel were able to recognize a burst suppression pattern on EEG and its significance. Fifty-eight percent of the respondents considered clinical observations more reliable than BIS. Almost all respondents reported adjusting anesthetic dosage based on the BIS index values (80%). However, the anesthetic dose was more often increased (90%) because of high BIS index values than lowered (55%) because of low BIS index values. CONCLUSION Despite our respondents' extensive use of DoA monitoring, the anesthesia personnel in our survey did not use all the information and the potential to guide the titration of anesthetics the DoA monitors provide. Thus, anesthesia personnel could generally benefit from increased knowledge of how EEG-based DoA monitoring can be used to assess and determine individual patients' need for anesthetic medication.
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Affiliation(s)
- Anders Aasheim
- Department of Research and Development, Division of Emergencies and Critical care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Leiv Arne Rosseland
- Department of Research and Development, Division of Emergencies and Critical care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ann-Chatrin Linqvist Leonardsen
- Department of Nursing, Health and Bioengineering, University of Southeastern Norway, Fredrikstad, Norway
- Department of Anesthesia, Østfold Hospital Trust, Kalnes, Norway
| | - Luis Romundstad
- Department of Anesthesia and Intensive Care medicine, Division of Emergencies and Critical care, Oslo University Hospital, Oslo, Norway
- Lovisenberg Diaconal University College, Oslo, Norway
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Duan WY, Peng K, Qin HM, Li BM, Xu YX, Wang DJ, Yu L, Wang H, Hu J, Wang QX. Esketamine accelerates emergence from isoflurane general anaesthesia by activating the paraventricular thalamus glutamatergic neurones in mice. Br J Anaesth 2024; 132:334-342. [PMID: 38044237 DOI: 10.1016/j.bja.2023.10.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/02/2023] [Accepted: 10/18/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Delayed emergence from general anaesthesia poses a significant perioperative safety hazard. Subanaesthetic doses of ketamine not only deepen anaesthesia but also accelerate recovery from isoflurane anaesthesia; however, the mechanisms underlying this phenomenon remain elusive. Esketamine exhibits a more potent receptor affinity and fewer adverse effects than ketamine and exhibits shorter recovery times after brief periods of anaesthesia. As the paraventricular thalamus (PVT) plays a pivotal role in regulating wakefulness, we studied its role in the emergence process during combined esketamine and isoflurane anaesthesia. METHODS The righting reflex and cortical electroencephalography were used as measures of consciousness in mice during isoflurane anaesthesia with coadministration of esketamine. The expression of c-Fos was used to determine neuronal activity changes in PVT neurones after esketamine administration. The effect of esketamine combined with isoflurane anaesthesia on PVT glutamatergic (PVTGlu) neuronal activity was monitored by fibre photometry, and chemogenetic technology was used to manipulate PVTGlu neuronal activity. RESULTS A low dose of esketamine (5 mg kg-1) accelerated emergence from isoflurane general anaesthesia (474 [30] s vs 544 [39] s, P=0.001). Esketamine (5 mg kg-1) increased PVT c-Fos expression (508 [198] vs 258 [87], P=0.009) and enhanced the population activity of PVTGlu neurones (0.03 [1.7]% vs 6.9 [3.4]%, P=0.002) during isoflurane anaesthesia (1.9 [5.7]% vs -5.1 [5.3]%, P=0.016) and emergence (6.1 [6.2]% vs -1.1 [5.0]%, P=0.022). Chemogenetic suppression of PVTGlu neurones abolished the arousal-promoting effects of esketamine (459 [33] s vs 596 [33] s, P<0.001). CONCLUSIONS Our results suggest that esketamine promotes recovery from isoflurane anaesthesia by activating PVTGlu neurones. This mechanism could explain the rapid arousability exhibited upon treatment with a low dose of esketamine.
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Affiliation(s)
- Wen-Ying Duan
- Department of Anesthesiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kang Peng
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China; Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Hui-Min Qin
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China
| | - Bai-Ming Li
- Department of Anesthesiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yun-Xin Xu
- Department of Anesthesiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dan-Jun Wang
- Department of Anesthesiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Le Yu
- Department of Anesthesiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hui Wang
- Department of Anesthesiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ji Hu
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China.
| | - Qing-Xiu Wang
- Department of Anesthesiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
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Langeron O, Castoldi N, Rognon N, Baillard C, Samama CM. How anesthesiology can deal with innovation and new technologies? Minerva Anestesiol 2024; 90:68-76. [PMID: 37526467 DOI: 10.23736/s0375-9393.23.17464-5] [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: 08/02/2023]
Abstract
Innovation and new technologies have always impacted significantly the anesthesiology practice all along the perioperative course, as it is recognized as one of the most transformative medical specialties specifically regarding patient's safety. Beside a number of major changes in procedures, equipment, training, and organization that aggregated to establish a strong safety culture with effective practices, anesthesiology is also a stakeholder in disruptive innovation. The present review is not exhaustive and aims to provide an overview on how innovation could change and improve anesthesiology practices through some examples as telemedicine (TM), machine learning and artificial intelligence (AI). For example, postoperative complications can be accurately predicted by AI from automated real-time electronic health record data, matching physicians' predictive accuracy. Clinical workflow could be facilitated and accelerated with mobile devices and applications, assuming that these tools should remain at the service of patients and care providers. Care providers and patients connections have improved, thanks to these digital and innovative transformations, without replacing existing relationships between them. It also should give time back to physicians and nurses to better spend it in the perioperative care, and to provide "personalized" medicine keeping a high level of standard of care.
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Affiliation(s)
- Olivier Langeron
- Department of Anesthesia and Intensive Care, Cochin University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France -
- Paris-Est Créteil University (UPEC), Paris, France -
- Innovation Department, Hotel Dieu de Paris Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France -
| | - Nicolas Castoldi
- Innovation Department, Hotel Dieu de Paris Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Nina Rognon
- Innovation Department, Hotel Dieu de Paris Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Christophe Baillard
- Department of Anesthesia and Intensive Care, Cochin University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
- Paris Cité University, Paris, France
| | - Charles M Samama
- Department of Anesthesia and Intensive Care, Cochin University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
- Paris Cité University, Paris, France
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4
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Rimbert S, Lelarge J, Guerci P, Bidgoli SJ, Meistelman C, Cheron G, Cebolla Alvarez AM, Schmartz D. Detection of Motor Cerebral Activity After Median Nerve Stimulation During General Anesthesia (STIM-MOTANA): Protocol for a Prospective Interventional Study. JMIR Res Protoc 2023; 12:e43870. [PMID: 36729587 PMCID: PMC10013682 DOI: 10.2196/43870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Accidental awareness during general anesthesia (AAGA) is defined as an unexpected awareness of the patient during general anesthesia. This phenomenon occurs in 1%-2% of high-risk practice patients and can cause physical suffering and psychological after-effects, called posttraumatic stress disorder. In fact, no monitoring techniques are satisfactory enough to effectively prevent AAGA; therefore, new alternatives are needed. Because the first reflex for a patient during an AAGA is to move, but cannot do so because of the neuromuscular blockers, we believe that it is possible to design a brain-computer interface (BCI) based on the detection of movement intention to warn the anesthetist. To do this, we propose to describe and detect the changes in terms of motor cortex oscillations during general anesthesia with propofol, while a median nerve stimulation is performed. We believe that our results could enable the design of a BCI based on median nerve stimulation, which could prevent AAGA. OBJECTIVE To our knowledge, no published studies have investigated the detection of electroencephalographic (EEG) patterns in relation to peripheral nerve stimulation over the sensorimotor cortex during general anesthesia. The main objective of this study is to describe the changes in terms of event-related desynchronization and event-related synchronization modulations, in the EEG signal over the motor cortex during general anesthesia with propofol while a median nerve stimulation is performed. METHODS STIM-MOTANA is an interventional and prospective study conducted with patients scheduled for surgery under general anesthesia, involving EEG measurements and median nerve stimulation at two different times: (1) when the patient is awake before surgery (2) and under general anesthesia. A total of 30 patients will receive surgery under complete intravenous anesthesia with a target-controlled infusion pump of propofol. RESULTS The changes in event-related desynchronization and event-related synchronization during median nerve stimulation according to the various propofol concentrations for 30 patients will be analyzed. In addition, we will apply 4 different offline machine learning algorithms to detect the median nerve stimulation at the cerebral level. Recruitment began in December 2022. Data collection is expected to conclude in June 2024. CONCLUSIONS STIM-MOTANA will be the first protocol to investigate median nerve stimulation cerebral motor effect during general anesthesia for the detection of intraoperative awareness. Based on strong practical and theoretical scientific reasoning from our previous studies, our innovative median nerve stimulation-based BCI would provide a way to detect intraoperative awareness during general anesthesia. TRIAL REGISTRATION Clinicaltrials.gov NCT05272202; https://clinicaltrials.gov/ct2/show/NCT05272202. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/43870.
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Affiliation(s)
- Sébastien Rimbert
- CHU Brugmann, Université Libre de Bruxelles, Bruxelles, Belgium.,Laboratory of Neurophysiology and Movement Biomechanics, Université Libre de Bruxelles Neurosciences Institute, Bruxelles, Belgium.,Inria Bordeaux Sud-Ouest, University of Bordeaux, Talence, France
| | - Julien Lelarge
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Philippe Guerci
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | | | - Claude Meistelman
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Guy Cheron
- Laboratory of Neurophysiology and Movement Biomechanics, Université Libre de Bruxelles Neurosciences Institute, Bruxelles, Belgium
| | - Ana Maria Cebolla Alvarez
- Laboratory of Neurophysiology and Movement Biomechanics, Université Libre de Bruxelles Neurosciences Institute, Bruxelles, Belgium
| | - Denis Schmartz
- CHU Brugmann, Université Libre de Bruxelles, Bruxelles, Belgium
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5
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Shi M, Huang Z, Xiao G, Xu B, Ren Q, Zhao H. Estimating the Depth of Anesthesia from EEG Signals Based on a Deep Residual Shrinkage Network. SENSORS (BASEL, SWITZERLAND) 2023; 23:1008. [PMID: 36679805 PMCID: PMC9865536 DOI: 10.3390/s23021008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
The reliable monitoring of the depth of anesthesia (DoA) is essential to control the anesthesia procedure. Electroencephalography (EEG) has been widely used to estimate DoA since EEG could reflect the effect of anesthetic drugs on the central nervous system (CNS). In this study, we propose that a deep learning model consisting mainly of a deep residual shrinkage network (DRSN) and a 1 × 1 convolution network could estimate DoA in terms of patient state index (PSI) values. First, we preprocessed the four raw channels of EEG signals to remove electrical noise and other physiological signals. The proposed model then takes the preprocessed EEG signals as inputs to predict PSI values. Then we extracted 14 features from the preprocessed EEG signals and implemented three conventional feature-based models as comparisons. A dataset of 18 patients was used to evaluate the models' performances. The results of the five-fold cross-validation show that there is a relatively high similarity between the ground-truth PSI values and the predicted PSI values of our proposed model, which outperforms the conventional models, and further, that the Spearman's rank correlation coefficient is 0.9344. In addition, an ablation experiment was conducted to demonstrate the effectiveness of the soft-thresholding module for EEG-signal processing, and a cross-subject validation was implemented to illustrate the robustness of the proposed method. In summary, the procedure is not merely feasible for estimating DoA by mimicking PSI values but also inspired us to develop a precise DoA-estimation system with more convincing assessments of anesthetization levels.
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Affiliation(s)
- Meng Shi
- School of Electronics, Peking University, Beijing 100084, China
| | - Ziyu Huang
- Department of Anesthesiology, Peking University People’s Hospital, Beijing 100044, China
| | - Guowen Xiao
- School of Electronics, Peking University, Beijing 100084, China
| | - Bowen Xu
- School of Electronics, Peking University, Beijing 100084, China
| | - Quansheng Ren
- School of Electronics, Peking University, Beijing 100084, China
| | - Hong Zhao
- Department of Anesthesiology, Peking University People’s Hospital, Beijing 100044, China
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6
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Nawafleh S, Alrawashdeh A, Ababneh O, Bani-Hani M, Al Modanat Z, Hani DB, Bataineh A, Al-Salameh F, Abuzaid S, Yasser O, Khairallah K. Perception and practices of depth of anesthesia monitoring and intraoperative awareness event rate among Jordanian anesthesiologists: a cross-sectional study. BMC Anesthesiol 2022; 22:402. [PMID: 36575378 PMCID: PMC9793501 DOI: 10.1186/s12871-022-01941-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/12/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Intraoperative awareness is the second most common complication of surgeries, and it negatively affects patients and healthcare professionals. Based on the limited previous studies, there is a wide variation in the incidence of intraoperative awareness and in the practices and attitudes toward depth of anesthesia (DoA) monitoring among healthcare systems and anesthesiologists. This study aimed to evaluate the Jordanian anesthesiologists' practice and attitudes toward DoA monitoring and estimate the event rate of intraoperative awareness among the participating anesthesiologists. METHODS A descriptive cross-sectional survey of Jordanian anesthesiologists working in public, private, and university hospitals was utilized using a questionnaire developed based on previous studies. Practice and attitude in using DoA monitors were evaluated. Anesthesiologists were asked to best estimate the number of anesthesia procedures and frequency of intraoperative awareness events in the year before. Percentages and 95% Confidence Intervals (95%CI) were reported and compared between groups using chi-square tests. RESULTS A total of 107 anesthesiologists responded and completed the survey. About one-third of the respondents (34.6%; 95% CI 26.1-44.2) had never used a DoA monitor and only 6.5% (95% CI 3.1-13.2) reported using it as a "daily practice". The use of a DoA monitor was associated with experience and type of health sector. However, 81.3% (95% CI 66.5-83.5) believed that currently available DoA monitors are effective for DoA monitoring and only 4.7% (95%CI 1.9-10.8) reported it as being "invalid". Most respondents reported that the main purpose of using a DoA monitor was to prevent awareness (86.0%; 95%CI 77.9-91.4), guide the delivery of anesthetics (63.6%; 95%CI 53.9-72.2), and reduce recovery time (57%; 95%CI 47.4-66.1). The event rate of intraoperative awareness was estimated at 0.4% among participating anesthesiologists. Most Jordanian hospitals lacked policy intending to prevent intraoperative awareness. CONCLUSIONS Most anesthesiologists believed in the role of DoA monitors in preventing intraoperative awareness, however, their attitudes and knowledge are inadequate, and few use DoA monitors in routine practices. In Jordan, large efforts are needed to regulate the use of DoA monitoring and reduce the incidence of intraoperative awareness.
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Affiliation(s)
- Sager Nawafleh
- grid.33801.390000 0004 0528 1681Department of General Surgery, Urology and Anesthesia, Faculty of Medicine, The Hashemite University, Zarqa, 13115 Jordan
| | - Ahmad Alrawashdeh
- grid.37553.370000 0001 0097 5797Department of Allied Medical Science, Faculty of Applied Medical Science, Jordan University of Science and Technology, Irbid, 22110 Jordan
| | - Omar Ababneh
- grid.9670.80000 0001 2174 4509Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman, 11942 Jordan
| | - Morad Bani-Hani
- grid.33801.390000 0004 0528 1681Department of General Surgery, Urology and Anesthesia, Faculty of Medicine, The Hashemite University, Zarqa, 13115 Jordan
| | - Zaid Al Modanat
- grid.14440.350000 0004 0622 5497Faculty of Medicine, Yarmouk University, Irbid, 21110 Jordan
| | - Diab Bani Hani
- grid.37553.370000 0001 0097 5797Department of Anesthesia and Recovery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 21110 Jordan
| | - Adel Bataineh
- grid.37553.370000 0001 0097 5797Department of Anesthesia and Recovery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 21110 Jordan
| | | | - Sajeda Abuzaid
- Department of Research and Data Analytics, Kernel Center, Irbid, 21110 Jordan
| | - Omer Yasser
- grid.37553.370000 0001 0097 5797Department of Anesthesia and Recovery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 21110 Jordan
| | - Khaled Khairallah
- grid.37553.370000 0001 0097 5797Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110 Jordan
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7
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Wang D, Guo Q, Liu D, Kong XX, Xu Z, Zhou Y, Su Y, Dai F, Ding HL, Cao JL. Association Between Burst-Suppression Latency and Burst-Suppression Ratio Under Isoflurane or Adjuvant Drugs With Isoflurane Anesthesia in Mice. Front Pharmacol 2021; 12:740012. [PMID: 34646140 PMCID: PMC8504134 DOI: 10.3389/fphar.2021.740012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
The same doses of anesthesia may yield varying depths of anesthesia in different patients. Clinical studies have revealed a possible causal relationship between deep anesthesia and negative short- and long-term patient outcomes. However, a reliable index and method of the clinical monitoring of deep anesthesia and detecting latency remain lacking. As burst-suppression is a characteristic phenomenon of deep anesthesia, the present study investigated the relationship between burst-suppression latency (BSL) and the subsequent burst-suppression ratio (BSR) to find an improved detection for the onset of intraoperative deep anesthesia. The mice were divided young, adult and old group treated with 1.0% or 1.5% isoflurane anesthesia alone for 2 h. In addition, the adult mice were pretreated with intraperitoneal injection of ketamine, dexmedetomidine, midazolam or propofol before they were anesthetized by 1.0% isoflurane for 2 h. Continuous frontal, parietal and occipital electroencephalogram (EEG) were acquired during anesthesia. The time from the onset of anesthesia to the first occurrence of burst-suppression was defined as BSL, while BSR was calculated as percentage of burst-suppression time that was spent in suppression periods. Under 1.0% isoflurane anesthesia, we found a negative correlation between BSL and BSR for EEG recordings obtained from the parietal lobes of young mice, from the parietal and occipital lobes of adult mice, and the occipital lobes of old mice. Under 1.5% isoflurane anesthesia, only the BSL calculated from EEG data obtained from the occipital lobe was negatively correlated with BSR in all mice. Furthermore, in adult mice receiving 1.0% isoflurane anesthesia, the co-administration of ketamine and midazolam, but not dexmedetomidine and propofol, significantly decreased BSL and increased BSR. Together, these data suggest that BSL can detect burst-suppression and predict the subsequent BSR under isoflurane anesthesia used alone or in combination with anesthetics or adjuvant drugs. Furthermore, the consistent negative correlation between BSL and BSR calculated from occipital EEG recordings recommends it as the optimal position for monitoring burst-suppression.
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Affiliation(s)
- Di Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China.,Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qingchen Guo
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
| | - Di Liu
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
| | - Xiang-Xi Kong
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
| | - Zheng Xu
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
| | - Yu Zhou
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
| | - Yan Su
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
| | - Feng Dai
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
| | - Hai-Lei Ding
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China.,NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Jun-Li Cao
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China.,NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China.,Department of Anesthesiology Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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8
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Wang Y, Wan C, Zhang Y, Zhou Y, Wang H, Yan F, Song D, Du R, Wang Q, Huang L. Detecting Connected Consciousness During Propofol-Induced Anesthesia Using EEG Based Brain Decoding. Int J Neural Syst 2021; 31:2150021. [PMID: 33970056 DOI: 10.1142/s0129065721500210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Connected consciousness refers to the state when external stimuli can enter into the stream of our consciousness experience. Emerging evidence suggests that although patients may not respond behaviorally to external stimuli during anesthesia, they may be aware of their surroundings. In this work, we investigated whether EEG based brain decoding could be used for detecting connected consciousness in the absence of behavioral responses during propofol infusion. A total of 14 subjects participated in our experiment. Subjects were asked to discriminate two types of auditory stimuli with a finger press during an ultraslow propofol infusion. We trained an EEG based brain decoding model using data collected in the awakened state using the same auditory stimuli and tested the model on data collected during the propofol infusion. The model provided a correct classification rate (CCR) of [Formula: see text]% when subjects were able to respond to the stimuli during the propofol infusion. The CCR dropped to [Formula: see text]% when subjects ceased responding and further decreased to [Formula: see text]% when we increased the propofol concentration by another 0.2 [Formula: see text]g/ml. After terminating the propofol infusion, we observed that the CCR rebounded to [Formula: see text]% before the subjects regained consciousness. With the classification results, we provided evidence that loss of consciousness is a gradual process and may progress from full consciousness to connected consciousness and then to disconnected consciousness.
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Affiliation(s)
- Yubo Wang
- School of Life Science and Technology, Xidian University, Xi'an, P. R. China
| | - Chenghao Wan
- School of Life Science and Technology, Xidian University, Xi'an, P. R. China
| | - Yun Zhang
- School of Life Science and Technology, Xidian University, Xi'an, P. R. China
| | - Yu Zhou
- School of Life Science and Technology, Xidian University, Xi'an, P. R. China
| | - Haidong Wang
- School of Life Science and Technology, Xidian University, Xi'an, P. R. China
| | - Fei Yan
- Department of Anesthesiology and Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China
| | - Dawei Song
- Department of Anesthesiology and Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China
| | - Ruini Du
- Department of Anesthesiology and Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China
| | - Qiang Wang
- Department of Anesthesiology and Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China
| | - Liyu Huang
- School of Life Science and Technology, Xidian University, Xi'an, P. R. China
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9
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Avilov O, Rimbert S, Popov A, Bougrain L. Optimizing Motor Intention Detection With Deep Learning: Towards Management of Intraoperative Awareness. IEEE Trans Biomed Eng 2021; 68:3087-3097. [PMID: 33687833 DOI: 10.1109/tbme.2021.3064794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This article shows the interest in deep learning techniques to detect motor imagery (MI) from raw electroencephalographic (EEG) signals when a functional electrical stimulation is added or not. Impacts of electrode montages and bandwidth are also reported. The perspective of this work is to improve the detection of intraoperative awareness during general anesthesia. METHODS Various architectures of EEGNet were investigated to optimize MI detection. They have been compared to the state-of-the-art classifiers in Brain-Computer Interfaces (based on Riemannian geometry, linear discriminant analysis), and other deep learning architectures (deep convolution network, shallow convolutional network). EEG data were measured from 22 participants performing motor imagery with and without median nerve stimulation. RESULTS The proposed architecture of EEGNet reaches the best classification accuracy (83.2%) and false-positive rate (FPR 19.0%) for a setup with only six electrodes over the motor cortex and frontal lobe and for an extended 4-38 Hz EEG frequency range while the subject is being stimulated via a median nerve. Configurations with a larger number of electrodes result in higher accuracy (94.5%) and FPR (6.1%) for 128 electrodes (and respectively 88.0% and 12.9% for 13 electrodes). CONCLUSION The present work demonstrates that using an extended EEG frequency band and a modified EEGNet deep neural network increases the accuracy of MI detection when used with as few as 6 electrodes which include frontal channels. SIGNIFICANCE The proposed method contributes to the development of Brain-Computer Interface systems based on MI detection from EEG.
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Liu YH, Qiu DJ, Jia L, Tan JT, Kang JM, Xie T, Xu HM. Depth of anesthesia measured by bispectral index and postoperative mortality: A meta-analysis of observational studies. J Clin Anesth 2019; 56:119-125. [DOI: 10.1016/j.jclinane.2019.01.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 11/25/2022]
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Rimbert S, Schmartz D, Bougrain L, Meistelman C, Baumann C, Guerci P. MOTANA: study protocol to investigate motor cerebral activity during a propofol sedation. Trials 2019; 20:534. [PMID: 31455386 PMCID: PMC6712668 DOI: 10.1186/s13063-019-3596-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 07/18/2019] [Indexed: 11/17/2022] Open
Abstract
Background Accidental Accidental awareness during general anesthesia (AAGA) occurs in 1–2% of high-risk practice patients and is a cause of severe psychological trauma, termed post-traumatic stress disorder (PTSD). However, no monitoring techniques can accurately predict or detect AAGA. Since the first reflex for a patient during AAGA is to move, a passive brain-computer interface (BCI) based on the detection of an intention of movement would be conceivable to alert the anesthetist. However, the way in which propofol (i.e., an anesthetic commonly used for the general anesthesia induction) affects motor brain activity within the electroencephalographic (EEG) signal has been poorly investigated and is not clearly understood. For this reason, a detailed study of the motor activity behavior with a step-wise increasing dose of propofol is required and would provide a proof of concept for such an innovative BCI. The main goal of this study is to highlight the occurrence of movement attempt patterns, mainly changes in oscillations called event-related desynchronization (ERD) and event-related synchronization (ERS), in the EEG signal over the motor cortex, in healthy subjects, without and under propofol sedation, during four different motor tasks. Methods MOTANA is an interventional, prospective, exploratory, physiological, monocentric, and randomized study conducted in healthy volunteers under light anesthesia, involving EEG measurements before and after target-controlled infusion of propofol at three different effect-site concentrations (0 μg.ml −1, 0.5 μg.ml −1, and 1.0 μg.ml −1). In this exploratory study, 30 healthy volunteers will perform 50 trials for the four motor tasks (real movement, motor imagery, motor imagery with median nerve stimulation, and median nerve stimulation alone) in a randomized sequence. In each conditions and for each trial, we will observe changes in terms of ERD and ERS according to the three propofol concentrations. Pre- and post-injection comparisons of propofol will be performed by paired series tests. Discussion MOTANA is an exploratory study aimed at designing an innovative BCI based on EEG-motor brain activity that would detect an attempt to move by a patient under anesthesia. This would be of interest in the prevention of AAGA. Trial registration Agence Nationale de Sécurité du Médicament (EUDRACT 2017-004198-1), NCT03362775. Registered on 29 August 2018. https://clinicaltrials.gov/ct2/show/NCT03362775?term=03362775&rank=1 Electronic supplementary material The online version of this article (10.1186/s13063-019-3596-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sébastien Rimbert
- Université de Lorraine, Inria, LORIA, Neurosys team, 615 rue du Jardin Botanique, Vandoeuvre-lès-Nancy, France.
| | - Denis Schmartz
- CHU Brugmann, Université Libre de Bruxelles, Place A.Van Gehuchten 4, Bruxelles, 1020, Belgium
| | - Laurent Bougrain
- Université de Lorraine, Inria, LORIA, Neurosys team, 615 rue du Jardin Botanique, Vandoeuvre-lès-Nancy, France
| | - Claude Meistelman
- Department of Anesthesiology and Critical Care Medicine, Universisty Hospital of Nancy, 9 Avenue de la Forêt de Haye, Vandoeuvre-lès-Nancy, 54500, France
| | - Cédric Baumann
- CHRU Nancy, plateforme d'aide à la recherche clinique, UMDS, Vandoeuvre-lès-Nancy, 54500, France
| | - Philippe Guerci
- Department of Anesthesiology and Critical Care Medicine, Universisty Hospital of Nancy, 9 Avenue de la Forêt de Haye, Vandoeuvre-lès-Nancy, 54500, France.,INSERM, U1116, Université de Lorraine, 615 rue du Jardin Botanique, Vandoeuvre-lès-Nancy, France
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Hou BJ, Du Y, Gu SX, Fan J, Wang R, Deng H, Guo DX, Wang L, Wang YY. General anesthesia combined with epidural anesthesia maintaining appropriate anesthesia depth may protect excessive production of inflammatory cytokines and stress hormones in colon cancer patients during and after surgery. Medicine (Baltimore) 2019; 98:e16610. [PMID: 31348308 PMCID: PMC6708929 DOI: 10.1097/md.0000000000016610] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The purpose of this study was to investigate the influences of varied anesthetic methods and depths on inflammatory cytokines and stress hormone levels in radical operation among colon cancer patients during perioperative period.A total of 120 patients were collected in the study and randomly divided into 4 groups, A: general anesthesia + Narcotrend D1, B: general anesthesia + Narcotrend D2, C: general anesthesia + epidural anesthesia + Narcotrend D1, D: general anesthesia + epidural anesthesia + Narcotrend D2. The levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, cortisol (Cor), adrenocorticotropic hormone (ACTH), and endothelin-1 (ET-1) were measured adopting commercial kits before anesthesia (T0), 4 hours after surgery (T1), 24 hours after surgery (T2), and 72 hours after surgery (T3).There was no significant difference in basic clinical characteristics among the groups. In comparison with group A, B and C, group D showed significantly lower levels of TNF-α, IL-6, IL-10, Cor, ACTH, and ET-1 at T1 and T2 (all, P < .05). Significantly higher levels of TNF-α, IL-6, IL-10, Cor, and ACTH were detected at T1 and T2 than those at T0 (all, P < .05), whereas, at T3, the levels of inflammatory cytokines and stress hormones were all decreased near to preoperation ones.General anesthesia combined with epidural anesthesia at Narcotrend D2 depth plays an important role in reducing immune and stress response in patients with colon cancer from surgery to 24 hours after surgery.
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Affiliation(s)
- Bao-Jun Hou
- Department of Anesthesiology, Hebei University of Engineering Affiliated Hospital
| | - Ying Du
- Department of Rehabilitation Therapy, Hebei University of Engineering School of Medicine, Handan, Hebei Province, China
| | - Shu-Xin Gu
- Department of Anesthesiology, Hebei University of Engineering Affiliated Hospital
| | - Jie Fan
- Department of Anesthesiology, Hebei University of Engineering Affiliated Hospital
| | - Ran Wang
- Department of Anesthesiology, Hebei University of Engineering Affiliated Hospital
| | - Hong Deng
- Department of Anesthesiology, Hebei University of Engineering Affiliated Hospital
| | - Dan-Xia Guo
- Department of Anesthesiology, Hebei University of Engineering Affiliated Hospital
| | - Li Wang
- Department of Anesthesiology, Hebei University of Engineering Affiliated Hospital
| | - Yan-Ying Wang
- Department of Anesthesiology, Hebei University of Engineering Affiliated Hospital
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Rimbert S, Riff P, Gayraud N, Schmartz D, Bougrain L. Median Nerve Stimulation Based BCI: A New Approach to Detect Intraoperative Awareness During General Anesthesia. Front Neurosci 2019; 13:622. [PMID: 31275105 PMCID: PMC6593137 DOI: 10.3389/fnins.2019.00622] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/29/2019] [Indexed: 11/24/2022] Open
Abstract
Hundreds of millions of general anesthesia are performed each year on patients all over the world. Among these patients, 0.1–0.2% are victims of Accidental Awareness during General Anesthesia (AAGA), i.e., an unexpected awakening during a surgical procedure under general anesthesia. Although anesthesiologists try to closely monitor patients using various techniques to prevent this terrifying phenomenon, there is currently no efficient solution to accurately detect its occurrence. We propose the conception of an innovative passive brain-computer interface (BCI) based on an intention of movement to prevent AAGA. Indeed, patients typically try to move to alert the medical staff during an AAGA, only to discover that they are unable to. First, we examine the challenges of such a BCI, i.e., the lack of a trigger to facilitate when to look for an intention to move, as well as the necessity for a high classification accuracy. Then, we present a solution that incorporates Median Nerve Stimulation (MNS). We investigate the specific modulations that MNS causes in the motor cortex and confirm that they can be altered by an intention of movement. Finally, we perform experiments on 16 healthy participants to assess whether an MI-based BCI using MNS is able to generate high classification accuracies. Our results show that MNS may provide a foundation for an innovative BCI that would allow the detection of AAGA.
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Affiliation(s)
| | - Pierre Riff
- Université de Lorraine, CNRS, Inria, LORIA, Nancy, France
| | - Nathalie Gayraud
- Université Côte d'Azur, Inria, Sophia-Antipolis Méditerrannée, Athena Team, Nice, France
| | - Denis Schmartz
- Le Centre Hospitalier Universitaire (CHU) Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Mora JC, Kaye AD, Romankowski ML, Delahoussaye PJ, Urman RD, Przkora R. Trends in Anesthesia-Related Liability and Lessons Learned. Adv Anesth 2018; 36:231-249. [PMID: 30414640 DOI: 10.1016/j.aan.2018.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Juan C Mora
- Department of Anesthesiology, Division of Pain Medicine, University of Florida, PO Box 100254, Room 2036, Gainesville, FL 32610-0254, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Room 656, 1542 Tulane Avenue, New Orleans, LA 70112, USA
| | - Matthew L Romankowski
- Department of Anesthesiology, Division of Pain Medicine, University of Florida, PO Box 100254, Room 2036, Gainesville, FL 32610-0254, USA
| | - Paul J Delahoussaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Room 659, 1542 Tulane Avenue, New Orleans, LA 70112, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Rene Przkora
- Department of Anesthesiology, Division of Pain Medicine, Multidisciplinary Pain Medicine Fellowship, Anesthesiology Residency, University of Florida, PO Box 100254, Room 2036, Gainesville, FL 32610-0254, USA.
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Corcione A, Angelini P, Bencini L, Bertellini E, Borghi F, Buccelli C, Coletta G, Esposito C, Graziano V, Guarracino F, Marchi D, Misitano P, Mori AM, Paternoster M, Pennestrì V, Perrone V, Pugliese L, Romagnoli S, Scudeller L, Corcione F. Joint consensus on abdominal robotic surgery and anesthesia from a task force of the SIAARTI and SIC. Minerva Anestesiol 2018; 84:1189-1208. [PMID: 29648413 DOI: 10.23736/s0375-9393.18.12241-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Minimally invasive surgical procedures have revolutionized the world of surgery in the past decades. While laparoscopy, the first minimally invasive surgical technique to be developed, is widely used and has been addressed by several guidelines and recommendations, the implementation of robotic-assisted surgery is still hindered by the lack of consensus documents that support healthcare professionals in the management of this novel surgical procedure. Here we summarize the available evidence and provide expert opinion aimed at improving the implementation and resolution of issues derived from robotic abdominal surgery procedures. A joint task force of Italian surgeons, anesthesiologists and clinical epidemiologists reviewed the available evidence on robotic abdominal surgery. Recommendations were graded according to the strength of evidence. Statements and recommendations are provided for general issues regarding robotic abdominal surgery, operating theatre organization, preoperative patient assessment and preparation, intraoperative management, and postoperative procedures and discharge. The consensus document provides evidence-based recommendations and expert statements aimed at improving the implementation and management of robotic abdominal surgery.
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Affiliation(s)
- Antonio Corcione
- Department of Critical Care Area, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Pierluigi Angelini
- Department of General, Laparoscopic and Robotic Surgery, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Lapo Bencini
- Division of Surgical Oncology and Robotics, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Elisabetta Bertellini
- Department of Anesthesia and Intensive Care, New Civile S. Agostino-Estense, Policlinico Hospital, Modena, Italy
| | - Felice Borghi
- Division of General and Surgical Oncology, Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy
| | - Claudio Buccelli
- Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Coletta
- Division of Operating Room Management, Department of Emergency and Critical Care, S. Croce e Carle Hospital, Cuneo, Italy
| | - Clelia Esposito
- Department of Critical Care Area, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Vincenzo Graziano
- Department of Anesthesia and Critical Care Medicine, Cardiothoracic Anesthesia and Intensive Care, Pisa University Hospital, Pisa, Italy
| | - Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Cardiothoracic Anesthesia and Intensive Care, Pisa University Hospital, Pisa, Italy
| | - Domenico Marchi
- Department of General Surgery, New Civile S. Agostino-Estense, Policlinico Hospital, Modena, Italy
| | - Pasquale Misitano
- Unit of General and Mini-Invasive Surgery, Department of General Surgery, Misericordia Hospital, Grosseto, Italy
| | - Anna M Mori
- Department of Anesthesiology and Reanimation, IRCCS Policlinic San Matteo Foundation, Pavia, Italy
| | - Mariano Paternoster
- Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Vincenzo Pennestrì
- Department of Anesthesia and Intensive Care Medicine, Misericordia Hospital, Grosseto, Italy
| | - Vittorio Perrone
- Department of General and Transplant Surgery, Pisa University Hospital, Pisa, Italy
| | - Luigi Pugliese
- Unit of General Surgery 2, IRCCS Policlinic San Matteo, Foundation, Pavia, Italy
| | - Stefano Romagnoli
- Department of Anesthesia and Critical Care, Careggi University Hospital, Florence, Italy
| | - Luigia Scudeller
- Unit of Clinical Epidemiology, Scientific Direction, IRCCS Policlinic San Matteo Foundation, Pavia, Italy -
| | - Francesco Corcione
- Department of General, Laparoscopic and Robotic Surgery, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
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Lu X, Jin X, Yang S, Xia Y. The correlation of the depth of anesthesia and postoperative cognitive impairment: A meta-analysis based on randomized controlled trials. J Clin Anesth 2018; 45:55-59. [DOI: 10.1016/j.jclinane.2017.12.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/22/2017] [Accepted: 12/05/2017] [Indexed: 11/26/2022]
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Zorrilla-Vaca A, Healy RJ, Wu CL, Grant MC. Relation between bispectral index measurements of anesthetic depth and postoperative mortality: a meta-analysis of observational studies. Can J Anaesth 2017; 64:597-607. [DOI: 10.1007/s12630-017-0872-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 12/12/2016] [Accepted: 03/21/2017] [Indexed: 11/28/2022] Open
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Tsai FF, Hu X, Lin YS, Peng CK, Fan SZ. Frontal electroencephalogram analysis with ensemble empirical mode decomposition during the induction of general anesthesia. Biomed Phys Eng Express 2016. [DOI: 10.1088/2057-1976/2/6/065004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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19
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Instantaneous 3D EEG Signal Analysis Based on Empirical Mode Decomposition and the Hilbert–Huang Transform Applied to Depth of Anaesthesia. ENTROPY 2015. [DOI: 10.3390/e17030928] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Sample entropy analysis of EEG signals via artificial neural networks to model patients' consciousness level based on anesthesiologists experience. BIOMED RESEARCH INTERNATIONAL 2015; 2015:343478. [PMID: 25738152 PMCID: PMC4337052 DOI: 10.1155/2015/343478] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 01/14/2015] [Indexed: 11/17/2022]
Abstract
Electroencephalogram (EEG) signals, as it can express the human brain's activities and reflect awareness, have been widely used in many research and medical equipment to build a noninvasive monitoring index to the depth of anesthesia (DOA). Bispectral (BIS) index monitor is one of the famous and important indicators for anesthesiologists primarily using EEG signals when assessing the DOA. In this study, an attempt is made to build a new indicator using EEG signals to provide a more valuable reference to the DOA for clinical researchers. The EEG signals are collected from patients under anesthetic surgery which are filtered using multivariate empirical mode decomposition (MEMD) method and analyzed using sample entropy (SampEn) analysis. The calculated signals from SampEn are utilized to train an artificial neural network (ANN) model through using expert assessment of consciousness level (EACL) which is assessed by experienced anesthesiologists as the target to train, validate, and test the ANN. The results that are achieved using the proposed system are compared to BIS index. The proposed system results show that it is not only having similar characteristic to BIS index but also more close to experienced anesthesiologists which illustrates the consciousness level and reflects the DOA successfully.
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Shulman RG, Hyder F, Rothman DL. Insights from neuroenergetics into the interpretation of functional neuroimaging: an alternative empirical model for studying the brain's support of behavior. J Cereb Blood Flow Metab 2014; 34:1721-35. [PMID: 25160670 PMCID: PMC4269754 DOI: 10.1038/jcbfm.2014.145] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 06/12/2014] [Accepted: 07/21/2014] [Indexed: 02/05/2023]
Abstract
Functional neuroimaging measures quantitative changes in neurophysiological parameters coupled to neuronal activity during observable behavior. These results have usually been interpreted by assuming that mental causation of behavior arises from the simultaneous actions of distinct psychological mechanisms or modules. However, reproducible localization of these modules in the brain using functional magnetic resonance imaging (MRI) and positron emission tomography (PET) imaging has been elusive other than for sensory systems. In this paper, we show that neuroenergetic studies using PET, calibrated functional magnetic resonance imaging (fMRI), (13)C magnetic resonance spectroscopy, and electrical recordings do not support the standard approach, which identifies the location of mental modules from changes in brain activity. Of importance in reaching this conclusion is that changes in neuronal activities underlying the fMRI signal are many times smaller than the high ubiquitous, baseline neuronal activity, or energy in resting, awake humans. Furthermore, the incremental signal depends on the baseline activity contradicting theoretical assumptions about linearity and insertion of mental modules. To avoid these problems, while making use of these valuable results, we propose that neuroimaging should be used to identify observable brain activities that are necessary for a person's observable behavior rather than being used to seek hypothesized mental processes.
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Affiliation(s)
- Robert G Shulman
- Magnetic Resonance Research Center, Yale University, New Haven, Connecticut, USA
| | - Fahmeed Hyder
- Magnetic Resonance Research Center, Yale University, New Haven, Connecticut, USA
- Departments of Diagnostic Radiology, Yale University, New Haven, Connecticut, USA
- Biomedical Engineering, Yale University, New Haven, Connecticut, USA
- Quantitative Neuroscience with Magnetic Resonance Core Center, Yale University, New Haven, Connecticut, USA
| | - Douglas L Rothman
- Magnetic Resonance Research Center, Yale University, New Haven, Connecticut, USA
- Departments of Diagnostic Radiology, Yale University, New Haven, Connecticut, USA
- Biomedical Engineering, Yale University, New Haven, Connecticut, USA
- Quantitative Neuroscience with Magnetic Resonance Core Center, Yale University, New Haven, Connecticut, USA
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A wavelet transform based method to determine depth of anesthesia to prevent awareness during general anesthesia. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2014; 2014:354739. [PMID: 25276220 PMCID: PMC4174978 DOI: 10.1155/2014/354739] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/10/2014] [Indexed: 02/04/2023]
Abstract
Awareness during general anesthesia for its serious psychological effects on patients and some juristically problems for anesthetists has been an important challenge during past decades. Monitoring depth of anesthesia is a fundamental solution to this problem. The induction of anesthesia alters frequency and mean of amplitudes of the electroencephalogram (EEG), and its phase couplings. We analyzed EEG changes for phase coupling between delta and alpha subbands using a new algorithm for depth of general anesthesia measurement based on complex wavelet transform (CWT) in patients anesthetized by Propofol. Entropy and histogram of modulated signals were calculated by taking bispectral index (BIS) values as reference. Entropies corresponding to different BIS intervals using Mann-Whitney U test showed that they had different continuous distributions. The results demonstrated that there is a phase coupling between 3 and 4 Hz in delta and 8-9 Hz in alpha subbands and these changes are shown better at the channel T7 of EEG. Moreover, when BIS values increase, the entropy value of modulated signal also increases and vice versa. In addition, measuring phase coupling between delta and alpha subbands of EEG signals through continuous CWT analysis reveals the depth of anesthesia level. As a result, awareness during anesthesia can be prevented.
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Affiliation(s)
- Timothy E Miller
- From the Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
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An alternative position for the BIS-Vista montage in frontal approach neurosurgical cases. J Neurosurg Anesthesiol 2013; 25:135-42. [PMID: 23456030 DOI: 10.1097/ana.0b013e31826ca3a0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Appropriate placement of the bispectral index (BIS)-vista montage for frontal approach neurosurgical procedures is a neuromonitoring challenge. The standard bifrontal application interferes with the operative field; yet to date, no other placements have demonstrated good agreement. The purpose of our study was to compare the standard BIS montage with an alternate BIS montage across the nasal dorsum for neuromonitoring. MATERIALS AND METHODS The authors performed a prospective study, enrolling patients and performing neuromonitoring using both the standard and the alternative montage on each patient. Data from the 2 placements were compared and analyzed using a Bland-Altman analysis, a Scatter plot analysis, and a matched-pair analysis. RESULTS Overall, 2567 minutes of data from each montage was collected on 28 subjects. Comparing the overall difference in score, the alternate BIS montage score was, on average, 2.0 (6.2) greater than the standard BIS montage score (P<0.0001). The Bland-Altman analysis revealed a difference in score of -2.0 (95% confidence interval, -14.1, 10.1), with 108/2567 (4.2%) of the values lying outside of the limit of agreement. The scatter plot analysis overall produced a trend line with the equation y=0.94x+0.82, with an R coefficient of 0.82. CONCLUSIONS We determined that the nasal montage produces values that have slightly more variability compared with that ideally desired, but the variability is not clinically significant. In cases where the standard BIS-vista montage would interfere with the operative field, an alternative positioning of the BIS montage across the nasal bridge and under the eye can be used.
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Application of Multivariate Empirical Mode Decomposition and Sample Entropy in EEG Signals via Artificial Neural Networks for Interpreting Depth of Anesthesia. ENTROPY 2013. [DOI: 10.3390/e15093325] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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26
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Jiang Y, Qiao B, Wu L, Lin X. Application of Narcotrend® Monitor for Evaluation of Depth of Anesthesia in Infants Undergoing Cardiac Surgery: a Prospective Control Study. Braz J Anesthesiol 2013; 63:273-8. [DOI: 10.1016/s0034-7094(13)70230-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 06/04/2012] [Indexed: 11/16/2022] Open
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Abstract
BACKGROUND Sedation or anesthesia is used to facilitate many cases of an estimated 45 million diagnostic and therapeutic medical procedures in the United States. Preclinical studies have called attention to the possibility that sedative-hypnotic drugs can increase pain perception, but whether this observation holds true in humans and whether pain-modulating effects are agent-specific or characteristic of IV sedation in general remain unclear. METHODS To study this important clinical question, the authors recruited 86 healthy volunteers and randomly assigned them to receive one of three sedative drugs: midazolam, propofol, or dexmedetomidine. The authors asked participants to rate their pain in response to four experimental pain tasks (i.e., cold, heat, ischemic, or electrical pain) before and during moderate sedation. RESULTS Midazolam increased cold, heat, and electrical pain perception significantly (10-point pain rating scale change, 0.82 ± 0.29, mean ± SEM). Propofol reduced ischemic pain and dexmedetomidine reduced both cold and ischemic pain significantly (-1.58 ± 0.28, mean ± SEM). The authors observed a gender-by-race interaction for dexmedetomidine. In addition to these drug-specific effects, the authors observed gender effects on pain perception; female subjects rated identical experimental pain stimuli higher than male subjects. The authors also noted race-drug interaction effects for dexmedetomidine, with higher doses of drug needed to sedate Caucasians compared with African Americans. CONCLUSIONS The results of the authors' study call attention to the fact that IV sedatives may increase pain perception. The effect of sedation on pain perception is agent- and pain type-specific. Knowledge of these effects provides a rational basis for analgesia and sedation to facilitate medical procedures.
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Hyder F, Fulbright RK, Shulman RG, Rothman DL. Glutamatergic function in the resting awake human brain is supported by uniformly high oxidative energy. J Cereb Blood Flow Metab 2013; 33:339-47. [PMID: 23299240 PMCID: PMC3587823 DOI: 10.1038/jcbfm.2012.207] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Rodent (13)C magnetic resonance spectroscopy studies show that glutamatergic signaling requires high oxidative energy in the awake resting state and allowed calibration of functional magnetic resonance imaging (fMRI) signal in terms of energy relative to the resting energy. Here, we derived energy used for glutamatergic signaling in the awake resting human. We analyzed human data of electroencephalography (EEG), positron emission tomography (PET) maps of oxygen (CMR(O2)) and glucose (CMR(glc)) utilization, and calibrated fMRI from a variety of experimental conditions. CMR(glc) and EEG in the visual cortex were tightly coupled over several conditions, showing that the oxidative demand for signaling was four times greater than the demand for nonsignaling events in the awake state. Variations of CMR(O2) and CMR(glc) from gray-matter regions and networks were within ±10% of means, suggesting that most areas required similar energy for ubiquitously high resting activity. Human calibrated fMRI results suggest that changes of fMRI signal in cognitive studies contribute at most ±10% CMR(O2) changes from rest. The PET data of sleep, vegetative state, and anesthesia show metabolic reductions from rest, uniformly >20% across, indicating no region is selectively reduced when consciousness is lost. Future clinical investigations will benefit from using quantitative metabolic measures.
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Affiliation(s)
- Fahmeed Hyder
- Magnetic Resonance Research Center, Yale University, New Haven, Connecticut 06520, USA.
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Cortical energy demands of signaling and nonsignaling components in brain are conserved across mammalian species and activity levels. Proc Natl Acad Sci U S A 2013; 110:3549-54. [PMID: 23319606 DOI: 10.1073/pnas.1214912110] [Citation(s) in RCA: 182] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The continuous need for ion gradient restoration across the cell membrane, a prerequisite for synaptic transmission and conduction, is believed to be a major factor for brain's high oxidative demand. However, do energy requirements of signaling and nonsignaling components of cortical neurons and astrocytes vary with activity levels and across species? We derived oxidative ATP demand associated with signaling (P(s)) and nonsignaling (P(ns)) components in the cerebral cortex using species-specific physiologic and anatomic data. In rat, we calculated glucose oxidation rates from layer-specific neuronal activity measured across different states, spanning from isoelectricity to awake and sensory stimulation. We then compared these calculated glucose oxidation rates with measured glucose metabolic data for the same states as reported by 2-deoxy-glucose autoradiography. Fixed values for P(s) and P(ns) were able to predict the entire range of states in the rat. We then calculated glucose oxidation rates from human EEG data acquired under various conditions using fixed P(s) and P(ns) values derived for the rat. These calculated metabolic data in human cerebral cortex compared well with glucose metabolism measured by PET. Independent of species, linear relationship was established between neuronal activity and neuronal oxidative demand beyond isoelectricity. Cortical signaling requirements dominated energy demand in the awake state, whereas nonsignaling requirements were ∼20% of awake value. These predictions are supported by (13)C magnetic resonance spectroscopy results. We conclude that mitochondrial energy support for signaling and nonsignaling components in cerebral cortex are conserved across activity levels in mammalian species.
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Blokland YM, Farquhar JDR, Mourisse J, Scheffer GJ, Lerou JGC, Bruhn J. Towards a novel monitor of intraoperative awareness: selecting paradigm settings for a movement-based brain-computer interface. PLoS One 2012; 7:e44336. [PMID: 22970202 PMCID: PMC3435418 DOI: 10.1371/journal.pone.0044336] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 08/01/2012] [Indexed: 11/23/2022] Open
Abstract
During 0.1-0.2% of operations with general anesthesia, patients become aware during surgery. Unfortunately, pharmacologically paralyzed patients cannot seek attention by moving. Their attempted movements may however induce detectable EEG changes over the motor cortex. Here, methods from the area of movement-based brain-computer interfacing are proposed as a novel direction in anesthesia monitoring. Optimal settings for development of such a paradigm are studied to allow for a clinically feasible system. A classifier was trained on recorded EEG data of ten healthy non-anesthetized participants executing 3-second movement tasks. Extensive analysis was performed on this data to obtain an optimal EEG channel set and optimal features for use in a movement detection paradigm. EEG during movement could be distinguished from EEG during non-movement with very high accuracy. After a short calibration session, an average classification rate of 92% was obtained using nine EEG channels over the motor cortex, combined movement and post-movement signals, a frequency resolution of 4 Hz and a frequency range of 8-24 Hz. Using Monte Carlo simulation and a simple decision making paradigm, this translated into a probability of 99% of true positive movement detection within the first two and a half minutes after movement onset. A very low mean false positive rate of <0.01% was obtained. The current results corroborate the feasibility of detecting movement-related EEG signals, bearing in mind the clinical demands for use during surgery. Based on these results further clinical testing can be initiated.
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Affiliation(s)
- Yvonne M Blokland
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Rinehart J, Liu N, Alexander B, Cannesson M. Review article: closed-loop systems in anesthesia: is there a potential for closed-loop fluid management and hemodynamic optimization? Anesth Analg 2011; 114:130-43. [PMID: 21965362 DOI: 10.1213/ane.0b013e318230e9e0] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Closed-loop (automated) controllers are encountered in all aspects of modern life in applications ranging from air-conditioning to spaceflight. Although these systems are virtually ubiquitous, they are infrequently used in anesthesiology because of the complexity of physiologic systems and the difficulty in obtaining reliable and valid feedback data from the patient. Despite these challenges, closed-loop systems are being increasingly studied and improved for medical use. Two recent developments have made fluid administration a candidate for closed-loop control. First, the further description and development of dynamic predictors of fluid responsiveness provides a strong parameter for use as a control variable to guide fluid administration. Second, rapid advances in noninvasive monitoring of cardiac output and other hemodynamic variables make goal-directed therapy applicable for a wide range of patients in a variety of clinical care settings. In this article, we review the history of closed-loop controllers in clinical care, discuss the current understanding and limitations of the dynamic predictors of fluid responsiveness, and examine how these variables might be incorporated into a closed-loop fluid administration system.
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Affiliation(s)
- Joseph Rinehart
- Department of Anesthesiology & Perioperative Care, University of California, Irvine, USA
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Current world literature. Curr Opin Anaesthesiol 2011; 24:224-33. [PMID: 21386670 DOI: 10.1097/aco.0b013e32834585d6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Monitoring the depth of anaesthesia. SENSORS 2010; 10:10896-935. [PMID: 22163504 PMCID: PMC3231065 DOI: 10.3390/s101210896] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 09/29/2010] [Accepted: 11/22/2010] [Indexed: 11/25/2022]
Abstract
One of the current challenges in medicine is monitoring the patients’ depth of general anaesthesia (DGA). Accurate assessment of the depth of anaesthesia contributes to tailoring drug administration to the individual patient, thus preventing awareness or excessive anaesthetic depth and improving patients’ outcomes. In the past decade, there has been a significant increase in the number of studies on the development, comparison and validation of commercial devices that estimate the DGA by analyzing electrical activity of the brain (i.e., evoked potentials or brain waves). In this paper we review the most frequently used sensors and mathematical methods for monitoring the DGA, their validation in clinical practice and discuss the central question of whether these approaches can, compared to other conventional methods, reduce the risk of patient awareness during surgical procedures.
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