Detecting Loss and Regain of Consciousness during Propofol Anesthesia using Multimodal Indices of Autonomic State

An unsupervised automated paradigm for artifact removal from electrodermal activity in an uncontrolled clinical setting

Objective. Electrodermal activity (EDA) reflects sympathetic nervous system activity through sweating-related changes in skin conductance and could be used in clinical settings in which patients cannot self-report pain, such as during surgery or when in a coma. To enable EDA data to be used robustly in clinical settings, we need to develop artifact detection and removal frameworks that can handle the types of interference experienced in clinical settings while salvaging as much useful information as possible.Approach. In this study, we collected EDA data from 70 subjects while they were undergoing surgery in the operating room. We then built a fully automated artifact removal framework to remove the heavy artifacts that resulted from the use of surgical electrocautery during the surgery and compared it to two existing state-of-the-art methods for artifact removal from EDA data. This automated framework consisted of first utilizing three unsupervised machine learning methods for anomaly detection, and then customizing the threshold to separate artifact for each data instance by taking advantage of the statistical properties of the artifact in that data instance. We also created simulated surgical data by introducing artifacts into cleaned surgical data and measured the performance of all three methods in removing it.Main results. Our method achieved the highest overall accuracy and precision and lowest overall error on simulated data. One of the other methods prioritized high sensitivity while sacrificing specificity and precision, while the other had low sensitivity, high error, and left behind several artifacts. These results were qualitatively similar between the simulated data instances and operating room data instances.Significance. Our framework allows for robust removal of heavy artifact from EDA data in clinical settings such as surgery, which is the first step to enable clinical integration of EDA as part of standard monitoring.

Tonic Electrodermal Activity is a Robust Marker of Psychological and Physiological Changes during Induction of Anesthesia

Electrodermal activity (EDA), which tracks sweat gland activity as a proxy for sympathetic activation, has the potential to be a biomarker of physiological and psychological changes in the clinic. To show this, in this study, we demonstrate that the tonic component of EDA responds consistently and robustly during induction of anesthesia in the operating room in 8 subjects during surgery. This response is seen bilaterally. The response shows a significant increase in EDA in anticipation of induction and then a gradual decrease in response to the administration of medication, which agrees with both the expected psychological effects of stress and anxiety and the physiological effects of anesthetic medication on sweat glands. The results also show a slightly faster response to drug in the arm directly receiving the medication intravenously compared to the opposite, though the magnitude of the effect evens out over time. Clinical Relevance- EDA can serve as a robust non-invasive biomarker in the clinic to track both psychologically and physiologically induced autonomic changes.

Biophysical Model: A Promising Method in the Study of the Mechanism of Propofol: A Narrative Review

The physiological and neuroregulatory mechanism of propofol is largely based on very limited knowledge. It is one of the important puzzling issues in anesthesiology and is of great value in both scientific and clinical fields. It is acknowledged that neural networks which are comprised of a number of neural circuits might be involved in the anesthetic mechanism. However, the mechanism of this hypothesis needs to be further elucidated. With the progress of artificial intelligence, it is more likely to solve this problem through using artificial neural networks to perform temporal waveform data analysis and to construct biophysical computational models. This review focuses on current knowledge regarding the anesthetic mechanism of propofol, an intravenous general anesthetic, by constructing biophysical computational models.

Quantitative assessment of the relationship between behavioral and autonomic dynamics during propofol-induced unconsciousness

During general anesthesia, both behavioral and autonomic changes are caused by the administration of anesthetics such as propofol. Propofol produces unconsciousness by creating highly structured oscillations in brain circuits. The anesthetic also has autonomic effects due to its actions as a vasodilator and myocardial depressant. Understanding how autonomic dynamics change in relation to propofol-induced unconsciousness is an important scientific and clinical question since anesthesiologists often infer changes in level of unconsciousness from changes in autonomic dynamics. Therefore, we present a framework combining physiology-based statistical models that have been developed specifically for heart rate variability and electrodermal activity with a robust statistical tool to compare behavioral and multimodal autonomic changes before, during, and after propofol-induced unconsciousness. We tested this framework on physiological data recorded from nine healthy volunteers during computer-controlled administration of propofol. We studied how autonomic dynamics related to behavioral markers of unconsciousness: 1) overall, 2) during the transitions of loss and recovery of consciousness, and 3) before and after anesthesia as a whole. Our results show a strong relationship between behavioral state of consciousness and autonomic dynamics. All of our prediction models showed areas under the curve greater than 0.75 despite the presence of non-monotonic relationships among the variables during the transition periods. Our analysis highlighted the specific roles played by fast versus slow changes, parasympathetic vs sympathetic activity, heart rate variability vs electrodermal activity, and even pulse rate vs pulse amplitude information within electrodermal activity. Further advancement upon this work can quantify the complex and subject-specific relationship between behavioral changes and autonomic dynamics before, during, and after anesthesia. However, this work demonstrates the potential of a multimodal, physiologically-informed, statistical approach to characterize autonomic dynamics.