1
|
Chen W, Feng Y, Chen X, Jiang F, Miao J, Chen S, Chen H. Comparison of Three Normalization Methods in Monitoring Analgesic Depth with Photoplethysmographic Diastolic Interval. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:5971-5975. [PMID: 33019332 DOI: 10.1109/embc44109.2020.9175443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The purpose of the present study was to investigate the ability of three different normalization methods, namely root mean square (RMS) value, mean value, and maximum which referred to pulse beat interval (PBI), based on photoplethysmographic diastolic interval (DI) in response to laryngeal mask airway (LMA) insertion under various remifentanil concentrations during general anesthesia. Sixty patients were randomly allocated to one of the four groups to receive a possible remifentanil effect-compartment target concentration (Ceremi) of 0, 1, 3, or 5 ng/ml, and an effect-compartment target controlled infusion of propofol to maintain the state entropy (SE) at 40~60. Three normalized measures DIRMS, DIMean, and DIPBI were compared with the DI values without normalization. Before LMA insertion, only DI showed a considerable correlation with remifentanil concentrations. DIRMS and DIMean performed better than DI in discriminating 'insufficient' concentrations (0 and 1 ng/ml) from 'sufficient' concentrations (3 and 5 ng/ml). DIRMS was superior to all other variables in grading analgesic depth after nociceptive event occurred with PK value of 0.836. These results demonstrate that the normalization using RMS value, compared to using mean value and maximum, seems to provide a more effective approach for signal pre-processing.
Collapse
|
2
|
Chen H, Jiang F, Drzymalski D, Chen W, Feng Y, Miao J, Jiao C, Chen X. A novel parameter derived from photoplethysmographic pulse wave to distinguish preeclampsia from non-preeclampsia. Pregnancy Hypertens 2019; 15:166-170. [PMID: 30825916 DOI: 10.1016/j.preghy.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/30/2018] [Accepted: 01/10/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the comparative hierarchical area ratio (CHAR), a novel parameter derived from the photoplethysmographic (PPG) pulse wave and differences in CHAR values in parturients with and without preeclampsia (PE). METHODS A total of 59 parturients (37 without and 22 with PE) was conducted at the Women's Hospital, Zhejiang University, School of Medicine in Hangzhou, China. We calculated the CHAR values derived from the PPG pulse wave and compared them in parturients with and without PE. RESULT The values of CHAR derived from the parturients with PE were lower compared to those without PE (p < 0.01). The ROC analysis indicated that the best threshold for the mean value of CHAR was 7.92 to predict PE with a sensitivity of 86.4% and a specificity of 87.1%, while the threshold for the standard deviation of CHAR was 0.76 with a sensitivity of 77.3% and a specificity of 77.4%. The area under the curve (AUC) was 0.91 for mean value of CHAR while 0.78 for standard deviation of CHAR. Meanwhile, a contrast of AUC between CHAR and the former parameter we proposed showed CHAR had better performance in distinguishing PE (0.908 over 0.615, p < 0.01). CONCLUSION The novel parameter, CHAR, derived from PPG pulse wave differs in parturients with and without PE with high sensitivity and specificity, suggesting that the CHAR might be an effective tool in differentiating the presence of PE.
Collapse
Affiliation(s)
- Hang Chen
- College of Biomedical Engineering and Instrument Science, Zhejiang University, China; Key Lab of Biomedical Engineering of Ministry of Education, Zhejiang University, China; Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, China
| | - Feng Jiang
- College of Biomedical Engineering and Instrument Science, Zhejiang University, China; Key Lab of Biomedical Engineering of Ministry of Education, Zhejiang University, China; Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, China
| | - Dan Drzymalski
- Tufts Medical Center, Department of Anesthesiology, Boston, MA, USA
| | - Wanlin Chen
- College of Biomedical Engineering and Instrument Science, Zhejiang University, China; Key Lab of Biomedical Engineering of Ministry of Education, Zhejiang University, China; Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, China
| | - Ying Feng
- Women's Hospital, Zhejiang University, School of Medicine, China
| | - Jiajun Miao
- College of Biomedical Engineering and Instrument Science, Zhejiang University, China; Key Lab of Biomedical Engineering of Ministry of Education, Zhejiang University, China; Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, China
| | - Cuicui Jiao
- Women's Hospital, Zhejiang University, School of Medicine, China
| | - Xinzhong Chen
- Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, China; Women's Hospital, Zhejiang University, School of Medicine, China.
| |
Collapse
|
3
|
Song IK, Ji SH, Kim EH, Lee JH, Kim JT, Kim HS. Comparison of the effect of different infusion rates of sufentanil on surgical stress index during cranial pinning in children under general anaesthesia: a randomized controlled study. BMC Anesthesiol 2017; 17:167. [PMID: 29216820 PMCID: PMC5721662 DOI: 10.1186/s12871-017-0448-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 11/16/2017] [Indexed: 01/17/2023] Open
Abstract
Background Surgical stress index (SSI) is an established indicator for intraoperative nociception. Opioids are used to block stimulus of cranial pinning in neurosurgery. We investigated the effect of different infusion rates of sufentanil on SSI during cranial pinning in children under general anaesthesia. Methods Forty-nine children (2–12 years of age) underwent neurosurgery with pinning. The children were randomized into three groups based on the rate of sufentanil infusion: 0.2, 0.5, and 0.8 μg·kg−1·hr.−1. Continuous sufentanil infusion began following neuromuscular blockade administration, at a rate determined by each patient’s assigned treatment group. Following preparation for surgery, cranial pinning was performed. Systolic, diastolic, and mean blood pressures, along with heart rate and photoplethysmographic data, were continuously recorded from 1 min prior to cranial pinning through 5 min after cranial pinning, in 1-min intervals. SSI was calculated following the completion of surgery. Differences in measured outcomes over time among the three groups were evaluated using a generalized estimation equation. Differences in pinning outcomes in the same group were evaluated with Freidman test. Results We found no statistical differences in long-term SSI that were associated with different infusion rates of sufentanil during cranial pinning. Blood pressures in all groups increased for 2 min after cranial pinning, and then decreased; we found no statistical difference in long-term blood pressure values among the groups. Heart rate increased after pinning in the group that received a low-dose infusion of sufentanil. Conclusions Since SSI was intended to measure the blunting effects of sufentanil towards the noxious stimulus of cranial pinning, our results suggest that SSI might not be sufficiently sensitive to monitor the nociceptive response in children. Trial registration (KCT0000978, Jan-07, 2014).
Collapse
Affiliation(s)
- In-Kyung Song
- Department of Anaesthesiology and Pain Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Sang-Hwan Ji
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Eun-Hee Kim
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Ji-Hyun Lee
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jin-Tae Kim
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Hee-Soo Kim
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea.
| |
Collapse
|
4
|
Morino M, Masaki C, Seo Y, Mukai C, Mukaibo T, Kondo Y, Shiiba S, Nakamoto T, Hosokawa R. Non-randomized controlled prospective study on perioperative levels of stress and dysautonomia during dental implant surgery. J Prosthodont Res 2014; 58:177-83. [PMID: 24981241 DOI: 10.1016/j.jpor.2014.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 03/12/2014] [Accepted: 03/17/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to compare pre- and postoperative autonomic activities and changes in salivary stress biomarkers between patients who received only local anesthesia and those who received local anesthesia together with intravenous sedation in dental implant surgery. METHODS A total of 21 patients were enrolled in this non-randomized controlled prospective study; 7 subjects underwent implant surgery under local anesthesia with intravenous sedation and 14 subjects underwent surgery under only local anesthesia. Stress was evaluated by measuring salivary levels of chromogranin A (CgA) and a spectral analysis of heart rate variability (HRV) at baseline (on a day other than the day of surgery), 1h preoperatively, and 1h postoperatively. HRV analysis yields low- (LF) and high-frequency (HF) components, the LF/HF ratio, and the component coefficient of variance (CCV[HF]), which provide indices of sympathetic and parasympathetic regulatory activity. RESULTS CgA levels were significantly higher (p<0.05) at baseline in patients who received sedation than those who did not, but CgA levels did not differ prior to surgery. Also, the values of most parameters, including LF, HF, LF/HF (L/H), and CCV(HF), did not significantly differ between groups or among the three time points. Only ΔL/H and ΔCCV(HF) were significantly lower (p<0.05) at 1h preoperatively in patients who received sedation than those who received only local anesthesia. CONCLUSIONS CgA levels were high in both groups immediately before surgery, and thus CgA values immediately before surgery may not be a reliable indicator of the need for intravenous sedation. Also, spectral analysis of HRV, especially ΔL/H and ΔCCV(HF), could be useful for assessing tension and anxiety.
Collapse
Affiliation(s)
- Miyuki Morino
- Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan
| | - Chihiro Masaki
- Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan
| | - Yoshinori Seo
- Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan
| | - Chisato Mukai
- Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan
| | - Taro Mukaibo
- Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan
| | - Yusuke Kondo
- Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan
| | - Shunji Shiiba
- Department of Dental Anesthesiology, Kyushu Dental University, Japan
| | - Tetsuji Nakamoto
- Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan
| | - Ryuji Hosokawa
- Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan.
| |
Collapse
|
5
|
Zhang L, Xu L, Zhu J, Gao Y, Luo Z, Wang H, Zhu Z, Yu Y, Shi H, Bao H. To clarify features of photoplethysmography in monitoring balanced anesthesia, compared with Cerebral State Index. Med Sci Monit 2014; 20:481-6. [PMID: 24662222 PMCID: PMC3972055 DOI: 10.12659/msm.889924] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Although photoplethysmography and cerebral state index (CSI) have been used as indices in monitoring vital signs perioperatively, there are only a few reports comparing the performance of photoplethysmography with CSI in monitoring anaesthesia depth. The aim of the present study was to clarify features of photoplethysmography in monitoring balanced general anesthesia compared with CSI. Material/Methods Forty-five patients undergoing elective operation under general anaesthesia were enrolled in this study. Anaesthesia was induced with target-controlled infusion propofol. The photoplethysmogram, CSI, Modified Observer’s Assessment of Alertness/Sedation Scale (MOAAS), and mean arterial pressure (MAP) were continuously monitored and recorded. Finger photoplethysmogram amplitude (PPGA) and pulse beat interval (PBI) were calculated off-line. Results For the period of time from pre-induction to pre-intubation, the coefficient of correlation between MOAAS and CSI was higher than those between MOAAS and PPGA, PBI, and MAP. CSI showed higher prediction probabilities (Pk) to differentiate the levels of MOAAS than did PPGA, PBI, and MAP. PPGA, PBI, and MAP values showed significant differences between before and after intubation, as well as pre- and post-incision (P<0.05), but no significant changes in cerebral state index (P>0.05). Conclusions The present study shows that photoplethysmography-derived parameters appear to be more suitable in monitoring the nociceptive component of balanced general anesthesia, while CSI performs well in detecting the sedation or hypnotic component of balanced general anesthesia.
Collapse
Affiliation(s)
- Lieliang Zhang
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland)
| | - Lei Xu
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland)
| | - Juan Zhu
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland)
| | - Yujie Gao
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland)
| | - Zhonghua Luo
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland)
| | - Hongyu Wang
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland)
| | - Zhongliang Zhu
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland)
| | - Yi Yu
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland)
| | - Hongwei Shi
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland)
| | - Hongguang Bao
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland)
| |
Collapse
|