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Peng K, Karunakaran KD, Green S, Borsook D. Machines, mathematics, and modules: the potential to provide real-time metrics for pain under anesthesia. NEUROPHOTONICS 2024; 11:010701. [PMID: 38389718 PMCID: PMC10883389 DOI: 10.1117/1.nph.11.1.010701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/08/2024] [Accepted: 01/16/2024] [Indexed: 02/24/2024]
Abstract
The brain-based assessments under anesthesia have provided the ability to evaluate pain/nociception during surgery and the potential to prevent long-term evolution of chronic pain. Prior studies have shown that the functional near-infrared spectroscopy (fNIRS)-measured changes in cortical regions such as the primary somatosensory and the polar frontal cortices show consistent response to evoked and ongoing pain in awake, sedated, and anesthetized patients. We take this basic approach and integrate it into a potential framework that could provide real-time measures of pain/nociception during the peri-surgical period. This application could have significant implications for providing analgesia during surgery, a practice that currently lacks quantitative evidence to guide patient tailored pain management. Through a simple readout of "pain" or "no pain," the proposed system could diminish or eliminate levels of intraoperative, early post-operative, and potentially, the transition to chronic post-surgical pain. The system, when validated, could also be applied to measures of analgesic efficacy in the clinic.
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Affiliation(s)
- Ke Peng
- University of Manitoba, Department of Electrical and Computer Engineering, Price Faculty of Engineering, Winnipeg, Manitoba, Canada
| | - Keerthana Deepti Karunakaran
- Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, United States
| | - Stephen Green
- Massachusetts Institute of Technology, Department of Mechanical Engineering, Boston, Massachusetts, United States
| | - David Borsook
- Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, United States
- Massachusetts General Hospital, Harvard Medical School, Department of Radiology, Boston, Massachusetts, United States
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2
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Kant S, Banerjee D, Sabe SA, Sellke F, Feng J. Microvascular dysfunction following cardiopulmonary bypass plays a central role in postoperative organ dysfunction. Front Med (Lausanne) 2023; 10:1110532. [PMID: 36865056 PMCID: PMC9971232 DOI: 10.3389/fmed.2023.1110532] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
Despite significant advances in surgical technique and strategies for tissue/organ protection, cardiac surgery involving cardiopulmonary bypass is a profound stressor on the human body and is associated with numerous intraoperative and postoperative collateral effects across different tissues and organ systems. Of note, cardiopulmonary bypass has been shown to induce significant alterations in microvascular reactivity. This involves altered myogenic tone, altered microvascular responsiveness to many endogenous vasoactive agonists, and generalized endothelial dysfunction across multiple vascular beds. This review begins with a survey of in vitro studies that examine the cellular mechanisms of microvascular dysfunction following cardiac surgery involving cardiopulmonary bypass, with a focus on endothelial activation, weakened barrier integrity, altered cell surface receptor expression, and changes in the balance between vasoconstrictive and vasodilatory mediators. Microvascular dysfunction in turn influences postoperative organ dysfunction in complex, poorly understood ways. Hence the second part of this review will highlight in vivo studies examining the effects of cardiac surgery on critical organ systems, notably the heart, brain, renal system, and skin/peripheral tissue vasculature. Clinical implications and possible areas for intervention will be discussed throughout the review.
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Affiliation(s)
| | | | | | | | - Jun Feng
- Cardiothoracic Surgery Research Laboratory, Department of Cardiothoracic Surgery, Rhode Island Hospital, Lifespan, Providence, RI, United States
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3
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Yücel MA, Lühmann AV, Scholkmann F, Gervain J, Dan I, Ayaz H, Boas D, Cooper RJ, Culver J, Elwell CE, Eggebrecht A, Franceschini MA, Grova C, Homae F, Lesage F, Obrig H, Tachtsidis I, Tak S, Tong Y, Torricelli A, Wabnitz H, Wolf M. Best practices for fNIRS publications. NEUROPHOTONICS 2021; 8:012101. [PMID: 33442557 PMCID: PMC7793571 DOI: 10.1117/1.nph.8.1.012101] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/02/2020] [Indexed: 05/09/2023]
Abstract
The application of functional near-infrared spectroscopy (fNIRS) in the neurosciences has been expanding over the last 40 years. Today, it is addressing a wide range of applications within different populations and utilizes a great variety of experimental paradigms. With the rapid growth and the diversification of research methods, some inconsistencies are appearing in the way in which methods are presented, which can make the interpretation and replication of studies unnecessarily challenging. The Society for Functional Near-Infrared Spectroscopy has thus been motivated to organize a representative (but not exhaustive) group of leaders in the field to build a consensus on the best practices for describing the methods utilized in fNIRS studies. Our paper has been designed to provide guidelines to help enhance the reliability, repeatability, and traceability of reported fNIRS studies and encourage best practices throughout the community. A checklist is provided to guide authors in the preparation of their manuscripts and to assist reviewers when evaluating fNIRS papers.
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Affiliation(s)
- Meryem A. Yücel
- Boston University, Neurophotonics Center, Biomedical Engineering, Boston, Massachusetts, United States
- Massachusetts General Hospital, Harvard Medical School, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
- Address all correspondence to Meryem A. Yücel,
| | - Alexander v. Lühmann
- Boston University, Neurophotonics Center, Biomedical Engineering, Boston, Massachusetts, United States
- Massachusetts General Hospital, Harvard Medical School, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
| | - Felix Scholkmann
- University Hospital Zurich, University of Zurich, Department of Neonatology, Biomedical Optics Research Laboratory, Neonatology Research, Zurich, Switzerland
- University of Bern, Institute for Complementary and Integrative Medicine, Bern, Switzerland
| | - Judit Gervain
- Université de Paris, CNRS, Integrative Neuroscience and Cognition Center, Paris, France
- Università di Padova, Department of Social and Developmental Psychology, Padua, Italy
| | - Ippeita Dan
- Chuo University, Faculty of Science and Engineering, Applied Cognitive Neuroscience Laboratory, Tokyo, Japan
| | - Hasan Ayaz
- Drexel University, School of Biomedical Engineering, Science and Health Systems, Philadelphia, Pennsylvania, United States
- Drexel University, College of Arts and Sciences, Department of Psychology, Philadelphia, Pennsylvania, United States
- Drexel University, Drexel Solutions Institute, Philadelphia, Pennsylvania, United States
- University of Pennsylvania, Department of Family and Community Health, Philadelphia, Pennsylvania, United States
- Children’s Hospital of Philadelphia, Center for Injury Research and Prevention, Philadelphia, Pennsylvania, United States
| | - David Boas
- Boston University, Neurophotonics Center, Biomedical Engineering, Boston, Massachusetts, United States
| | - Robert J. Cooper
- University College London, DOT-HUB, Department of Medical Physics and Biomedical Engineering, Biomedical Optics Research Laboratory, London, United Kingdom
| | - Joseph Culver
- Washington University School of Medicine, Department of Radiology, St. Louis, Missouri, United States
| | - Clare E. Elwell
- University College London, Department of Medical Physics and Biomedical Engineering, London, United Kingdom
| | - Adam Eggebrecht
- Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, Missouri, United States
| | - Maria A. Franceschini
- Massachusetts General Hospital, Harvard Medical School, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
| | - Christophe Grova
- Concordia University, Department of Physics and PERFORM Centre, Multimodal Functional Imaging Lab, Montreal, Québec, Canada
- McGill University, Biomedical Engineering Department, Multimodal Functional Imaging Lab, Montreal, Québec, Canada
| | - Fumitaka Homae
- Tokyo Metropolitan University, Department of Language Sciences, Tokyo, Japan
| | - Frédéric Lesage
- Polytechnique Montréal, Department Electrical Engineering, Montreal, Canada
| | - Hellmuth Obrig
- University Hospital Leipzig, Max-Planck-Institute for Human Cognitive and Brain Sciences and Clinic for Cognitive Neurology, Leipzig, Germany
| | - Ilias Tachtsidis
- University College London, Department of Medical Physics and Biomedical Engineering, London, United Kingdom
| | - Sungho Tak
- Korea Basic Science Institute, Research Center for Bioconvergence Analysis, Ochang, Cheongju, Republic of Korea
| | - Yunjie Tong
- Weldon School of Biomedical Engineering Purdue University, West Lafayette, Indiana, United States
| | - Alessandro Torricelli
- Politecnico di Milano, Dipartimento di Fisica, Milan, Italy
- Consiglio Nazionale delle Ricerche, Istituto di Fotonica e Nanotecnologie, Milan, Italy
| | | | - Martin Wolf
- University Hospital Zurich, University of Zurich, Department of Neonatology, Biomedical Optics Research Laboratory, Neonatology Research, Zurich, Switzerland
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Spence J, Lamy A, Bosch J, Thabane L, Gagnon S, Power P, Browne A, Murkin J, Devereaux PJ. Feasibility of studying the association between intraoperative regional cerebral oxygen saturation and postoperative functional decline (ReFUNCTION): a pilot sub-study of NeuroVISION-Cardiac Surgery. Can J Anaesth 2020; 67:1497-1506. [PMID: 32767054 DOI: 10.1007/s12630-020-01777-3] [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: 03/01/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Function describes an individual's ability to perform everyday activities. In the context of cardiac surgery, functional changes quantify the effect of surgery on one's day-to-day life. Decreases in regional cerebral oxygen saturation (rScO2) measured using near-infrared spectroscopy (NIRS) has been associated with postoperative cognitive decline but its relationship with function has not been studied. We sought to determine the feasibility of conducting a large observational study examining the relationship between decreases in rScO2 during cardiac surgery and postoperative functional decline. METHODS We undertook a single-centre, pilot sub-study of the NeuroVISION-Cardiac Surgery pilot study, which included adults undergoing isolated coronary artery bypass grafting on cardiopulmonary bypass; all patients enrolled in NeuroVISION-Cardiac Surgery were included. Function was evaluated at baseline, 30 days, and three months using the Standardized Assessment of Global activities in the Elderly (SAGE) scale. Blinded NIRS monitors were affixed for the duration of surgery. Our feasibility outcomes were to recruit one patient per week, obtain complete NIRS data in ≥ 90%, obtain SAGE at all time-points in ≥ 90%, and determine the time required for NIRS data to be transcribed into case report forms. RESULTS 49/50 patients enrolled in NeuroVISION-Cardiac Surgery were recruited over 48 weeks (1.02 patients/week). Of the 49 included patients, 49 (100%) had complete NIRS data and 44 (90%) had complete SAGE data. The time required for NIRS data collection was a mean (standard deviation) of 5.5 (1.8) min per patient. CONCLUSION This pilot study shows the feasibility of conducting a large observational study examining the relationship between decreases in cerebral saturation during cardiac surgery and postoperative functional decline. TRIAL REGISTRATION www.clinicaltrials.gov (NCT04241289); registered 27 January 2020.
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Affiliation(s)
- Jessica Spence
- Departments of Anesthesia and Critical Care and Health Research Methods, Evaluation, and Impact, McMaster University, Hamilton, Canada. .,Population Health Research Institute, Hamilton, ON, Canada.
| | - Andre Lamy
- Population Health Research Institute, Hamilton, ON, Canada.,Departments of Surgery (Cardiac Surgery) and Health Research Methods, Evaluation, and Impact, McMaster University, Hamilton, Canada
| | - Jackie Bosch
- Population Health Research Institute, Hamilton, ON, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Lehana Thabane
- Population Health Research Institute, Hamilton, ON, Canada.,Department of Health Research Methods, Evaluation, and Impact, McMaster University, Hamilton, Canada
| | | | - Patricia Power
- Population Health Research Institute, Hamilton, ON, Canada
| | - Austin Browne
- Population Health Research Institute, Hamilton, ON, Canada
| | - John Murkin
- Department of Anesthesiology and Perioperative Medicine, University of Western Ontario, London, ON, Canada
| | - P J Devereaux
- Population Health Research Institute, Hamilton, ON, Canada.,Departments of Medicine and Health Research Methods, Evaluation, and Impact, McMaster University, Hamilton, Canada
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Holmgaard F, Vistisen ST, Ravn HB, Scheeren TWL. The response of a standardized fluid challenge during cardiac surgery on cerebral oxygen saturation measured with near-infrared spectroscopy. J Clin Monit Comput 2020; 34:245-251. [PMID: 31134474 PMCID: PMC7080680 DOI: 10.1007/s10877-019-00324-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 03/28/2019] [Indexed: 02/03/2023]
Abstract
Near infrared spectroscopy (NIRS) has been used to evaluate regional cerebral tissue oxygen saturation (ScO2) during the last decades. Perioperative management algorithms advocate to maintain ScO2, by maintaining or increasing cardiac output (CO), e.g. with fluid infusion. We hypothesized that ScO2 would increase in responders to a standardized fluid challenge (FC) and that the relative changes in CO and ScO2 would correlate. This study is a retrospective substudy of the FLuid Responsiveness Prediction Using Extra Systoles (FLEX) trial. In the FLEX trial, patients were administered two standardized FCs (5 mL/kg ideal body weight each) during cardiac surgery. NIRS monitoring was used during the intraoperative period and CO was monitored continuously. Patients were considered responders if stroke volume increased more than 10% following FC. Datasets from 29 non-responders and 27 responders to FC were available for analysis. Relative changes of ScO2 did not change significantly in non-responders (mean difference - 0.3% ± 2.3%, p = 0.534) or in fluid responders (mean difference 1.6% ± 4.6%, p = 0.088). Relative changes in CO and ScO2 correlated significantly, p = 0.027. Increasing CO by fluid did not change cerebral oxygenation. Despite this, relative changes in CO correlated to relative changes in ScO2. However, the clinical impact of the present observations is unclear, and the results must be interpreted with caution.Trial registration:http://ClinicalTrial.gov identifier for main study (FLuid Responsiveness Prediction Using Extra Systoles-FLEX): NCT03002129.
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Affiliation(s)
- Frederik Holmgaard
- Department of Cardiothoracic Anesthesiology, Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Simon T Vistisen
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Clinical Medicine, Aarhus University, Århus, Denmark.,Department of Anesthesiology & Intensive Care, Aarhus University Hospital, Århus, Denmark
| | - Hanne B Ravn
- Department of Cardiothoracic Anesthesiology, Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Thomas W L Scheeren
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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6
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Holmgaard F, Vedel AG, Rasmussen LS, Paulson OB, Nilsson JC, Ravn HB. The association between postoperative cognitive dysfunction and cerebral oximetry during cardiac surgery: a secondary analysis of a randomised trial. Br J Anaesth 2019; 123:196-205. [PMID: 31104758 DOI: 10.1016/j.bja.2019.03.045] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/11/2019] [Accepted: 03/15/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Postoperative cognitive dysfunction (POCD) occurs commonly after cardiac surgery. Near-infrared spectroscopy (NIRS) has been used to monitor regional cerebral oxygen saturation (rScO2) in order to minimise the occurrence of POCD by applying dedicated interventions when rScO2 decreases. However, the association between rScO2 intraoperatively and POCD has not been clarified. METHODS This is a secondary analysis of a randomised trial with physician-blinded NIRS monitoring and cognitive testing at discharge from hospital and at 3 months after surgery. The association between intraoperative rScO2 values and POCD at discharge from hospital and at 3 months after surgery was investigated. The prespecified candidate predictive variable of interest was cumulative time during surgery with rScO2 ≥10% below its preoperative value. RESULTS One hundred and fifty-three patients had complete NIRS data and neurocognitive assessments at discharge, and 44 of these patients (29%) had POCD. At 3 months, 148 patients had complete data, and 12 (8%) of these patients had POCD. The median time with rScO2 >10% below preoperative values did not differ for patients with and without POCD at discharge (difference=0.0 min; Hodges-Lehmann 95% confidence interval, -3.11-1.47, P=0.88). Other rScO2 time thresholds that were assessed were also not significantly different between those with and without POCD at discharge. This applied both to absolute rScO2 values and relative changes from preoperative values. Similar results were found in relation to POCD at 3 months. CONCLUSIONS No significant association was found between intraoperative rScO2 values and POCD. These findings bring into question the rationale for attempting to avoid decreases in rScO2 if the goal is to prevent POCD. CLINICAL TRIAL REGISTRATION NCT02185885.
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Affiliation(s)
- Frederik Holmgaard
- Department of Cardiothoracic Anesthesia, Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Anne G Vedel
- Department of Cardiothoracic Anesthesia, Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Anesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars S Rasmussen
- Department of Anesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Olaf B Paulson
- Neurobiological Research Unit, The Neuro Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens C Nilsson
- Department of Cardiothoracic Anesthesia, Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hanne B Ravn
- Department of Cardiothoracic Anesthesia, Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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