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Ionescu CM, Copot D, Yumuk E, De Keyser R, Muresan C, Birs IR, Ben Othman G, Farbakhsh H, Ynineb AR, Neckebroek M. Development, Validation, and Comparison of a Novel Nociception/Anti-Nociception Monitor against Two Commercial Monitors in General Anesthesia. SENSORS (BASEL, SWITZERLAND) 2024; 24:2031. [PMID: 38610243 PMCID: PMC11013864 DOI: 10.3390/s24072031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/12/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024]
Abstract
In this paper, we present the development and the validation of a novel index of nociception/anti-nociception (N/AN) based on skin impedance measurement in time and frequency domain with our prototype AnspecPro device. The primary objective of the study was to compare the Anspec-PRO device with two other commercial devices (Medasense, Medstorm). This comparison was designed to be conducted under the same conditions for the three devices. This was carried out during total intravenous anesthesia (TIVA) by investigating its outcomes related to noxious stimulus. In a carefully designed clinical protocol during general anesthesia from induction until emergence, we extract data for estimating individualized causal dynamic models between drug infusion and their monitored effect variables. Specifically, these are Propofol hypnotic drug to Bispectral index of hypnosis level and Remifentanil opioid drug to each of the three aforementioned devices. When compared, statistical analysis of the regions before and during the standardized stimulus shows consistent difference between regions for all devices and for all indices. These results suggest that the proposed methodology for data extraction and processing for AnspecPro delivers the same information as the two commercial devices.
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Affiliation(s)
- Clara M. Ionescu
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
- Department of Automation, Technical University Cluj-Napoca, Memorandumului Street 20, 400114 Cluj, Romania;
| | - Dana Copot
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
| | - Erhan Yumuk
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
- Department of Control and Automation Engineering, Istanbul Technical University, Maslak, Istanbul 34469, Turkey
| | - Robin De Keyser
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
| | - Cristina Muresan
- Department of Automation, Technical University Cluj-Napoca, Memorandumului Street 20, 400114 Cluj, Romania;
| | - Isabela Roxana Birs
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
- Department of Automation, Technical University Cluj-Napoca, Memorandumului Street 20, 400114 Cluj, Romania;
| | - Ghada Ben Othman
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
| | - Hamed Farbakhsh
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
| | - Amani R. Ynineb
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
| | - Martine Neckebroek
- Department of Anesthesia, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium;
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Ghita M, Birs IR, Copot D, Muresan CI, Neckebroek M, Ionescu CM. Parametric Modeling and Deep Learning for Enhancing Pain Assessment in Postanesthesia. IEEE Trans Biomed Eng 2023; 70:2991-3002. [PMID: 37527300 DOI: 10.1109/tbme.2023.3274541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
OBJECTIVE The problem of reliable and widely accepted measures of pain is still open. It follows the objective of this work as pain estimation through post-surgical trauma modeling and classification, to increase the needed reliability compared to measurements only. METHODS This article proposes (i) a recursive identification method to obtain the frequency response and parameterization using fractional-order impedance models (FOIM), and (ii) deep learning with convolutional neural networks (CNN) classification algorithms using time-frequency data and spectrograms. The skin impedance measurements were conducted on 12 patients throughout the postanesthesia care in a proof-of-concept clinical trial. Recursive least-squares system identification was performed using a genetic algorithm for initializing the parametric model. The online parameter estimates were compared to the self-reported level by the Numeric Rating Scale (NRS) for analysis and validation of the results. Alternatively, the inputs to CNNs were the spectrograms extracted from the time-frequency dataset, being pre-labeled in four intensities classes of pain during offline and online training with the NRS. RESULTS The tendency of nociception could be predicted by monitoring the changes in the FOIM parameters' values or by retraining online the network. Moreover, the tissue heterogeneity, assumed during nociception, could follow the NRS trends. The online predictions of retrained CNN have more specific trends to NRS than pain predicted by the offline population-trained CNN. CONCLUSION We propose tailored online identification and deep learning for artefact corrupted environment. The results indicate estimations with the potential to avoid over-dosing due to the objectivity of the information. SIGNIFICANCE Models and artificial intelligence (AI) allow objective and personalized nociception-antinociception prediction in the patient safety era for the design and evaluation of closed-loop analgesia controllers.
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Ghita M, Birs IR, Copot D, Muresan CI, Ionescu CM. Bioelectrical impedance analysis of thermal-induced cutaneous nociception. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Karer G, Škrjanc I. Improved Individualized Patient-Oriented Depth-of-Hypnosis Measurement Based on Bispectral Index. SENSORS (BASEL, SWITZERLAND) 2022; 23:293. [PMID: 36616891 PMCID: PMC9824030 DOI: 10.3390/s23010293] [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: 10/28/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Total intravenous anesthesia is an anesthesiologic technique where all substances are injected intravenously. The main task of the anesthesiologist is to assess the depth of anesthesia, or, more specifically, the depth of hypnosis (DoH), and accordingly adjust the dose of intravenous anesthetic agents. However, it is not possible to directly measure the anesthetic agent concentrations or the DoH, so the anesthesiologist must rely on various vital signs and EEG-based measurements, such as the bispectral (BIS) index. The ability to better measure DoH is directly applicable in clinical practice-it improves the anesthesiologist's assessment of the patient state regarding anesthetic agent concentrations and, consequently, the effects, as well as provides the basis for closed-loop control algorithms. This article introduces a novel structure for modeling DoH, which employs a residual dynamic model. The improved model can take into account the patient's individual sensitivity to the anesthetic agent, which is not the case when using the available population-data-based models. The improved model was tested using real clinical data. The results show that the predictions of the BIS-index trajectory were improved considerably. The proposed model thus seems to provide a good basis for a more patient-oriented individualized assessment of DoH, which should lead to better administration methods that will relieve the anesthesiologist's workload and will benefit the patient by providing improved safety, individualized treatment, and, thus, alleviation of possible adverse effects during and after surgery.
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Opioid Dose, Pain, and Recovery following Abdominal Surgery: A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11247320. [PMID: 36555937 PMCID: PMC9781588 DOI: 10.3390/jcm11247320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/04/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022] Open
Abstract
Background: The optimal dosage for opioids given to patients after surgery for pain management remains controversial. We examined the association of higher post-surgical opioid use with pain relief and recovery. Methods: We retrospectively enrolled adult patients who underwent elective abdominal surgery at our hospital between August 2021 and April 2022. Patients were divided into the “high-intensity” or “low-intensity” groups based on their post-surgical opioid use. Generalized estimating equation models were used to assess the associations between pain scores at rest and during movement on days 1, 2, 3, and 5 after surgery as primary outcomes. The self-reported recovery and incidence of adverse events were analyzed as secondary outcomes. Results: Among the 1170 patients in the final analysis, 293 were in the high-intensity group. Patients in the high-intensity group received nearly double the amount of oral morphine equivalents per day compared to those in the low-intensity group (84.52 vs. 43.80), with a mean difference of 40.72 (95% confidence interval (CI0 38.96−42.48, p < 0.001) oral morphine equivalents per day. At all timepoints, the high-intensity group reported significantly higher pain scores at rest (difference in means 0.45; 95% CI, 0.32 to 0.58; p < 0.001) and during movement (difference in means 0.56; 95% CI, 0.41 to 0.71; p < 0.001) as well as significantly lower recovery scores (mean difference (MD) −8.65; 95% CI, −10.55 to −6.67; p < 0.001). A post hoc analysis found that patients with moderate to severe pain during movement were more likely to receive postoperative high-intensity opioid use. Furthermore, patients in the non-high-intensity group got out of bed sooner (MD 4.31 h; p = 0.001), required urine catheters for shorter periods of time (MD 12.26 h; p < 0.001), and were hospitalized for shorter periods (MD 1.17 days; p < 0.001). The high-intensity group was at a higher risk of chronic postsurgical pain (odds ratio 1.54; 95% CI, 1.14 to 2.08, p = 0.005). Conclusions: High-intensity opioid use after elective abdominal surgery may not be sufficient for improving pain management or the quality of recovery compared to non-high-intensity use. Our results strengthen the argument for a multimodal approach that does not rely so heavily on opioids.
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Ghita M, Ghita M, Copot D, Birs I, Muresan CI, Ionescu CM. Lumped Parametric Model for Skin Impedance Data in Patients with Postoperative Pain. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:4708-4711. [PMID: 36086513 DOI: 10.1109/embc48229.2022.9871666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The societal and economic burden of unassessed and unmodeled postoperative pain is high and predicted to rise over the next decade, leading to over-dosing as a result of subjective (NRS-based) over-estimation by the patient. This study identifies how post-surgical trauma alters the parameters of impedance models, to detect and examine acute pain variability. Model identification is performed on clinical data captured from post-anesthetized patients, using Anspec-PRO prototype apriori validated for clinical pain assessment. The multisine excitation of this in-house developed device enables utilizing the complex skin impedance frequency response in data-driven electrical models. The single-dispersion Cole model is proposed to fit the clinical curve in the given frequency range. Changes in identified parameters are analyzed for correlation with the patient's reported pain for the same time moment. The results suggest a significant correlation for the capacitor component. Clinical Relevance- Individual model parameters validated on patients in the post-anesthesia care unit extend the knowledge for objective pain detection to positively influence the outcome of clinical analgesia management.
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Schiavo M, Padula F, Latronico N, Paltenghi M, Visioli A. A modified PID-based control scheme for depth-of-hypnosis control: Design and experimental results. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 219:106763. [PMID: 35349908 DOI: 10.1016/j.cmpb.2022.106763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/05/2022] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Many methodologies have been proposed for the control of total intravenous anesthesia in general surgery, as this yields a reduced stress for the anesthesiologist and an increased safety for the patient. The objective of this work is to design a PID-based control system for the regulation of the depth of hypnosis by propofol and remifentanil coadministration that takes into account the clinical practice. METHODS With respect to a standard PID control system, additional functionalities have been implemented in order to consider specific requirements related to the clinical practice. In particular, suitable boluses are determined and used in the induction phase and a nonzero baseline infusion is used in the maintenance phase when the predicted effect-site concentration drops below a safety threshold. RESULTS The modified controller has been experimentally assessed on a group of 10 patients receiving general anesthesia for elective plastic surgery. The control system has been able to induce and maintain adequate anesthesia without any manual intervention from the anesthesiologist. CONCLUSIONS Results confirm the effectiveness of the overall design approach and, in particular, highlight that the new version of the control system, with respect to a standard PID controller, provides significant advantages from a clinical standpoint.
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Affiliation(s)
- Michele Schiavo
- Dipartimento di Ingegneria dell'Informazione, University of Brescia, Brescia, Italy.
| | - Fabrizio Padula
- Curtin Centre for Optimisation and Decision Science, Curtin University, Perth, Australia.
| | - Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; Department of Anesthesiology, Critical Care and Emergency Spedali Civili di Brescia, Brescia, Italy.
| | - Massimiliano Paltenghi
- Department of Anesthesiology, Critical Care and Emergency Spedali Civili di Brescia, Brescia, Italy.
| | - Antonio Visioli
- Dipartimento di Ingegneria Meccanica e Industriale University of Brescia, Brescia, Italy.
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Ghita M, Neckebroek M, Juchem J, Copot D, Muresan CI, Ionescu CM. Bioimpedance Sensor and Methodology for Acute Pain Monitoring. SENSORS (BASEL, SWITZERLAND) 2020; 20:E6765. [PMID: 33256120 PMCID: PMC7729453 DOI: 10.3390/s20236765] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 12/13/2022]
Abstract
The paper aims to revive the interest in bioimpedance analysis for pain studies in communicating and non-communicating (anesthetized) individuals for monitoring purpose. The plea for exploitation of full potential offered by the complex (bio)impedance measurement is emphasized through theoretical and experimental analysis. A non-invasive, low-cost reliable sensor to measure skin impedance is designed with off-the-shelf components. This is a second generation prototype for pain detection, quantification, and modeling, with the objective to be used in fully anesthetized patients undergoing surgery. The 2D and 3D time-frequency, multi-frequency evaluation of impedance data is based on broadly available signal processing tools. Furthermore, fractional-order impedance models are implied to provide an indication of change in tissue dynamics correlated with absence/presence of nociceptor stimulation. The unique features of the proposed sensor enhancements are described and illustrated here based on mechanical and thermal tests and further reinforced with previous studies from our first generation prototype.
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Affiliation(s)
- Mihaela Ghita
- Research Group of Dynamical Systems and Control, Ghent University, Tech Lane Science Park 125, 9052 Ghent, Belgium; (J.J.); (D.C.); (C.M.I.)
- EEDT—Core Lab on Decision and Control, Flanders Make Consortium, Tech Lane Science Park 131, 9052 Ghent, Belgium
| | - Martine Neckebroek
- Department of Anesthesia, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium;
| | - Jasper Juchem
- Research Group of Dynamical Systems and Control, Ghent University, Tech Lane Science Park 125, 9052 Ghent, Belgium; (J.J.); (D.C.); (C.M.I.)
- EEDT—Core Lab on Decision and Control, Flanders Make Consortium, Tech Lane Science Park 131, 9052 Ghent, Belgium
| | - Dana Copot
- Research Group of Dynamical Systems and Control, Ghent University, Tech Lane Science Park 125, 9052 Ghent, Belgium; (J.J.); (D.C.); (C.M.I.)
- EEDT—Core Lab on Decision and Control, Flanders Make Consortium, Tech Lane Science Park 131, 9052 Ghent, Belgium
| | - Cristina I. Muresan
- Department of Automation, Technical University of Cluj-Napoca, Memorandumului 28, 400114 Cluj-Napoca, Romania;
| | - Clara M. Ionescu
- Research Group of Dynamical Systems and Control, Ghent University, Tech Lane Science Park 125, 9052 Ghent, Belgium; (J.J.); (D.C.); (C.M.I.)
- EEDT—Core Lab on Decision and Control, Flanders Make Consortium, Tech Lane Science Park 131, 9052 Ghent, Belgium
- Department of Automation, Technical University of Cluj-Napoca, Memorandumului 28, 400114 Cluj-Napoca, Romania;
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