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Amirfarzan H, Cassidy KJ, Moaddab M, Demin M, Schumann R, Lewis B. Assessment of seizure duration and utility of using SedLine ® EEG tracing in veterans undergoing electroconvulsive therapy: a retrospective analysis. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:8. [PMID: 38321515 PMCID: PMC10845389 DOI: 10.1186/s44158-024-00143-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/20/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) endures as a definitive treatment for refractory depression and catatonia and is also considered an effective treatment for a number of other severe psychiatric disorders (Lisanby, N Engl J Med 357:1939-1945, 2007)(Weiner and Prudic, Biol Psychiatry 73:105-106, 2013). GA is an essential component of the ECT procedure for various reasons (Lee, Jenkins and Sparkle, Life 11, 2021). Monitoring anesthetic effects on the brain is desirable as anesthetic agents affect seizure duration and recovery (Rasulo, Hopkins, Lobo, et al, Neurocrit Care 38:296-311, 2023) (Jones , Nittur , Fleming and Applegate, BMC Anesthesiol 21:105, 2021) (Soehle , Kayser , Ellerkmann and Schlaepfer, BJA 112:695-702, 2013). Perioperative anesthetic effects on consciousness can be assessed with brain function monitoring using raw electroencephalogram (EEG) traces and processed EEG indices. OBJECTIVE We examined the usefulness and utility of the SedLine® anesthetic effect monitor during ECT procedures. We hypothesized that the seizure duration as measured by the EEG tracing of the ECT machine is equivalent to the duration assessed by the SedLine® EEG tracing. A secondary objective was to describe the SedLine® patient state indices (PSI) at different phases of treatment. METHODS Following IRB approval, we analyzed the data of the electronic medical records of 45 ECT treatments of 23 patients in an urban VA medical center between July 01, 2021, and March 30, 2022. We compared the seizure duration in minutes and seconds as measured either by the ECT machine EEG tracing or the SedLine® EEG tracing. We then collected SedLine® processed EEG indices at four different stages during the treatment. Appropriate comparative and observational statistical analyses were applied. RESULTS There was no significant difference in measured seizure duration between the two methods examined (p < 0.05). We observed a lag of the SedLine PSI value at the time before stimulus delivery and limited PSI utility during the course of ECT. CONCLUSION The SedLine® EEG tracing can be an alternative to the machine EEG tracing for the determination of seizure duration. The SedLine® processed EEG indices are not consistently useful before and after ECT delivery. Anesthetic effect monitoring during ECT is feasible.
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Affiliation(s)
- Houman Amirfarzan
- Department of Anesthesia, Critical Care and Pain Medicine, VA Boston Healthcare System, Tufts University School of Medicine, Boston, MA, USA.
| | - Kaitlin Jane Cassidy
- Cooperative Studies Program Clinical Trials Coordinating Center, VA Boston Healthcare System, Boston, MA, USA
| | - Mehrak Moaddab
- Department of Anesthesia, Critical Care and Pain Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ma Demin
- Department of Psychiatry, VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA
| | - Roman Schumann
- Department of Anesthesia, Critical Care and Pain Medicine, VA Boston Healthcare System, Tufts University School of Medicine, Boston, MA, USA
| | - Bradford Lewis
- Department of Psychiatry, VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA
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Zhang Y, Wang Y, Cheng H, Yan F, Li D, Song D, Wang Q, Huang L. EEG spectral slope: A reliable indicator for continuous evaluation of consciousness levels during propofol anesthesia. Neuroimage 2023; 283:120426. [PMID: 37898378 DOI: 10.1016/j.neuroimage.2023.120426] [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: 07/11/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 10/30/2023] Open
Abstract
The level of consciousness undergoes continuous alterations during anesthesia. Prior to the onset of propofol-induced complete unconsciousness, degraded levels of behavioral responsiveness can be observed. However, a reliable index to monitor altered consciousness levels during anesthesia has not been sufficiently investigated. In this study, we obtained 60-channel EEG data from 24 healthy participants during an ultra-slow propofol infusion protocol starting with an initial concentration of 1 μg/ml and a stepwise increase of 0.2 μg/ml in concentration. Consecutive auditory stimuli were delivered every 5 to 6 s, and the response time to the stimuli was used to assess the responsiveness levels. We calculated the spectral slope in a time-resolved manner by extracting 5-second EEG segments at each auditory stimulus and estimated their correlation with the corresponding response time. Our results demonstrated that during slow propofol infusion, the response time to external stimuli increased, while the EEG spectral slope, fitted at 15-45 Hz, became steeper, and a significant negative correlation was observed between them. Moreover, the spectral slope further steepened at deeper anesthetic levels and became flatter during anesthesia recovery. We verified these findings using an external dataset. Additionally, we found that the spectral slope of frontal electrodes over the prefrontal lobe had the best performance in predicting the response time. Overall, this study used a time-resolved analysis to suggest that the EEG spectral slope could reliably track continuously altered consciousness levels during propofol anesthesia. Furthermore, the frontal spectral slope may be a promising index for clinical monitoring of anesthesia depth.
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Affiliation(s)
- Yun Zhang
- School of Life Science and Technology, Xidian University, No.2 TaiBai South Road, Xi'an 710061, China
| | - Yubo Wang
- School of Life Science and Technology, Xidian University, No.2 TaiBai South Road, Xi'an 710061, China
| | - Huanhuan Cheng
- School of Life Science and Technology, Xidian University, No.2 TaiBai South Road, Xi'an 710061, China
| | - Fei Yan
- Department of Anesthesiology & Center for Brain Science, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an 710061, China
| | - Dingning Li
- School of Life Science and Technology, Xidian University, No.2 TaiBai South Road, Xi'an 710061, China
| | - Dawei Song
- Department of Anesthesiology & Center for Brain Science, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an 710061, China
| | - Qiang Wang
- Department of Anesthesiology & Center for Brain Science, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an 710061, China.
| | - Liyu Huang
- School of Life Science and Technology, Xidian University, No.2 TaiBai South Road, Xi'an 710061, China.
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3
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Gkrouzoudi A, Tsingotjidou A, Jirkof P. A systematic review on reporting of refinement measures in mouse ECG telemetry implantation surgery. Lab Anim 2023; 57:9-25. [PMID: 36117425 DOI: 10.1177/00236772221115492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Telemetric monitoring is used in many scientific fields, such as cardiovascular research, neurology, endocrinology, as well as animal welfare research. Nowadays, implanted electrocardiogram (ECG) radiotelemetry units are the gold standard for monitoring ECG traces, heart rate and heart rate variability in freely moving mice. Telemetry technology can be a valuable tool when studies utilize it adequately, while prioritizing animal welfare. Recently, concerns have been raised in many research fields, including animal research, regarding the reproducibility of research findings, with insufficient reporting being one of the underlying causes.A systematic review was performed by making use of three literature databases, in order to include all publications until 31.12.2019, where the surgical placing of ECG recording telemetry devices in adult mice was involved. Data extracted from the publications included selected items recommended by the ARRIVE guidelines. We focused on aspects related to the refinement of the surgery and experimental conditions that aim to improve animal welfare. In general, the quality of reporting was low in the analyzed 234 publications. Based on our analyses, we assume there has been no improvement in this field's reporting quality since 2010 when the ARRIVE guidelines on reporting were introduced. Additionally, even though expert recommendations on telemetry surgery refinement have been available since many years now, no increase in uptake (or reporting) of these measures prior (e.g., acclimatization), during (e.g., asepsis) or after (e.g., social housing) the surgery could be observed.
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Affiliation(s)
- Alexandra Gkrouzoudi
- Laboratory of Anatomy, Histology and Embryology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Anastasia Tsingotjidou
- Laboratory of Anatomy, Histology and Embryology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Paulin Jirkof
- Division for Surgical Research, University Hospital Zurich, University of Zurich, Switzerland.,Office for Animal Welfare and 3Rs, University of Zurich, Switzerland
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4
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Boysen PG, Patel JH, King AN. Brief History of Opioids in Perioperative and Periprocedural Medicine to Inform the Future. Ochsner J 2023; 23:43-49. [PMID: 36936479 PMCID: PMC10016219 DOI: 10.31486/toj.22.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Opioids and derivatives of opium had been used as analgesics for thousands of years before the introduction of inhalational anesthetic agents. Once these early volatile agents were in widespread use, opioids were used as part of anesthetic care for premedication, as intraoperative adjuncts to general anesthesia, and for the management of postoperative pain. Evidence of growing dependence on opioids in the perioperative and periprocedural patient is supported by the ongoing research to develop synthetic opioids and to customize the pharmacokinetics and pharmacodynamics to achieve specific therapeutic goals. Methods: We explore the history of opioid use in perioperative care as a means of future management in light of new persistent opioid abuse. Results: As the opium chemical structure has been modified, newer nonopioid analgesics have been approved and brought into clinical practice. Opioid-sparing and opioid-free anesthetic techniques are not only a possibility, but a reality. Conclusion: Continuing research in neurobiology and addiction genetics will ultimately lead to a pharmacogenetic approach to patients at risk for new persistent opioid abuse.
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Affiliation(s)
- Philip G. Boysen
- Emeritus Professor and Chair, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Address correspondence to Philip G. Boysen, MD, MBA, FACP, FCCP, FCCM, Medical Director, Biomat USA Plasmapheresis Center, 5661 Bullard Ave., New Orleans, LA 70128. Tel: (504) 246-1135.
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5
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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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6
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Han L, Drover DR, Chen MC, Saxena AR, Eagleman SL, Nekhendzy V, Capasso R. Evaluation of patient state index, bispectral index, and entropy during drug induced sleep endoscopy with dexmedetomidine. J Clin Monit Comput 2022; 37:727-734. [PMID: 36550344 DOI: 10.1007/s10877-022-00952-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022]
Abstract
Multiple electroencephalographic (EEG) monitors and their associated EEG markers have been developed to aid in assessing the level of sedation in the operating room. While many studies have assessed the response of these markers to propofol sedation and anesthetic gases, few studies have compared these markers when using dexmedetomidine, an alpha-2 agonist. Fifty-one patients underwent drug induced sleep endoscopy with dexmedetomidine sedation. Continuous EEG was captured using SedLine (Masimo, Inc), and a playback system was used to extract the bispectral index (BIS) (Medtronic Inc), the patient state index (PSI) (Masimo, Inc), the state and response Entropy (GE Healthcare), and calculate the spectral edge frequency 95% (SEF95). Richmond Agitation-Sedation Scale (RASS) scores were assessed continually throughout the procedure and in recovery. We assessed the correlation between EEG markers and constructed ordinal logistic regression models to predict the RASS score and compare EEG markers. All three commercial EEG metrics were significantly associated with the RASS score (p < 0.001 for all metrics) whereas SEF95 alone was insufficient at characterizing dexmedetomidine sedation. PSI and Entropy achieved higher accuracy at predicing deeper levels of sedation as compared to BIS (PSI: 58.3%, Entropy: 58.3%, BIS: 44.4%). Lightening secondary to RASS score assessment is significantly captured by all three commercial EEG metrics (p < 0.001). Commercial EEG monitors can capture changes in the brain state associated with the RASS score during dexmedetomidine sedation. PSI and Entropy were highly correlated and may be better suited for assessing deeper levels of sedation.
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Affiliation(s)
- Lichy Han
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, 300 Pasteur Drive Room H3580 MC 5640, Stanford, CA, 94305-5117, USA.
| | - David R Drover
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, 300 Pasteur Drive Room H3580 MC 5640, Stanford, CA, 94305-5117, USA
| | - Marianne C Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, 300 Pasteur Drive Room H3580 MC 5640, Stanford, CA, 94305-5117, USA
| | - Amit R Saxena
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, 300 Pasteur Drive Room H3580 MC 5640, Stanford, CA, 94305-5117, USA
| | - Sarah L Eagleman
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Vladimir Nekhendzy
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, 300 Pasteur Drive Room H3580 MC 5640, Stanford, CA, 94305-5117, USA
| | - Robson Capasso
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, CA, USA
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7
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Yoo JH, Ok SY, Kim SH, Chung JW, Park SY, Kim MG, Cho HB, Song SH, Choi SJ, Oh HC. Comparison of bispectral index and phase lag entropy during general anesthesia: Sevoflurane or propofol anesthesia. Medicine (Baltimore) 2022; 101:e31191. [PMID: 36343067 PMCID: PMC9646625 DOI: 10.1097/md.0000000000031191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Phase-lag entropy (PLE) based on functional connectivity between different regions of the brain may be superior to conventional depth of anesthesia (DoA) methods for monitoring changes in consciousness. However, few studies have compared the PLE and bispectral index (BIS) methods for monitoring consciousness during clinical anesthesia, such as total intravenous anesthesia (TIVA) or anesthesia via inhalation. Therefore, we evaluated differences between the PLE and BIS methods in clinical anesthesia, including TIVA using propofol and anesthesia with sevoflurane. METHODS The observational trial included 60 patients scheduled for elective surgery under general anesthesia. The BIS and PLE electrodes were placed together on the left temporal-frontal area of all patients. During anesthesia, anesthetic levels were adjusted using the BIS values, which are generally used to monitor the DoA; the level of anesthesia was maintained at between 40 and 60. BIS- and PLE-derived values were recorded continuously. Anesthetic events, the concentration of each anesthetic, and standard monitoring values were recorded. The patients included were divided into 2 groups, the TIVA and sevoflurane groups, with 30 patients in each. For the TIVA group, anesthesia was induced and maintained using propofol and remifentanil target-controlled infusion. For the sevoflurane group, anesthesia was induced using propofol and maintained using sevoflurane and remifentanil. RESULTS From loss of consciousness until the anesthetic maintenance period, PLE values were higher than BIS values at several time points. During the recovery period, BIS values were higher than PLE values (all P < .001). Spaghetti plots showed that there was more variation among the BIS values than among the PLE values. CONCLUSIONS For monitoring DoA during general anesthesia and surgery, PLE values vary less than BIS values; thus, PLE may be more reliable for monitoring changes in consciousness. However, further studies are needed to evaluate the clinical application of these methods in general anesthesia.
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Affiliation(s)
- Jae Hwa Yoo
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Yongsan-gu, Seoul, Republic of Korea
- *Correspondence: Jae Hwa Yoo, Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, 59 Daesagwan-gil, Yongsan-gu, Seoul 04401, Republic of Korea (e-mail: )
| | - Si Young Ok
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Yongsan-gu, Seoul, Republic of Korea
| | - Sang Ho Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Yongsan-gu, Seoul, Republic of Korea
| | - Ji Won Chung
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Yongsan-gu, Seoul, Republic of Korea
| | - Sun Young Park
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Yongsan-gu, Seoul, Republic of Korea
| | - Mun Gyu Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Yongsan-gu, Seoul, Republic of Korea
| | - Ho Bum Cho
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Yongsan-gu, Seoul, Republic of Korea
| | - Sang Hoon Song
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Yongsan-gu, Seoul, Republic of Korea
| | - Sang Jin Choi
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Yongsan-gu, Seoul, Republic of Korea
| | - Hong Chul Oh
- Department of Cardiovascular and thoracic surgery, Soonchunhyang University Hospital Seoul, Yongsan-gu, Seoul, Republic of Korea
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8
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Huang Y, Wen P, Song B, Li Y. Real-Time Depth of Anaesthesia Assessment Based on Hybrid Statistical Features of EEG. SENSORS (BASEL, SWITZERLAND) 2022; 22:6099. [PMID: 36015860 PMCID: PMC9414837 DOI: 10.3390/s22166099] [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: 07/07/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
This paper proposed a new depth of anaesthesia (DoA) index for the real-time assessment of DoA using electroencephalography (EEG). In the proposed new DoA index, a wavelet transform threshold was applied to denoise raw EEG signals, and five features were extracted to construct classification models. Then, the Gaussian process regression model was employed for real-time assessment of anaesthesia states. The proposed real-time DoA index was implemented using a sliding window technique and validated using clinical EEG data recorded with the most popular commercial DoA product Bispectral Index monitor (BIS). The results are evaluated using the correlation coefficients and Bland-Altman methods. The outcomes show that the highest and the average correlation coefficients are 0.840 and 0.814, respectively, in the testing dataset. Meanwhile, the scatter plot of Bland-Altman shows that the agreement between BIS and the proposed index is 94.91%. In contrast, the proposed index is free from the electromyography (EMG) effect and surpasses the BIS performance when the signal quality indicator (SQI) is lower than 15, as the proposed index can display high correlation and reliable assessment results compared with clinic observations.
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Affiliation(s)
- Yi Huang
- School of Engineering, University of Southern Queensland, Toowoomba 4350, Australia
| | - Peng Wen
- School of Engineering, University of Southern Queensland, Toowoomba 4350, Australia
| | - Bo Song
- School of Engineering, University of Southern Queensland, Toowoomba 4350, Australia
| | - Yan Li
- School of Mathematics, Physics and Computing, University of Southern Queensland, Toowoomba 4350, Australia
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9
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Gantzel M, Gasbjerg KS, Hägi-Pedersen D, Meyhoff CS, Olsen MH, Mathiesen O, Jakobsen JC, Lunn TH. Effect of dexamethasone on intraoperative remifentanil dose in total knee arthroplasty surgery under general anaesthesia. Acta Anaesthesiol Scand 2022; 66:1070-1076. [PMID: 35908167 PMCID: PMC9543467 DOI: 10.1111/aas.14118] [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: 03/12/2022] [Revised: 07/01/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022]
Abstract
Background The effects of glucocorticoids may include both genomic and rapid nongenomic effects. The potential rapid analgesic effect during surgery has not previously been investigated. We aimed to explore the effect of dexamethasone on intraoperative infusion rate of remifentanil in patients undergoing total knee arthroplasty (TKA) surgery under general anaesthesia. Methods In this post hoc subgroup analysis, we included patients randomised in the DEX‐2‐TKA trial, who were operated under total intravenous anaesthesia with remifentanil and propofol. Trial medication, intravenous dexamethasone 24 mg or placebo, was administered immediately after anaesthesia onset. The primary outcome was the median weight‐corrected infusion rate of remifentanil during surgery. Secondary outcomes included median weight‐corrected infusion rate of propofol, median intraoperative bispectral index and time spent in the post‐anaesthesia care unit. Results Eighty‐seven patients were included in the analysis of the primary outcome. A significantly higher remifentanil infusion rate was observed in the dexamethasone group compared with the placebo group, p = .02. None of the secondary outcomes resulted in statistically significant differences between groups. Conclusion This explorative post hoc analysis of the randomised DEX‐2‐TKA trail showed that patients undergoing TKA surgery under general anaesthesia and who received dexamethasone seemed to have a higher remifentanil infusion rate compared with patients who received placebo. The clinical implications of the potentially increased remifentanil infusion rate need to be validated and explored further. Clinical trial registration ClinicalTrials.gov Identifier: NCT05002361 (12 August 2021).
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Affiliation(s)
- Maria Gantzel
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Kasper Smidt Gasbjerg
- Research Centre of Anaesthesiology and Intensive Care Medicine, Department of Anaesthesiology, Naestved-Slagelse- Ringsted Hospitals, Denmark
| | - Daniel Hägi-Pedersen
- Research Centre of Anaesthesiology and Intensive Care Medicine, Department of Anaesthesiology, Naestved-Slagelse- Ringsted Hospitals, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Christian Sylvest Meyhoff
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Markus Harboe Olsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ole Mathiesen
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark.,Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | - Janus Christian Jakobsen
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark.,Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Troels Haxholdt Lunn
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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10
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Schmierer T, Li T, Li Y. A novel empirical wavelet SODP and spectral entropy based index for assessing the depth of anaesthesia. Health Inf Sci Syst 2022; 10:10. [PMID: 35685297 PMCID: PMC9170862 DOI: 10.1007/s13755-022-00178-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/26/2022] [Indexed: 11/27/2022] Open
Abstract
The requirement for anaesthesia during modern surgical procedures is unquestionable to ensure a safe experience for patients with successful recovery. Assessment of the depth of anaesthesia (DoA) is an important and ongoing field of research to ensure patient stability during and post-surgery. This research addresses the limitations of current DoA indexes by developing a new index based on electroencephalography (EEG) signal analysis. Empirical wavelet transformation (EWT) methods are employed to extract wavelet coefficients before statistical analysis. The features Spectral Entropy and Second Order Difference Plot are extracted from the wavelet coefficients. These features are used to train a new index, SSEDoA, utilising a Support Vector Machine (SVM) with a linear kernel function. The new index accurately assesses the DoA to illustrate the transition between different anaesthetic stages. Testing was undertaken with nine patients and an additional four patients with low signal quality. Across the nine patients we tested, an average correlation of 0.834 was observed with the Bispectral (BIS) index. The analysis of the DoA stage transition exhibited a Choen's Kappa of 0.809, indicative of a high agreement.
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Affiliation(s)
- Thomas Schmierer
- School of Mathematics, Physics and Computing, University of Southern Queensland, Darling Heights, Australia
| | - Tianning Li
- School of Mathematics, Physics and Computing, University of Southern Queensland, Darling Heights, Australia
| | - Yan Li
- School of Mathematics, Physics and Computing, University of Southern Queensland, Darling Heights, Australia
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11
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Zhang L, Li H, Deng L, Fang K, Cao Y, Huang C, Gu E, Li J. Electroencephalogram Mechanism of Dexmedetomidine Deepening Sevoflurane Anesthesia. Front Neurosci 2022; 16:913042. [PMID: 35645714 PMCID: PMC9133498 DOI: 10.3389/fnins.2022.913042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/25/2022] [Indexed: 11/28/2022] Open
Abstract
Dexmedetomidine, as an α2-adrenoceptor agonist, plays anti-sympathetic, sedative and analgesic roles in perioperative period. Also, dexmedetomidine can reduce the minimal alveolar concentration (MAC) of sevoflurane and the risk of postoperative cognitive dysfunction (POCD) induced by sevoflurane anesthesia. But so far, the electroencephalogram (EEG) mechanism of dexmedetomidine deepening sevoflurane anesthesia is not clear. In this study, by analyzing the changes of the power spectrum and bicoherence spectrum of EEG before and after dexmedetomidine infusion, the EEG mechanism of dexmedetomidine deepening sevoflurane anesthesia was studied. We analyzed dexmedetomidine-induced changes in power spectrum and bicoherence spectrum in 23 patients under sevoflurane anesthesia. After anesthesia induction, the sevoflurane concentration was maintained at 0.8 MAC for 15 min, and then dexmedetomidine was administered at a loading dose of 0.8 μg/kg in 10 min, followed by a maintenance rate of 0.5 μg⋅kg–1⋅h–1. Frontal EEG data from 5 min before and 10 min after dexmedetomidine infusion were compared. After dexmedetomidine infusion, the mean α power peak decreased from 6.09 to 5.43 dB and shifted to a lower frequency, the mean θ bicoherence peak increased from 29.57 to 41.25% and shifted to a lower frequency, and the median α bicoherence peak increased from 41.49 to 46.36% and shifted to a lower frequency. These results demonstrate that dexmedetomidine deepens sevoflurane anesthesia, and enhances α and θ bicoherences while shifting peak values of these bands to lower frequencies through regulating thalamo-cortical reverberation networks probably.
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Affiliation(s)
- Lei Zhang
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, School of Pharmacy, Anhui Institute of Innovative Drugs, Anhui Medical University, Hefei, China
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Hua Li
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Liyun Deng
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Kun Fang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yuanyuan Cao
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Cheng Huang
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, School of Pharmacy, Anhui Institute of Innovative Drugs, Anhui Medical University, Hefei, China
- Key Laboratory of Anti-inflammatory and Immune Medicine, Ministry of Education, Hefei, China
- Institute for Liver Diseases of Anhui Medical University, Hefei, China
| | - Erwei Gu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
- *Correspondence: Erwei Gu,
| | - Jun Li
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, School of Pharmacy, Anhui Institute of Innovative Drugs, Anhui Medical University, Hefei, China
- Key Laboratory of Anti-inflammatory and Immune Medicine, Ministry of Education, Hefei, China
- Institute for Liver Diseases of Anhui Medical University, Hefei, China
- Jun Li,
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12
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Chandran R, De Sousa K, Koo SH, Lim YY, Shang L, Paiputra F, Tan JH, Ching TTH, Khoo X. A device to detect leakage at the patient end of total intravenous anaesthesia. J Med Eng Technol 2021; 46:95-101. [PMID: 34881660 DOI: 10.1080/03091902.2021.2006349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The use of total intravenous anaesthesia (TIVA) is limited by concerns of disconnections of the tubing, resulting in accidental awareness. We designed a sensor device to detect leakages at the patient end and notify the medical personnel, thereby allowing immediate intervention in preventing awareness. For moisture detection, resistive sensing was selected as the working principle. The prototype was in proximity to the tubing from the TIVA pump and the patient's intravenous cannula, and able to detect leakages in all potential leakage sites and activate an alarm. Our device consists of a disposable bandage (sensor), attached to a reusable clamp that is directly coupled to a central module (SparkFun MicroView, a small microcontroller with built-in Organic Light-Emitting Diode (OLED) display). The disposable bandage is wrapped around the possible leakage sites. Crucially, the disposable bandage is integrated with two separate moisture sensing threads. When moisture is present, the central module detects a drop in resistance across the moisture sensing threads and activates a flashing LED and buzzer. We have successfully created a functional leak detection device, comprising a moisture sensing bandage and an audio and visual alert system, to address the problem of undetected TIVA leakages at the patient end.
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Affiliation(s)
- Rajkumar Chandran
- Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, Singapore, Singapore
| | - Kalindi De Sousa
- Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, Singapore, Singapore
| | - Seok Hwee Koo
- Clinical Trials and Research Unit, Changi General Hospital, Singapore, Singapore
| | - Yin Yu Lim
- Ministry of Health Holdings, Singapore, Singapore
| | - Lei Shang
- Ministry of Health Holdings, Singapore, Singapore
| | - Fleming Paiputra
- Pillar of Engineering Product Development, Singapore University of Technology and Design, Singapore, Singapore
| | - Joanne Huishan Tan
- Pillar of Engineering Product Development, Singapore University of Technology and Design, Singapore, Singapore
| | - Terry Tsz Him Ching
- Pillar of Engineering Product Development, Singapore University of Technology and Design, Singapore, Singapore
| | - Xiaojuan Khoo
- Pillar of Engineering Product Development, Singapore University of Technology and Design, Singapore, Singapore.,Science, Mathematics and Technology, Singapore University of Technology and Design, Singapore, Singapore
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13
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Time-Frequency Analysis of EEG Signals and GLCM Features for Depth of Anesthesia Monitoring. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2021; 2021:8430565. [PMID: 34422035 PMCID: PMC8376433 DOI: 10.1155/2021/8430565] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
One of the important tasks in the operating room is monitoring the depth of anesthesia (DoA) during surgery, and noninvasive techniques are very popular. Hence, we propose a new scheme for DoA monitoring considering the time-frequency analysis of electroencephalography (EEG) signals and GLCM features extracted from them. To this end, at first, the time-frequency map (TFM) of each channel of each EEG is computed by smoothed pseudo-Wigner–Ville distribution (SPWVD), where the EEG signal used in this paper is recorded in 15 channels. After that, we consider the gray-level co-occurrence matrix (GLCM) to obtain the content of TFM, and after that, four features such as homogeneity, correlation, energy, and contrast are obtained for each GLCM. Finally, after the selection of efficient features using the minimum redundancy maximum relevance (MRMR) method, the K-nearest neighbor (KNN) classifier is utilized to determine the DoA. Here, we consider the three states, namely, deep hypnotic, surgical anesthesia, and sedation and awake states according to bispectral index (BIS), and each EEG epoch is classified to these states. We also employ data augmentation to enhance the training phase and increase accuracy. We obtain the accuracy and confusion matrix of the proposed method. We also analyze the effects of a number of gray levels of GLCM, distance measure in KNN classifier, and parameters of data augmentation on the performance of the proposed method. Results indicate the efficiency of the proposed method to determine the DoA during surgery.
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14
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Nam SW, Oh AY, Koo BW, Kim BY, Han J, Chung SH. Effects of depth of neuromuscular blockade on the BIS-guided propofol requirement: A randomized controlled trial. Medicine (Baltimore) 2021; 100:e26576. [PMID: 34398011 PMCID: PMC8294904 DOI: 10.1097/md.0000000000026576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/10/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Deep neuromuscular blockade is considered beneficial for improving the surgical space condition during laparoscopic surgery. Adequacy of the surgical space condition may affect the anesthetists' decision regarding titration of depth of anesthesia. We investigated whether deep neuromuscular blockade reduces the propofol requirement under bispectral index monitoring compared to moderate neuromuscular blockade. METHODS Adult patients undergoing elective laparoscopic colorectal surgery were randomly allocated to a moderate or deep group. A train-of-four count of 1-2 in the moderate group, and a post-tetanic count of 1-2 in the deep group, were maintained by continuous infusion of rocuronium. The induction and maintenance of anesthesia were achieved by target-controlled infusion of propofol and remifentanil. The dose of propofol was adjusted to maintain the bispectral index in the range of 40-50. The remifentanil dose was titrated to maintain the systolic blood pressure to within 20% of the ward values. RESULTS A total of 82 patients were included in the analyses. The mean±SD dose of propofol was 7.54 ± 1.66 and 7.42 ± 1.01 mg·kg-1·h-1 in the moderate and deep groups, respectively (P = .104). The mean±SD dose of remifentanil was 4.84 ± 1.74 and 4.79 ± 1.77 μg kg-1 h-1 in the moderate and deep groups, respectively (P = .688). In comparison to the moderate group, the deep group showed significantly lower rates of intraoperative patient movement (42.9% vs 22.5%, respectively, P = .050) and additional neuromuscular blocking agent administration (76% vs 53%, respectively, P = .007). Postoperative complications, including pulmonary complications, wound problems and reoperation, were not different between the two groups. CONCLUSION Deep neuromuscular blockade did not reduce the bispectral index-guided propofol requirement compared to moderate neuromuscular blockade during laparoscopic colon surgery, despite reducing movement of the patient and the requirement for a rescue neuromuscular blocking agent. TRIAL REGISTRATION Clinicaltrials.gov (NCT03890406).
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Affiliation(s)
- Sun Woo Nam
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Ah-Young Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bon-Wook Koo
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Bo Young Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Jiwon Han
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Sung Hoon Chung
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
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15
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Isoflurane effects on the N1 and other long-latency auditory evoked potentials in Wistar rats. Neurosci Res 2021; 173:71-79. [PMID: 34186108 DOI: 10.1016/j.neures.2021.06.004] [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: 01/05/2021] [Revised: 06/09/2021] [Accepted: 06/22/2021] [Indexed: 10/21/2022]
Abstract
Long-latency auditory evoked potentials (LLAEPs) may help further advances in understanding consciousness under general anesthesia and promote more objective means of assessing sedation depth than conventional clinical signs. Among the LLAEP components, the auditory N1 shows promise as a measure of sedation depth and a marker of consciousness, but findings are so far inconclusive. Research with animals can help elucidate the effects of various anesthetics on the N1 and other LLAEPs, but investigations of LLAEPs under anesthesia in animals is lacking. To address this deficit, we examined the P1, N1, P2, and N2, along with their corresponding peak-to-peak complexes, in 10 Wistar rats anesthetized with 1.5-2 % isoflurane in pure oxygen and again after recovery. While under anesthesia, subdermal needle electrodes were inserted and secured for electroencephalographic (EEG) recordings. LLAEPs were assessed during a 20-min, passive, two-tone (500 ms inter-tone interval) paradigm with randomized short (1 s) and long (5 s) inter-pair intervals (IPIs). Overall, while the LLAEP peaks under isoflurane were less defined, they were not eliminated. The peak-to-peak amplitudes, particularly the P1-N1, were significantly smaller under isoflurane than during post-recovery. Our preliminary findings indicate that isoflurane produces global suppression across LLAEP components, presumably reflecting impaired integration of top-down and bottom-up attention and sensory systems under profound sedation with isoflurane.
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16
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Keeble H, Lavrador JP, Pereira N, Lente K, Brogna C, Gullan R, Bhangoo R, Vergani F, Ashkan K. Electromagnetic Navigation Systems and Intraoperative Neuromonitoring: Reliability and Feasibility Study. Oper Neurosurg (Hagerstown) 2021; 20:373-382. [PMID: 33432974 DOI: 10.1093/ons/opaa407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 09/21/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND A recent influx of intraoperative technology is being used in neurosurgery, but few reports investigate the accuracy and safety of these technologies when used simultaneously. OBJECTIVE To assess the ability to use an electromagnetic navigation system alongside multimodal intraoperative neurophysiological monitoring (IONM). METHODS Single-institution prospective cohort study of patients requiring craniotomy for brain tumor resection operated using an electromagnetic navigation system (AxiEM, Medtronic®). motor evoked potentials, somatosensory evoked potentials (SSEPs), electroencephalography, and electromyography were recorded and analyzed with AxiEM on (with/without filters) and off. The neurological outcomes of the patients were recorded. RESULTS A total of 15 patients were included (8 males/7 females, mean age 52.13 yr). Even though the raw acquisition is affected by the electromagnetic field (particularly SSEPs), no significant difference was detected in the morphology, amplitude, and latency of the different monitoring modalities (AxiEM off vs on) after the appropriate software filter application. Adjustments to the frequency of SSEP stimulation and number of averages, and reductions to the low-pass filters were applied. Notch filters were used appropriately and changes to the physical setup of the IONM and electromagnetic navigation system equipment reduced noise. Postoperatively, none of the patients developed new focal deficits; 7 patients showed improvement in their motor deficit (4 recovered fully). CONCLUSION The information provided by the IONM in intracranial neurosurgery patients whilst also using electromagnetic navigation systems is reliable for monitoring, mapping, and detecting intraoperative complications, provided that the appropriate software filters and tools are applied.
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Affiliation(s)
| | - José Pedro Lavrador
- Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom
| | | | | | - Christian Brogna
- Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom
| | - Richard Gullan
- Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom
| | - Ranjeev Bhangoo
- Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom
| | - Francesco Vergani
- Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom
| | - Keyoumars Ashkan
- Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom
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17
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Madanu R, Rahman F, Abbod MF, Fan SZ, Shieh JS. Depth of anesthesia prediction via EEG signals using convolutional neural network and ensemble empirical mode decomposition. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2021; 18:5047-5068. [PMID: 34517477 DOI: 10.3934/mbe.2021257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
According to a recently conducted survey on surgical complication mortality rate, 47% of such cases are due to anesthetics overdose. This indicates that there is an urgent need to moderate the level of anesthesia. Recently deep learning (DL) methods have played a major role in estimating the depth of Anesthesia (DOA) of patients and has played an essential role in control anesthesia overdose. In this paper, Electroencephalography (EEG) signals have been used for the prediction of DOA. EEG signals are very complex signals which may require months of training and advanced signal processing techniques. It is a point of debate whether DL methods are an improvement over the already existing traditional EEG signal processing approaches. One of the DL algorithms is Convolutional neural network (CNN) which is very popular algorithm for object recognition and is widely growing its applications in processing hierarchy in the human visual system. In this paper, various decomposition methods have been used for extracting the features EEG signal. After acquiring the necessary signals values in image format, several CNN models have been deployed for classification of DOA depending upon their Bispectral Index (BIS) and the signal quality index (SQI). The EEG signals were converted into the frequency domain using and Empirical Mode Decomposition (EMD), and Ensemble Empirical Mode Decomposition (EEMD). However, because of the inter mode mixing observed in EMD method; EEMD have been utilized for this study. The developed CNN models were used to predict the DOA based on the EEG spectrum images without the use of handcrafted features which provides intuitive mapping with high efficiency and reliability. The best trained model gives an accuracy of 83.2%. Hence, this provides further scope and research which can be carried out in the domain of visual mapping of DOA using EEG signals and DL methods.
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Affiliation(s)
- Ravichandra Madanu
- Department of Mechanical Engineering, Yuan Ze University, Taoyuan 320, Taiwan
| | - Farhan Rahman
- Department of Electronics and Communication Engineering, Vellore Institute of Technology, Tamil Nadu 632014, India
| | - Maysam F Abbod
- Department of Electronic and Computer Engineering, Brunel University London, Uxbridge UB8 3PH, UK
| | - Shou-Zen Fan
- Department of Anesthesiology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Jiann-Shing Shieh
- Department of Mechanical Engineering, Yuan Ze University, Taoyuan 320, Taiwan
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18
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Ra JS, Li T, Li Y. A novel spectral entropy-based index for assessing the depth of anaesthesia. Brain Inform 2021; 8:10. [PMID: 33978842 PMCID: PMC8116386 DOI: 10.1186/s40708-021-00130-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/12/2021] [Indexed: 12/05/2022] Open
Abstract
Anaesthesia is a state of temporary controlled loss of awareness induced for medical operations. An accurate assessment of the depth of anaesthesia (DoA) helps anesthesiologists to avoid awareness during surgery and keep the recovery period short. However, the existing DoA algorithms have limitations, such as not robust enough for different patients and having time delay in assessment. In this study, to develop a reliable DoA measurement method, pre-denoised electroencephalograph (EEG) signals are divided into ten frequency bands (α, β1, β2, β3, β4, β, βγ, γ, δ and θ), and the features are extracted from different frequency bands using spectral entropy (SE) methods. SE from the beta-gamma frequency band (21.5–38.5 Hz) and SE from the beta frequency band show the highest correlation (R-squared value: 0.8458 and 0.7312, respectively) with the most popular DoA index, bispectral index (BIS). In this research, a new DoA index is developed based on these two SE features for monitoring the DoA. The highest Pearson correlation coefficient by comparing the BIS index for testing data is 0.918, and the average is 0.80. In addition, the proposed index shows an earlier reaction than the BIS index when the patient goes from deep anaesthesia to moderate anaesthesia, which means it is more suitable for the real-time DoA assessment. In the case of poor signal quality (SQ), while the BIS index exhibits inflexibility with cases of poor SQ, the new proposed index shows reliable assessment results that reflect the clinical observations.
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Affiliation(s)
- Jee Sook Ra
- School of Sciences, University of Southern Queensland, West St, Darling Heights, Toowomba, QLD, 4350, Australia.
| | - Tianning Li
- School of Sciences, University of Southern Queensland, West St, Darling Heights, Toowomba, QLD, 4350, Australia
| | - Yan Li
- School of Sciences, University of Southern Queensland, West St, Darling Heights, Toowomba, QLD, 4350, Australia
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19
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Blevins CE, Celeste NA, Marx JO. Effects of Oxygen Supplementation on Injectable and Inhalant Anesthesia in C57BL/6 Mice. JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE 2021; 60:289-297. [PMID: 33972009 DOI: 10.30802/aalas-jaalas-20-000143] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Oxygen supplementation is rarely considered when anesthetizing laboratory mice, despite reports that mice become profoundly hypoxic under anesthesia. Little is known about the effects of hypoxia on anesthetic performance. This article focuses on the effects of oxygen supplementation on physiologic parameters and depth of anesthesia in male and female C57BL/6 mice. Anesthesia was performed via common injectable anesthetic protocols and with isoflurane. Mice anesthetized with injectable anesthesia received one of 3 drug protocols. Low-dose ketamine/xylazine (100/8 mg/kg) was chosen to provide immobilization of mice, suitable for imaging procedures. Medium-dose ketamine/xylazine/acepromazine (100/10/1 mg/kg) was chosen as a dose that has been recommended for surgical procedures. High-dose ketamine/xylazine/acepromazine (150/12/3 mg/kg) was chosen after pilot studies to provide a long duration of a deep plane of anesthesia. We also tested the effects of oxygen supplementation on the minimum alveolar concentration (MAC) of isoflurane in mice. Mice breathed supplemental 100% oxygen, room air, or medical air with 21% oxygen. Anesthetized mice that did not receive supplemental oxygen all became hypoxic, while hypoxia was prevented in mice that received oxygen. Oxygen supplementation did not affect the MAC of isoflurane. At the high injectable dose, all mice not receiving oxygen supplementation died while all mice receiving oxygen supplementation survived. At low and medium doses, supplemental oxygen reduced the duration of the surgical plane of anesthesia (low dose with oxygen: 22 ± 14 min; low dose without supplementation: 29 ± 18 min; medium dose with oxygen: 43 ± 18 min; medium dose without supplementation: 61 ± 27 min). These results suggest that mice anesthetized with injectable and inhalant anesthesia without supplemental oxygen are routinely hypoxic. This hypoxia prolongs the duration of anesthesia with injectable drug protocols and affects survival at high doses of injectable anesthetics. Because of variable responses to injectable anesthetics in mice, oxygen supplementation is recommended for all anesthetized mice.
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Affiliation(s)
- Caroline E Blevins
- University Laboratory Animal Resources, University of Pennsylvania, Philadelphia, Pennsylvania; University of Pennsylvania School of Veterinary Medicine, Philadelphia, Dept. of Pathobiology, Philadelphia, Pennsylvania
| | - Natalie A Celeste
- The Ohio State University College of Veterinary Medicine, Columbus, Ohio
| | - James O Marx
- University Laboratory Animal Resources, University of Pennsylvania, Philadelphia, Pennsylvania; University of Pennsylvania School of Veterinary Medicine, Philadelphia, Dept. of Pathobiology, Philadelphia, Pennsylvania;,
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20
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Effect of general inhalational anesthesia on intraocular pressure measurements in normal and glaucomatous children. Int Ophthalmol 2021; 41:2455-2463. [PMID: 33759070 DOI: 10.1007/s10792-021-01800-6] [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: 09/16/2020] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the agreement between the intraocular pressure (IOP) measurements in the awake condition and under different stages of general inhalational anesthesia using sevoflurane in both glaucomatous and normal children. METHODS A prospective study was performed on 43 glaucomatous children and 30 age-matched controls. Baseline IOP of one eye was measured immediately before general anesthesia using Perkins tonometer and then re-measured under light, intermediate, and deep anesthesia, and then after intubation. Depth of anesthesia was determined using bispectral index pediatric sensor. The agreement between the IOP measurements before and during different stages of anesthesia was analyzed using Bland-Altman plots. Systematic and proportionate deviations between the IOP measurements were analyzed. RESULTS The mean age was 58.6 ± 41.99 months. The mean IOP was significantly lower at all stages of anesthesia in both groups. The coefficient of variation was over 20% in all measurements under anesthesia. For all IOP measurements during anesthesia, the limits of agreement were > 7 mmHg difference in the control group and > 20 mmHg in the glaucomatous group. The best agreement was with the IOP measurement after intubation (mean limit of agreement of -1.4 mmHg, 1.96 s range, -8.8-6 mm Hg) in the control group and with the IOP measurement under intermediate anesthesia (mean limit of agreement of -4.2 mmHg, 1.96 s range, -15.1-6.8 mm Hg) in the glaucomatous group. CONCLUSIONS Inhalational anesthesia has variable effects on IOP measurement at all stages of anesthesia. Caution should be taken when extrapolating the true IOP from these measurements.
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21
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Liu C, Shi F, Fu B, Luo T, Zhang L, Zhang Y, Zhang Y, Yu S, Yu T. GABA A receptors in the basal forebrain mediates emergence from propofol anaesthesia in rats. Int J Neurosci 2020; 132:802-814. [PMID: 33174773 DOI: 10.1080/00207454.2020.1840375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of the current study was to explore the role of the basal forebrain (BF) in propofol anaesthesia. METHODS In the present study, we observed the neural activities of the BF during propofol anaesthesia using calcium fibre photometry recording. Subsequently, ibotenic acid was injected into the BF to verify the role of the BF in propofol anaesthesia. Finally, to test whether GABAA receptors in the BF were involved in modulating propofol anaesthesia, muscimol (GABAA receptor agonist) and gabazine (GABAA receptor antagonist) were microinjected into the BF. Cortical electroencephalogram (EEG), time to loss of righting reflex (LORR), and recovery of righting reflex (RORR) under propofol anaesthesia were recorded and analysed. RESULTS The activity of BF neurons was inhibited during induction of propofol anaesthesia and activated during emergence from propofol anaesthesia. In addition, non-specifical lesion of BF neurons significantly prolonged the time to RORR and increased delta power in the frontal cortex under propofol anaesthesia. Next, microinjection of muscimol into the BF delayed emergence from propofol anaesthesia, increased delta power of the frontal cortex, and decreased gamma power under propofol anaesthesia. Conversely, infusion of gabazine accelerated emergence times and decreased EEG delta power. CONCLUSIONS The basal forebrain is involved in modulating frontal cortex delta activity and emergence from propofol anaesthesia. Additionally, the GABAA receptors in the basal forebrain are involved in regulating emergence propofol anaesthesia.
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Affiliation(s)
- Chengxi Liu
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Fu Shi
- Guizhou Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Bao Fu
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Tianyuan Luo
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Lin Zhang
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yu Zhang
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Yi Zhang
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Anesthesiology, the Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Shouyang Yu
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Tian Yu
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
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22
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Sanavia E, García M, del Castillo J, González R, López-Herce J, Mencía S. Efecto del bloqueo neuromuscular sobre la monitorización biespectral en los niños críticamente enfermos. An Pediatr (Barc) 2020; 93:251-256. [DOI: 10.1016/j.anpedi.2019.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 11/29/2022] Open
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23
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Park Y, Han SH, Byun W, Kim JH, Lee HC, Kim SJ. A Real-Time Depth of Anesthesia Monitoring System Based on Deep Neural Network With Large EDO Tolerant EEG Analog Front-End. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2020; 14:825-837. [PMID: 32746339 DOI: 10.1109/tbcas.2020.2998172] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In this article, we present a real-time electroencephalogram (EEG) based depth of anesthesia (DoA) monitoring system in conjunction with a deep learning framework, AnesNET. An EEG analog front-end (AFE) that can compensate ±380-mV electrode DC offset using a coarse digital DC servo loop is implemented in the proposed system. The EEG-based MAC, EEGMAC, is introduced as a novel index to accurately predict the DoA, which is designed for applying to patients anesthetized by both volatile and intravenous agents. The proposed deep learning protocol consists of four layers of convolutional neural network and two dense layers. In addition, we optimize the complexity of the deep neural network (DNN) to operate on a microcomputer such as the Raspberry Pi 3, realizing a cost-effective small-size DoA monitoring system. Fabricated in 110-nm CMOS, the prototype AFE consumes 4.33 μW per channel and has the input-referred noise of 0.29 μVrms from 0.5 to 100 Hz with the noise efficiency factor of 2.2. The proposed DNN was evaluated with pre-recorded EEG data from 374 subjects administrated by inhalational anesthetics under surgery, achieving an average squared and absolute errors of 0.048 and 0.05, respectively. The EEGMAC with subjects anesthetized by an intravenous agent also showed a good agreement with the bispectral index value, confirming the proposed DoA index is applicable to both anesthetics. The implemented monitoring system with the Raspberry Pi 3 estimates the EEGMAC within 20 ms, which is about thousand-fold faster than the BIS estimation in literature.
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Orhon ZN, Orhon C. Investigation of the Optimum Time for Intravenous Access After Anesthesia Induction with Sevoflurane in Pediatric Patients Without Premedication. Medeni Med J 2020; 35:85-90. [PMID: 32733756 PMCID: PMC7384515 DOI: 10.5222/mmj.2020.22309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/30/2020] [Indexed: 11/05/2022] Open
Abstract
Objective: Anesthesia induction is usually achieved with sevoflurane for pediatric patients without vascular access. The aim of this study was to investigate the optimum intravenous access time and to evaluate the corresponding bispectral index (BIS) value in pediatric patients after sevoflurane induction. Method: This prospective study included 100 children enrolled between January 1, 2017 and January 1, 2018 at Istanbul Medeniyet University Goztepe Training and Research Hospital. Anesthesia was induced with 8% sevoflurane and oxygen. Measurements included mask adaptation time, time to loss of the ciliary reflex, time to recovery of regular breathing, and optimal timing of intravenous access time with the corresponding BIS values, as well as the time elapsed for the BIS value to fall below 60. Results: The mean mask adaptation time was 27.8±28.4 s, time to loss of the ciliary reflex was 39.7±10.3 s, and time to reach regular respiration was 88.5±116.9 s, with mean BIS value of 80.4±16.9, 70.2±10.4, and 52.4±12.1, respectively. The mean time for BIS to fall below 60 was 72.54±24.41 s. The mean time required for the the iniation of optimal intravenous access was 104.92±36.45 s, with a mean BIS value of 30±10.1. Conclusion Following anesthesia induction with sevoflurane in children, the BIS value below 60 which is the upper limit for surgical anesthesia, was found to be insufficient for intravenous intervention. For pediatric patients undergoing sevoflurane induction it has been concluded that, the BIS value below 30 or an average waiting time of 104.9 s is ideal for initiation of optimal intravenous access.
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Affiliation(s)
- Zeynep Nur Orhon
- Istanbul Medeniyet University, Faculty of Medicine, Goztepe Training and Research Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey
| | - Cem Orhon
- Private Yuzyıl Hospital, Department of Neurosurgery, Istanbul, Turkey
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Comte B, Baumbach J, Benis A, Basílio J, Debeljak N, Flobak Å, Franken C, Harel N, He F, Kuiper M, Méndez Pérez JA, Pujos-Guillot E, Režen T, Rozman D, Schmid JA, Scerri J, Tieri P, Van Steen K, Vasudevan S, Watterson S, Schmidt HH. Network and Systems Medicine: Position Paper of the European Collaboration on Science and Technology Action on Open Multiscale Systems Medicine. NETWORK AND SYSTEMS MEDICINE 2020; 3:67-90. [PMID: 32954378 PMCID: PMC7500076 DOI: 10.1089/nsm.2020.0004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction: Network and systems medicine has rapidly evolved over the past decade, thanks to computational and integrative tools, which stem in part from systems biology. However, major challenges and hurdles are still present regarding validation and translation into clinical application and decision making for precision medicine. Methods: In this context, the Collaboration on Science and Technology Action on Open Multiscale Systems Medicine (OpenMultiMed) reviewed the available advanced technologies for multidimensional data generation and integration in an open-science approach as well as key clinical applications of network and systems medicine and the main issues and opportunities for the future. Results: The development of multi-omic approaches as well as new digital tools provides a unique opportunity to explore complex biological systems and networks at different scales. Moreover, the application of findable, applicable, interoperable, and reusable principles and the adoption of standards increases data availability and sharing for multiscale integration and interpretation. These innovations have led to the first clinical applications of network and systems medicine, particularly in the field of personalized therapy and drug dosing. Enlarging network and systems medicine application would now imply to increase patient engagement and health care providers as well as to educate the novel generations of medical doctors and biomedical researchers to shift the current organ- and symptom-based medical concepts toward network- and systems-based ones for more precise diagnoses, interventions, and ideally prevention. Conclusion: In this dynamic setting, the health care system will also have to evolve, if not revolutionize, in terms of organization and management.
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Affiliation(s)
- Blandine Comte
- Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, Université Clermont Auvergne, INRAE, UNH, Clermont-Ferrand, France
| | - Jan Baumbach
- TUM School of Life Sciences Weihenstephan (WZW), Technical University of Munich (TUM), Freising-Weihenstephan, Germany
| | | | - José Basílio
- Institute of Vascular Biology and Thrombosis Research, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Nataša Debeljak
- Medical Centre for Molecular Biology, Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Åsmund Flobak
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- The Cancer Clinic, St. Olav's University Hospital, Trondheim, Norway
| | - Christian Franken
- Digital Health Systems, Einsingen, Germany
- Department of Pharmacology and Personalised Medicine, Faculty of Health, Medicine and Life Science, Maastricht University, Maastricht, The Netherlands
| | | | - Feng He
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Martin Kuiper
- Department of Biology, Faculty of Natural Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Juan Albino Méndez Pérez
- Department of Computer Science and Systems Engineering, Universidad de La Laguna, Tenerife, Spain
| | - Estelle Pujos-Guillot
- Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, Université Clermont Auvergne, INRAE, UNH, Clermont-Ferrand, France
| | - Tadeja Režen
- Centre for Functional Genomics and Bio-Chips, Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Damjana Rozman
- Centre for Functional Genomics and Bio-Chips, Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Johannes A. Schmid
- Institute of Vascular Biology and Thrombosis Research, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Jeanesse Scerri
- Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Paolo Tieri
- CNR National Research Council, IAC Institute for Applied Computing, Rome, Italy
| | | | - Sona Vasudevan
- Georgetown University Medical Centre, Washington, District of Columbia, USA
| | - Steven Watterson
- Northern Ireland Centre for Stratified Medicine, Ulster University, Londonderry, United Kingdom
| | - Harald H.H.W. Schmidt
- Department of Pharmacology and Personalised Medicine, Faculty of Health, Medicine and Life Science, MeHNS, Maastricht University, The Netherlands
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Sun Y, Wei C, Cui V, Xiu M, Wu A. Electroencephalography: Clinical Applications During the Perioperative Period. Front Med (Lausanne) 2020; 7:251. [PMID: 32582735 PMCID: PMC7296088 DOI: 10.3389/fmed.2020.00251] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 05/11/2020] [Indexed: 12/28/2022] Open
Abstract
Electroencephalography (EEG) monitoring has become technically feasible in daily clinical anesthesia practice. EEG is a sensitive method for detecting neurophysiological changes in the brain and represents an important frontier in the monitoring and treatment of patients in the perioperative period. In this review, we briefly introduce the essential principles of EEG. We review EEG application during anesthesia practice in the operating room, including the use of processed EEG in depth of anesthesia assessment, raw EEG monitoring in recognizing brain states under different anesthetic agents, the use of EEG in the prevention of perioperative neurocognitive disorders and detection of cerebral ischemia. We then discuss EEG utilization in the intensive care units, including the use of EEG in sedative level titration and prognostication of clinical outcomes. Existing literature provides insight into both the advances and challenges of the clinical applications of EEG. Future study is clearly needed to elucidate the precise EEG features that can reliably optimize perioperative care for individual patients.
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Affiliation(s)
- Yi Sun
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Changwei Wei
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Victoria Cui
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Meihong Xiu
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Anshi Wu
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Gu Y, Yang F, Zhang Y, Zheng J, Wang J, Li B, Ma T, Cui X, Lu K, Ma H. The effects of different doses of dexmedetomidine on the requirements for propofol for loss of consciousness in patients monitored via the bispectral index: a double-blind, placebo-controlled trial. BMC Anesthesiol 2020; 20:96. [PMID: 32334510 PMCID: PMC7183661 DOI: 10.1186/s12871-020-01013-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 04/15/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The α2-adrenergic agonist dexmedetomidine (DEX) is a sedative and can be used as an adjunct to hypnotics. The study sought to evaluate the effects of different doses of DEX on the requirements for propofol for loss of consciousness (LOC) in patients monitored via the bispectral index (BIS). METHODS In this randomized, double-blind, three arm parallel group design and placebo-controlled trial, 73 patients aged between 18 and ~ 65 years with a BMI range of 18.0-24.5 kg·m- 2 and an American Society of Anesthesiologists (ASA) grade I or II who were scheduled for general anesthesia at the General Hospital of Ningxia Medical University were included in this study. Anesthesiologists and patients were blinded to the syringe contents. All patients were randomly assigned in a 1:1:1 ratio to receive a 0.5 μg·kg- 1 DEX infusion (0.5 μg·kg- 1 DEX group; n = 24), a 1.0 μg·kg- 1 DEX infusion (1.0 μg·kg- 1 DEX group; n = 25) or a saline infusion (control group; n = 24) for 10 min. Propofol at a concentration of 20 mg·kg- 1·h- 1 was then infused at the end of the DEX or saline infusion. The propofol infusion was stopped when the patient being infused lost consciousness. The primary endpoint were propofol requirements for LOC and BIS value at LOC. RESULTS The data from 73 patients were analyzed. The propofol requirements for LOC was reduced in the DEX groups compared with the control group (1.12 ± 0.33 mg·kg- 1 for the 0.5 μg·kg- 1 DEX group vs. 1.79 ± 0.39 mg·kg- 1 for the control group; difference, 0.68 mg·kg- 1 [95% CI, 0.49 to 0.87]; P = 0.0001) (0.77 ± 0.27 mg·kg- 1 for the 1.0 μg·kg- 1 DEX group vs. 1.79 ± 0.39 mg·kg- 1 for the control group; difference, 1.02 mg·kg- 1 [95% CI, 0.84 to 1.21]; P = 0.0001). The propofol requirements for LOC was lower in the 1.0 μg·kg- 1 DEX group than the 0.5 μg·kg- 1 DEX group (0.77 ± 0.27 mg·kg- 1 vs. 1.12 ± 0.33 mg·kg- 1, respectively; difference, 0.34 mg·kg- 1 [95% CI, 0.16 to 0.54]; P = 0.003). At the time of LOC, the BIS value was higher in the DEX groups than in the control group (67.5 ± 3.5 for group 0.5 μg·kg- 1 DEX vs. 60.5 ± 3.8 for the control group; difference, 7.04 [95% CI, 4.85 to 9.23]; P = 0.0001) (68.4 ± 4.1 for group 1.0 μg·kg- 1 DEX vs. 60.5 ± 3.8 for the control group; difference, 7.58 [95% CI, 5.41 to 9.75]; P = 0.0001). CONCLUSION The study showed that DEX (both 0.5 and 1.0 μg·kg- 1 DEX) reduced the propofol requirements for LOC. DEX pre-administration increased the BIS value for LOC induced by propofol. CLINICAL TRIAL REGISTRATION The study was registered at ClinicalTrials.gov (trial ID: NCT02783846 on May 26, 2016).
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Affiliation(s)
- Yang Gu
- Department of Anesthesiology, Ningxia Medical University, Yinchuan, 750004, China.,Department of Anesthesiology, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750002, China
| | - Fan Yang
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Yonghai Zhang
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Junwei Zheng
- Department of Anesthesiology, Ningxia Medical University, Yinchuan, 750004, China
| | - Jie Wang
- Department of Anesthesiology, Ningxia Medical University, Yinchuan, 750004, China
| | - Bin Li
- Department of Anesthesiology, Ningxia Medical University, Yinchuan, 750004, China
| | - Tao Ma
- Department of Anesthesiology, Ningxia Medical University, Yinchuan, 750004, China
| | - Xiang Cui
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Kaimei Lu
- Department of Anesthesiology, Ningxia Medical University, Yinchuan, 750004, China
| | - Hanxiang Ma
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, 750004, China.
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Morgan SP, Canfarotta F, Piletska EV, Grillo F, Korposh S, Liu L, Hernandez FU, Correia R, Norris A, Sinha R, Hayes-Gill BR, Piletsky SA. Optical fiber sensors for monitoring in critical care. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:1139-1143. [PMID: 31946095 DOI: 10.1109/embc.2019.8856893] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Monitoring of key physiological and pharmacological parameters is an important part of a closed loop control system in critical care. Optical fiber sensors provide a versatile platform technology that can be easily incorporated into existing in-dwelling catheters or face masks. With appropriate functional coatings they can be used to monitor a range of relevant parameters and two different examples are presented: (i) respiration monitoring; (ii) drug level monitoring. Respiration monitoring involves monitoring of temperature and humidity in inhaled and exhaled breath. The optical fiber sensor consists of a fiber Bragg grating to measure temperature and a tip coating whose refractive index changes with humidity. The sensor is demonstrated to be able to track breath to breath changes when incorporated into a mask. Drug level monitoring is demonstrated in vitro using a long period grating coated with molecularly imprinted polymer nanoparticles that are sensitive to fentanyl. The sensor has a limit of detection of 50ng/ml.
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Bocskai T, Kovács M, Szakács Z, Gede N, Hegyi P, Varga G, Pap I, Tóth I, Révész P, Szanyi I, Németh A, Gerlinger I, Karádi K, Lujber L. Is the bispectral index monitoring protective against postoperative cognitive decline? A systematic review with meta-analysis. PLoS One 2020; 15:e0229018. [PMID: 32053678 PMCID: PMC7018011 DOI: 10.1371/journal.pone.0229018] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/28/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Several studies have suggested that monitoring the depth of anaesthesia might prevent the development of postoperative cognitive decline. We aimed to conduct a meta-analysis to investigate the effects of bispectral index (BIS) monitoring in anaesthesia. METHODS We searched in six major electronic databases. Trials were included if they discussed anaesthesia with and without BIS monitoring or low (<50) and high (≥50) BIS levels and which measured the risk of postoperative delirium (POD) and/or postoperative cognitive dysfunction (POCD). RESULTS We included fourteen studies in the systematic review, eight of which were eligible for meta-analysis. BIS proved to be protective against POD at 1 day postoperatively in a cohort of 2138 patients (16.1% vs. 22.8% for BIS vs. no BIS groups, respectively; relative risk [RR] 0.71; 95% confidence interval [CI] 0.59 to 0.85, without significant between-study heterogeneity I2 = 0.0%, P = 0.590). The use of BIS was neutral for POCD at 1 week but protective for POCD at 12 weeks (15.8% vs. 18.8% for BIS vs. no BIS groups, respectively; RR = 0.84, CI: 0.66 to 1.08), without significant between-study heterogeneity (I2 = 25.8%, P = 0.260). The neutral association at 1 week proved to be underpowered with trial sequential analysis. In the comparison of low BIS versus high BIS, the incidence of POD at 1 day was similar in the groups. CONCLUSION Our findings suggest a protective effect of BIS compared to not using BIS regarding the incidence of POD at 1 day and POCD at 12 weeks. However, limitations of the evidence warrant further investigation to identify those groups of patients by age, comorbid conditions and other individual variables who would benefit the most from the use of BIS monitoring.
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Affiliation(s)
- Timea Bocskai
- Department of Anaesthesiology and Intensive Care, Medical School, University of Pécs, Pécs, Hungary
| | - Márton Kovács
- Department of Otorhinolaryngology (ENT), Medical School, University of Pécs, Pécs, Hungary
| | - Zsolt Szakács
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Noémi Gede
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
- Hungarian Academy of Sciences–University of Szeged, Momentum Gastroenterology Multidisciplinary Research Group, Szeged, Hungary
| | - Gábor Varga
- Department of Oral Biology, Semmelweis University, Budapest, Hungary
| | - István Pap
- Department of Otorhinolaryngology (ENT), Medical School, University of Pécs, Pécs, Hungary
| | - István Tóth
- Department of Otorhinolaryngology (ENT), Medical School, University of Pécs, Pécs, Hungary
| | - Péter Révész
- Department of Otorhinolaryngology (ENT), Medical School, University of Pécs, Pécs, Hungary
| | - István Szanyi
- Department of Otorhinolaryngology (ENT), Medical School, University of Pécs, Pécs, Hungary
| | - Adrienne Németh
- Department of Otorhinolaryngology (ENT), Medical School, University of Pécs, Pécs, Hungary
| | - Imre Gerlinger
- Department of Otorhinolaryngology (ENT), Medical School, University of Pécs, Pécs, Hungary
| | - Kázmér Karádi
- Institute of Behavioral Sciences, Medical School, University of Pécs, Pécs, Hungary
| | - László Lujber
- Department of Otorhinolaryngology (ENT), Medical School, University of Pécs, Pécs, Hungary
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Sanavia E, García M, Castillo JD, González R, López-Herce J, Mencía S. Effect of neuromuscular blockade on the bispectral index in critically ill patients. An Pediatr (Barc) 2020; 93:251-256. [PMID: 34092338 DOI: 10.1016/j.anpede.2019.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/16/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION It has been suggested that neuromuscular blockade (NMB) affects the capacity of bispectral index (BIS) monitoring to measure consciousness in sedated children. Our aim was to analyse the impact of NMB on BIS values in critically ill children. METHODS We conducted a prospective observational study of children monitored with a BIS system that received a continuous infusion of vecuronium. We analysed data on clinical, diagnostic and haemodynamic variables, sedatives, analgesics, muscle relaxants, and BIS parameters. We compared BIS parameters before the use of a muscle relaxant, during its administration, before its discontinuation and for the 24h following the end of the infusion. RESULTS The analysis included 35 patients (median age, 30 months). The most common diagnosis was heart disease (85%). The most frequent indication for initiation of NMB was low cardiac output (45%), followed by adaptation to mechanical ventilation (20%). Neuromuscular blockade did not produce a significant change in BIS values. We found a decrease was observed in electromyography (EMG) values at 6h (34.9±9.4 vs 31.2±7; P=.008) and 12h after initiation of NMB (34.9±9.4 vs 28.6±4.8; P =.006). We observed a small significant increase in BIS after discontinuation of NMB (from 42.7±11 to 48.4±14.5, P=.001), and 6 and 12h later (51.3±16.6; P=.015). There were no differences in the doses of sedatives or analgesics except for fentanyl, of which the dose was lowered after discontinuation of vecuronium. CONCLUSION Continuous NMB produces small changes on BIS values that are not clinically significant and therefore does not interfere with BIS consciousness monitoring in critically ill children.
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Affiliation(s)
- Eva Sanavia
- Servicio de Pediatría, Hospital Infanta Leonor, Madrid, Spain
| | - Mirian García
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Red de Salud Materno Infantil y del Desarrollo (RedSAMID), Madrid, Spain.
| | - Jimena Del Castillo
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Red de Salud Materno Infantil y del Desarrollo (RedSAMID), Madrid, Spain
| | - Rafael González
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Red de Salud Materno Infantil y del Desarrollo (RedSAMID), Madrid, Spain
| | - Jesús López-Herce
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Red de Salud Materno Infantil y del Desarrollo (RedSAMID), Madrid, Spain
| | - Santiago Mencía
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Red de Salud Materno Infantil y del Desarrollo (RedSAMID), Madrid, Spain
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Levine AT, Li B, Barnes P, Lomber SG, Butler BE. Assessment of anesthesia on physiological stability and BOLD signal reliability during visual or acoustic stimulation in the cat. J Neurosci Methods 2020; 334:108603. [PMID: 31982459 DOI: 10.1016/j.jneumeth.2020.108603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neuroimaging methods including fMRI provide powerful tools to observe whole-brain functional networks. This is particularly powerful in animal models, allowing these networks to be probed using complementary methods. However, most animals must be anesthetized for neuroimaging, giving rise to complications resulting from anesthetic effects on the animal's physiological and neurological functions. For example, an established protocol for feline neuroimaging involves co-administration of ketamine and isoflurane - the latter of which is known to suppress cortical function. NEW METHOD Here, we compare this established protocol to alfaxalone, a single-agent anesthetic for functional neuroimaging. We first compare the two in a controlled environment to assess relative safety and to measure physiological stability over an extended time window. We then compare patterns of auditory and visually-evoked activity measured at 7 T to assess mean signal strength and between-subjects signal variability. RESULTS IN COMPARISON WITH EXISTING METHODS We show that alfaxalone results in more stable respiratory rates over the 120 min testing period, with evidence of smaller between-measurements variability within this time window, when compared to ketamine plus isoflurane. Moreover, we demonstrate that both agents evoke similar mean BOLD signals across animals, but that alfaxalone elicits more consistent BOLD activity in response to sound stimuli across all ROIs observed. CONCLUSIONS Alfaxalone is observed to be more physiologically stable, evoking a more consistent BOLD signal across animals than the co-administration of ketamine and isoflurane. Thus, an alfaxalone-based protocol may represent a better approach for neuroimaging in animal models requiring anesthesia.
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Affiliation(s)
- Alexandra T Levine
- Department of Physiology & Pharmacology, University of Western Ontario, London, Ontario, N6A 5C1, Canada; Brain and Mind Institute, University of Western Ontario, London, Ontario, N6A 3K7, Canada
| | - Benson Li
- Department of Psychology, University of Western Ontario, London, Ontario, N6A 5C2, Canada
| | - Paisley Barnes
- Department of Physiology & Pharmacology, University of Western Ontario, London, Ontario, N6A 5C1, Canada
| | - Stephen G Lomber
- Department of Psychology, University of Western Ontario, London, Ontario, N6A 5C2, Canada; Department of Physiology & Pharmacology, University of Western Ontario, London, Ontario, N6A 5C1, Canada; Brain and Mind Institute, University of Western Ontario, London, Ontario, N6A 3K7, Canada; National Centre for Audiology, University of Western Ontario, London, Ontario, N6G 1H1, Canada
| | - Blake E Butler
- Department of Psychology, University of Western Ontario, London, Ontario, N6A 5C2, Canada; Brain and Mind Institute, University of Western Ontario, London, Ontario, N6A 3K7, Canada; National Centre for Audiology, University of Western Ontario, London, Ontario, N6G 1H1, Canada.
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Aryafar M, Bozorgmehr R, Alizadeh R, Gholami F. A cross-sectional study on monitoring depth of anesthesia using brain function index among elective laparotomy patients. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Hernandez-Avalos I, Mota-Rojas D, Mora-Medina P, Martínez-Burnes J, Casas Alvarado A, Verduzco-Mendoza A, Lezama-García K, Olmos-Hernandez A. Review of different methods used for clinical recognition and assessment of pain in dogs and cats. Int J Vet Sci Med 2019; 7:43-54. [PMID: 31819890 PMCID: PMC6882480 DOI: 10.1080/23144599.2019.1680044] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 12/28/2022] Open
Abstract
In light of the need to perform surgical techniques and the importance of animal welfare because of acute pain, the objectives of the veterinary anaesthetists are to manage muscle relaxation and adequate analgesia in order to conserve a balance in the autonomic nervous system, enhance the action of the parasympathetic system in the face of the emerging action of the sympathetic portion provoked by the surgeon, and maintain a balance among them. The aim of the present review is to describe different evaluation criteria for acute pain using unidimensional and multidimensional scales, correlating these findings to parasympathetic tone activity (PTA) and bispectral index (BIS) assessment, to conduct an objective evaluation of pain that patients (dog or cat) perceives, in order to administrate an adequate analgesic treatment in each case. In conclusion, this integral, objective evaluation will allow veterinarians – especially anaesthesiologists – to improve the management of pain in the patients.
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Affiliation(s)
| | - Daniel Mota-Rojas
- Neurophysiology of Pain, Behavior and Assessment of Welfare in Domestic Animals, DPAA, Universidad Autónoma Metropolitana (UAM), Mexico City, Mexico
| | - Patricia Mora-Medina
- Livestock Science Department, Universidad Nacional Autónoma de México (UNAM), FESC, Mexico
| | - Julio Martínez-Burnes
- Graduate and Research Department, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Tamaulipas, Victoria City, Tamaulipas, Mexico
| | - Alejandro Casas Alvarado
- Neurophysiology of Pain, Behavior and Assessment of Welfare in Domestic Animals, DPAA, Universidad Autónoma Metropolitana (UAM), Mexico City, Mexico
| | - Antonio Verduzco-Mendoza
- Departamento Bioterio y Cirugía Experimental, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra (INR-LGII), Mexico City, Mexico
| | - Karina Lezama-García
- Neurophysiology of Pain, Behavior and Assessment of Welfare in Domestic Animals, DPAA, Universidad Autónoma Metropolitana (UAM), Mexico City, Mexico
| | - Adriana Olmos-Hernandez
- Departamento Bioterio y Cirugía Experimental, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra (INR-LGII), Mexico City, Mexico
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Saadeh W, Khan FH, Altaf MAB. Design and Implementation of a Machine Learning Based EEG Processor for Accurate Estimation of Depth of Anesthesia. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2019; 13:658-669. [PMID: 31180871 DOI: 10.1109/tbcas.2019.2921875] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Accurate monitoring of the depth of anesthesia (DoA) is essential for intraoperative and postoperative patient's health. Commercially available electroencephalograph (EEG)-based DoA monitors are recommended only for certain anesthetic drugs and specific age-group patients. This paper presents a machine learning classification processor for accurate DoA estimation irrespective of the patient's age and anesthetic drug. The classification is solely based on six features extracted from EEG signal, i.e., spectral edge frequency (SEF), beta ratio, and four bands of spectral energy (FBSE). A machine learning fine decision tree classifier is adopted to achieve a four-class DoA classification (deep, moderate, and light DoA versus awake state). The feature selection and the classification processor are optimized to achieve the highest classification accuracy for the state of moderate anesthesia required for the surgical operations. The proposed 256-point fast Fourier transform accelerator is implemented to realize SEF, beta ratio, and FBSE that enables minimal latency and high accuracy feature extraction. The proposed DoA processor is implemented using a 65 nm CMOS technology and experimentally verified using field programming gate array (FPGA) based on the EEG recordings of 75 patients undergoing elective surgery with different types of anesthetic agents. The processor achieves an average accuracy of 92.2% for all DoA states, with a latency of 1s The 0.09 mm2 DoA processor consumes 140nJ/classification.
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Sun H, Nagaraj SB, Akeju O, Purdon PL, Westover BM. Brain Monitoring of Sedation in the Intensive Care Unit Using a Recurrent Neural Network. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2018:1-4. [PMID: 30440304 DOI: 10.1109/embc.2018.8513185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Over and under-sedation are common in critically ill patients admitted to the Intensive Care Unit. Clinical assessments provide limited time resolution and are based on behavior rather than the brain itself. Existing brain monitors have been developed primarily for non-ICU settings. Here, we use a clinical dataset from 154 ICU patients in whom the Richmond Agitation-Sedation Score is assessed about every 2 hours. We develop a recurrent neural network (RNN) model to discriminate between deep vs. no sedation, trained end-to-end from raw EEG spectrograms without any feature extraction. We obtain an average area under the ROC of 0.8 on 10-fold cross validation across patients. Our RNN is able to provide reliable estimates of sedation levels consistently better compared to a feed-forward model with simple smoothing. Decomposing the prediction error in terms of sedatives reveals that patient-specific calibration for sedatives is expected to further improve sedation monitoring.
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Sharma HS, Muresanu DF, Nozari A, Castellani RJ, Dey PK, Wiklund L, Sharma A. Anesthetics influence concussive head injury induced blood-brain barrier breakdown, brain edema formation, cerebral blood flow, serotonin levels, brain pathology and functional outcome. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 146:45-81. [PMID: 31349932 DOI: 10.1016/bs.irn.2019.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Several lines of evidences show that anesthetics influence neurotoxicity and neuroprotection. The possibility that different anesthetic agents potentially influence the pathophysiological and functional outcome following neurotrauma was examined in a rat model of concussive head injury (CHI). The CHI was produced by an impact of 0.224N on the right parietal bone by dropping a weight of 114.6g from a 20cm height under different anesthetic agents, e.g., inhaled ether anesthesia or intraperitoneally administered ketamine, pentobarbital, equithesin or urethane anesthesia. Five hour CHI resulted in profound volume swelling and brain edema formation in both hemispheres showing disruption of the blood-brain barrier (BBB) to Evans blue and radioiodine. A marked decrease in the cortical CBF and a profound increase in plasma or brain serotonin levels were seen at this time. Neuronal damages were present in several parts of the brain. These pathological changes were most marked in CHI under ether anesthesia followed by ketamine (35mg/kg, i.p.), pentobarbital (50mg/kg, i.p.), equithesin (3mL/kg, i.p.) and urethane (1g/kg, i.p.). The functional outcome on Rota Rod performances or grid walking tests was also most adversely affected after CHI under ether anesthesia followed by pentobarbital, equithesin and ketamine. Interestingly, the plasma and brain serotonin levels strongly correlated with the development of brain edema in head injured animals in relation to different anesthetic agents used. These observations suggest that anesthetic agents are detrimental to functional and pathological outcomes in CHI probably through influencing the circulating plasma and brain serotonin levels, not reported earlier. Whether anesthetics could also affect the efficacy of different neuroprotective agents in CNS injuries is a new subject that is currently being examined in our laboratory.
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Affiliation(s)
- Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
| | - Dafin Fior Muresanu
- Department of Clinical Neurosciences, University of Medicine & Pharmacy, Cluj-Napoca, Romania; "RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Ala Nozari
- Anesthesia and Critical Care, Massachusetts General Hospital, Boston, MA, United States
| | - Rudy J Castellani
- Department of Pathology, University of Maryland, Baltimore, MD, United States
| | - Prasanta Kumar Dey
- Neurophysiology Research Unit, Department of Physiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Lars Wiklund
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
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Ki S, Kim KM, Lee YH, Bang JY, Choi BM, Noh GJ. Phase lag entropy as a hypnotic depth indicator during propofol sedation. Anaesthesia 2019; 74:1033-1040. [PMID: 31106853 DOI: 10.1111/anae.14704] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2019] [Indexed: 11/29/2022]
Abstract
Phase lag entropy, an electro-encephalography-based hypnotic depth indicator, calculates diversity in temporal patterns of phase relationship. We compared the performance of phase lag entropy with the bispectral index™ in 30 patients scheduled for elective surgery. We initiated a target-controlled infusion of propofol using the Schnider model, and assessed sedation levels using the Modified Observer's Assessment of Alertness/Sedation scale every 30 s with each stepwise increase in the effect-site propofol concentration. Phase lag entropy and bispectral index values were recorded. The correlation coefficient and prediction probability between phase lag entropy or bispectral index and the sedation level or effect-site propofol concentration were analysed. We calculated baseline variabilities of phase lag entropy and bispectral index. In addition, we applied a non-linear mixed-effects model to obtain the pharmacodynamic relationships among the effect-site propofol concentration, phase lag entropy or bispectral index and sedation level. As sedation increased, phase lag entropy and bispectral index both decreased. The prediction probability values of phase lag entropy and bispectral index for sedation levels were 0.697 and 0.700 (p = 0.261) and for the effect-site concentration of propofol were 0.646 and 0.630 (p = 0.091), respectively. Baseline variability in phase lag entropy and bispectral index was 3.3 and 5.7, respectively. The predicted propofol concentrations, using the Schnider pharmacokinetic model, producing a 50% probability of moderate and deep sedation were 1.96 and 3.01 μg.ml-1 , respectively. Phase lag entropy was found to be useful as a hypnotic depth indicator in patients receiving propofol sedation.
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Affiliation(s)
- S Ki
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University, Busan, Korea
| | - K M Kim
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Hallym University of College of Medicine, Anyang, Korea
| | - Y H Lee
- Department of Anaesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - J Y Bang
- Department of Anaesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - B M Choi
- Department of Anaesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - G J Noh
- Department of Anaesthesiology and Pain Medicine and Department of Clinical Pharmacology and Therapeutics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Caporro M, Rossetti AO, Seiler A, Kustermann T, Nguepnjo Nguissi NA, Pfeiffer C, Zimmermann R, Haenggi M, Oddo M, De Lucia M, Zubler F. Electromyographic reactivity measured with scalp-EEG contributes to prognostication after cardiac arrest. Resuscitation 2019; 138:146-152. [DOI: 10.1016/j.resuscitation.2019.03.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 03/03/2019] [Accepted: 03/06/2019] [Indexed: 01/02/2023]
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Ferreira AL, Nunes C, Mendes JG, Amorim P. Do we have today a reliable method to detect the moment of loss of consciousness during induction of general anaesthesia? REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2019; 66:93-103. [PMID: 30077394 DOI: 10.1016/j.redar.2018.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/03/2018] [Accepted: 06/13/2018] [Indexed: 06/08/2023]
Abstract
This review aims to give an overview of the current state of monitoring depth of anaesthesia and detecting the moment of loss of consciousness, from the first clinical signs involved in anaesthesia to the latest technologies used in this area. Such techniques are extremely important for the development of automatic systems for anaesthesia control, including preventing intraoperative awareness episodes and overdoses. A search in the databases Pubmed and IEEE Xplore was performed using terms such anaesthetic monitoring, depth of anaesthesia, loss of consciousness, as well as anaesthesia indexes, namely BIS. Despite the several methods capable of monitoring the hypnotic state of anaesthesia, there is still no methodology to accurate detect the moment of loss of consciousness during induction of general anaesthesia.
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Affiliation(s)
- A L Ferreira
- LAETA/INEGI, Faculdade de Engenharia da Universidade do Porto, Oporto, Portugal; Centro de Investigação Clínica em Anestesiologia, Serviço de Anestesiologia, Centro Hospitalar do Porto, Oporto, Portugal.
| | - C Nunes
- Centro de Investigação Clínica em Anestesiologia, Serviço de Anestesiologia, Centro Hospitalar do Porto, Oporto, Portugal; Departamento de Ciências e Tecnologia, Universidade Aberta, Oporto, Portugal
| | - J G Mendes
- LAETA/INEGI, Faculdade de Engenharia da Universidade do Porto, Oporto, Portugal
| | - P Amorim
- Centro de Investigação Clínica em Anestesiologia, Serviço de Anestesiologia, Centro Hospitalar do Porto, Oporto, Portugal
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Giraldo JC, Acosta C, Giraldo-Grueso M. Frequency of anesthetic overdose with mean alveolar concentration-guided anesthesia at high altitude. Med Gas Res 2019; 8:150-153. [PMID: 30713667 PMCID: PMC6352576 DOI: 10.4103/2045-9912.248265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/02/2018] [Indexed: 11/04/2022] Open
Abstract
This study reported the frequency of anesthetic overdose measured with the bispectral index in a high altitude city (Bogotá-Colombia, 2600 meters above sea level). We assembled a prospective cohort of patients. Preoperative variables were described, and 10 minutes after the surgical incision, bispectral index, mean alveolar concentration, mean arterial pressure, and oxygen saturation were recorded. Bispectral index was classified as superficial (60), adequate (40-60), and deep (> 40). Mean alveolar concentration was classified as low (< 0.8), normal (0.8-1.2), and high (> 1.2). We included 50 patients. The mean age of the patients was 36.3 ± 13.5 years; 48% were male and 78% were categorized as ASA I. Mean values of mean alveolar concentration and bispectral index were 1.14 ± 0.18 and 38.66 ± 6.9, respectively. Frequency of anesthetic overdose measured with bispectral index was 54% and only 20% with mean alveolar concentration. In total, 78% of patients received normal mean alveolar concentration values, and among these patients, 49% had deep bispectral index levels and 51% were adequate. There was no correlation between mean alveolar concentration and bispectral index (Pearson r = 0.161, P = 0.246) or between bispectral index and mean arterial pressure (Pearson r = 0.367, P = 0.08). All patients older than 60 years exhibited deep bispectral index levels, and although we did not identify a correlation between age and bispectral index, a tendency was observed (Pearson r = -0.087, P = 0.538). Safe and effective anesthesia overdose could be a common phenomenon. Bispectral index-guided anesthesia could be a helpful and reliable tool in the assessment and prevention of anesthesia overdose at high altitude. The study was approved by the ethics committee of the Fundación Cardioinfantil-Instituto de cardiología, Bogota, Colombia (approved number: 312017).
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Affiliation(s)
- Juan C Giraldo
- Cardiothoracic Anesthesia Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | | | - Manuel Giraldo-Grueso
- Vascular Function Research Laboratory, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
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Harnessing olfactory bulb oscillations to perform fully brain-based sleep-scoring and real-time monitoring of anaesthesia depth. PLoS Biol 2018; 16:e2005458. [PMID: 30408025 PMCID: PMC6224033 DOI: 10.1371/journal.pbio.2005458] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 10/04/2018] [Indexed: 12/11/2022] Open
Abstract
Real-time tracking of vigilance states related to both sleep or anaesthesia has been a goal for over a century. However, sleep scoring cannot currently be performed with brain signals alone, despite the deep neuromodulatory transformations that accompany sleep state changes. Therefore, at heart, the operational distinction between sleep and wake is that of immobility and movement, despite numerous situations in which this one-to-one mapping fails. Here we demonstrate, using local field potential (LFP) recordings in freely moving mice, that gamma (50–70 Hz) power in the olfactory bulb (OB) allows for clear classification of sleep and wake, thus providing a brain-based criterion to distinguish these two vigilance states without relying on motor activity. Coupled with hippocampal theta activity, it allows the elaboration of a sleep scoring algorithm that relies on brain activity alone. This method reaches over 90% homology with classical methods based on muscular activity (electromyography [EMG]) and video tracking. Moreover, contrary to EMG, OB gamma power allows correct discrimination between sleep and immobility in ambiguous situations such as fear-related freezing. We use the instantaneous power of hippocampal theta oscillation and OB gamma oscillation to construct a 2D phase space that is highly robust throughout time, across individual mice and mouse strains, and under classical drug treatment. Dynamic analysis of trajectories within this space yields a novel characterisation of sleep/wake transitions: whereas waking up is a fast and direct transition that can be modelled by a ballistic trajectory, falling asleep is best described as a stochastic and gradual state change. Finally, we demonstrate that OB oscillations also allow us to track other vigilance states. Non-REM (NREM) and rapid eye movement (REM) sleep can be distinguished with high accuracy based on beta (10–15 Hz) power. More importantly, we show that depth of anaesthesia can be tracked in real time using OB gamma power. Indeed, the gamma power predicts and anticipates the motor response to stimulation both in the steady state under constant anaesthetic and dynamically during the recovery period. Altogether, this methodology opens the avenue for multi-timescale characterisation of brain states and provides an unprecedented window onto levels of vigilance. Real-time tracking of vigilance states related to wake, sleep, and anaesthesia has been a goal for over a century. However identification of wakefulness and different sleep states cannot currently be performed routinely with brain signals and instead relies on motor activity. Here we demonstrate that 50–70 Hz electrical oscillations in the olfactory bulb (OB) of mice are a reliable indicator for global brain states. Recording this activity with an implanted electrode allows for clear classification of sleep and wake, without the need for motor activity monitoring. We construct a fully automatic sleep scoring algorithm that relies on brain activity alone and is robust throughout time, between animals, and after drug administration. Our method also tracks in real time the depth of anaesthesia both in the steady state under constant anaesthetic and dynamically during the recovery period from anaesthesia. Furthermore, this index predicts responsiveness to noxious stimulation under anaesthesia. Altogether, this methodology opens the avenue for characterisation of vigilance states based on OB recordings.
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Yang YL, Seok HS, Noh GJ, Choi BM, Shin H. Postoperative Pain Assessment Indices Based on Photoplethysmography Waveform Analysis. Front Physiol 2018; 9:1199. [PMID: 30210363 PMCID: PMC6121033 DOI: 10.3389/fphys.2018.01199] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 08/08/2018] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study was to derive parameters that might reflect postoperative pain from photoplethysmography (PPG) and verify the derived parameters in postoperative pain assessment. We obtained preoperative and postoperative PPG and 100-mm visual analog scale (VAS) from 65 surgical patients and extracted a total of 51 PPG morphology-based parameters and their normalized parameters from these PPGs obtained. Pain discrimination performances of these derived parameters were assessed by statistical analyses, including Wilcoxon signed rank test with Bonferroni correction, classification accuracy based on logistic regression, and 4-fold cross validation. After comparing these parameters derived from PPG in pre- and post-operative conditions, statistically significant difference was found in 36 of the 51 parameters. Using logistic classification, dynamic between-pulse parameters such as normalized systolic amplitude variation and normalized diastolic amplitude variation showed better pain classification performance than the static within-pulse parameters. VAS score was 0 in every pre-operation condition, but >60 VAS was observed in the post-operative condition. Systolic peak amplitude variation normalized by PPG AC amplitude showed the best performance in classifying post-operative pain, with accuracy, sensitivity, specificity, and positive predictivity values of 79.5, 74.0, 86.0, and 84.5%, respectively. These results are superior to those of the surgical pleth index (SPI, GE Healthcare, Chicago, IL, United States) at 65.9, 65.9, 66.5, and 66.5%, respectively.
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Affiliation(s)
- Yoon La Yang
- Interdisciplinary Program in Biomedical Engineering, Chonnam National University, Gwangju, South Korea
| | - Hyeon Seok Seok
- Department of Biomedical Engineering, Chonnam National University, Yeosu, South Korea
| | - Gyu-Jeong Noh
- Department of Clinical Pharmacology and Therapeutics, University of Ulsan College of Medicine, Seoul, South Korea.,Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Byung-Moon Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hangsik Shin
- Interdisciplinary Program in Biomedical Engineering, Chonnam National University, Gwangju, South Korea.,Department of Biomedical Engineering, Chonnam National University, Yeosu, South Korea
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Youngblood BL, Ueyama Y, Muir WW, Belfort GM, Hammond RH, Dai J, Salituro FG, Robichaud AJ, Doherty JJ. A new method for determining levels of sedation in dogs: A pilot study with propofol and a novel neuroactive steroid anesthetic. J Neurosci Methods 2018; 305:82-88. [PMID: 29772269 DOI: 10.1016/j.jneumeth.2018.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/11/2018] [Accepted: 05/12/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Different levels of consciousness are required in order to perform different medical procedures. Sedation scales established to objectively define various levels of sedation in humans have not been thoroughly characterized in non-human species. Postural changes in rats or dogs are useful as gross measures of sedation but are inadequate for quantitative assessment since graded levels of sedation are difficult to delineate and obscured by movement abnormalities. NEW METHOD A new canine sedation scoring (CSS) method was developed based on the modified observer's assessment of alertness and sedation score (MOAA/S) used in humans. The method employed a combination of physical, auditory and somatosensory stimuli of increasing intensity. Cardiovascular, respiratory, and a neurophysiological measure of sedation (bispectral index: BIS) data were recorded. Validation studies were performed following intravenous loading and constant rate infusion of propofol or a novel synthetic neuroactive steroid (SGE-746). RESULTS Four levels of consciousness were identified: 1) Awake, 2) Moderate Sedation (MS), 3) Deep Sedation (DS) and 4) General Anesthesia (GA). Cardiorespiratory measurements obtained after bolus administration of propofol and SGE-746 and at the end of each CRI remained within normal limits. Canine sedation scores correlated with BIS for SGE-746. SGE-746 exhibited a more gradual exposure-response relationship than propofol. Larger increases in the plasma concentration from awake values were required to achieve different levels of sedation with SGE-746 compared to propofol. COMPARISON WITH EXISTING METHODS No other canine sedation scoring methods are widely accepted. CONCLUSION A CSS method, based on the human MOAA/S scale defined four levels of consciousness in dogs and provided better resolution of sedation depth than BIS alone.
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Affiliation(s)
- B L Youngblood
- QTest Laboratories, 6456 Fiesta Drive, Columbus, OH 43235, USA.
| | - Y Ueyama
- QTest Laboratories, 6456 Fiesta Drive, Columbus, OH 43235, USA
| | - W W Muir
- QTest Laboratories, 6456 Fiesta Drive, Columbus, OH 43235, USA
| | - G M Belfort
- Sage Therapeutics, 215 First Street, Cambridge, MA 02142, USA
| | - R H Hammond
- Sage Therapeutics, 215 First Street, Cambridge, MA 02142, USA
| | - J Dai
- Sage Therapeutics, 215 First Street, Cambridge, MA 02142, USA
| | - F G Salituro
- Sage Therapeutics, 215 First Street, Cambridge, MA 02142, USA
| | - A J Robichaud
- Sage Therapeutics, 215 First Street, Cambridge, MA 02142, USA
| | - J J Doherty
- Sage Therapeutics, 215 First Street, Cambridge, MA 02142, USA
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Cho SH, Kim SS, Hyun DM, Yoon HS, Han JW, Kim JS. Comparison between cerebral state index and bispectral index during desflurane anesthesia. Korean J Anesthesiol 2018; 71:447-452. [PMID: 29739183 PMCID: PMC6283714 DOI: 10.4097/kja.d.17.00084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/11/2018] [Indexed: 11/13/2022] Open
Abstract
Background Cerebral state index (CSI) is an anesthesia depth monitor alternative to bispectral index (BIS). Published comparative studies have used propofol or sevoflurane. However, studies using desflurane have not been reported yet. Different volatile anesthetics have different electroencephalography signatures. The performance of CSI may be different in desflurane anesthesia. Therefore, the objective of this study was to compare CSI and BIS during desflurane anesthesia. Methods Thirty-three patients were recruited. Desflurane and remifentanil were used to maintain general anesthesia. BIS and CSI were recorded simultaneously every minute. End-tidal concentration of desflurane was maintained at 4% from the beginning of surgery for 5 minutes. Pairwise data of CSI and BIS were obtained five times at one-minute intervals. This process was repeated in the order of 6%, 8%, and 10%. Results BIS and CSI were negatively correlated with the end-tidal concentration of desflurane with a similar degree of correlation (correlation coefficient BIS: –0.847, CSI: –0.844). The relationship between CSI and BIS had a good linearity with a slope close to 1 (R2 = 0.905, slope = 1.01). For the relationship between CSI and BIS at each end-tidal concentration of desflurane, CSI and BIS showed good linearity in 4% and 10% (R2 = 0.559, 0.540). However, the linearity and slope were decreased in 6% and 8% (R2 = 0.163, 0.014). Conclusions CSI showed an equivalent degree of overall performance compared to BIS in desflurane anesthesia. Accounting for previous literature, CSI can be used as a good substitute for BIS regardless of the kind of anesthetics used.
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Affiliation(s)
- Sang-Hyeon Cho
- Department of Anesthesiology and Pain Medicine, GangNeung Asan Hospital, Gangneung, Korea
| | - Sung-Su Kim
- Department of Anesthesiology and Pain Medicine, GangNeung Asan Hospital, Gangneung, Korea
| | - Dong-Min Hyun
- Department of Anesthesiology and Pain Medicine, GangNeung Asan Hospital, Gangneung, Korea
| | - Hyeong-Suk Yoon
- Department of Anesthesiology and Pain Medicine, GangNeung Asan Hospital, Gangneung, Korea
| | - Jung-Woo Han
- Department of Anesthesiology and Pain Medicine, GangNeung Asan Hospital, Gangneung, Korea
| | - Jin Sun Kim
- Department of Anesthesiology and Pain Medicine, GangNeung Asan Hospital, Gangneung, Korea
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Yu YN, Doctor F, Fan SZ, Shieh JS. An Adaptive Monitoring Scheme for Automatic Control of Anaesthesia in dynamic surgical environments based on Bispectral Index and Blood Pressure. J Med Syst 2018; 42:95. [PMID: 29654373 DOI: 10.1007/s10916-018-0933-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 03/11/2018] [Indexed: 11/26/2022]
Abstract
During surgical procedures, bispectral index (BIS) is a well-known measure used to determine the patient's depth of anesthesia (DOA). However, BIS readings can be subject to interference from many factors during surgery, and other parameters such as blood pressure (BP) and heart rate (HR) can provide more stable indicators. However, anesthesiologist still consider BIS as a primary measure to determine if the patient is correctly anaesthetized while relaying on the other physiological parameters to monitor and ensure the patient's status is maintained. The automatic control of administering anesthesia using intelligent control systems has been the subject of recent research in order to alleviate the burden on the anesthetist to manually adjust drug dosage in response physiological changes for sustaining DOA. A system proposed for the automatic control of anesthesia based on type-2 Self Organizing Fuzzy Logic Controllers (T2-SOFLCs) has been shown to be effective in the control of DOA under simulated scenarios while contending with uncertainties due to signal noise and dynamic changes in pharmacodynamics (PD) and pharmacokinetic (PK) effects of the drug on the body. This study considers both BIS and BP as part of an adaptive automatic control scheme, which can adjust to the monitoring of either parameter in response to changes in the availability and reliability of BIS signals during surgery. The simulation of different control schemes using BIS data obtained during real surgical procedures to emulate noise and interference factors have been conducted. The use of either or both combined parameters for controlling the delivery Propofol to maintain safe target set points for DOA are evaluated. The results show that combing BIS and BP based on the proposed adaptive control scheme can ensure the target set points and the correct amount of drug in the body is maintained even with the intermittent loss of BIS signal that could otherwise disrupt an automated control system.
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Affiliation(s)
- Yu-Ning Yu
- Department of Mechanical Engineering, and Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Chungli, 320, Taiwan, Republic of China
| | - Faiyaz Doctor
- School of Computer Science and Electronic Engineering, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK.
| | - Shou-Zen Fan
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, 100, Taiwan, Republic of China
| | - Jiann-Shing Shieh
- Department of Mechanical Engineering, and Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Chungli, 320, Taiwan, Republic of China.
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Watase T, Shimizu K, Ohara K, Komiya H, Kanno K, Hatori K, Noma N, Honda K, Tsuboi Y, Katagiri A, Shinoda M, Ogiso B, Iwata K. Role of medullary astroglial glutamine synthesis in tooth pulp hypersensitivity associated with frequent masseter muscle contraction. Mol Pain 2018; 14:1744806918763270. [PMID: 29448913 PMCID: PMC5858619 DOI: 10.1177/1744806918763270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The mechanisms underlying tooth pulp hypersensitivity associated with masseter muscle hyperalgesia remain largely underinvestigated. In the present study, we aimed to determine whether masseter muscle contraction induced by daily electrical stimulation influences the mechanical head-withdrawal threshold and genioglossus electromyography activity caused by the application of capsaicin to the upper first molar tooth pulp. We further investigated whether astroglial glutamine synthesis is involved in first molar tooth pulp hypersensitivity associated with masseter muscle contraction. Methods The first molar tooth pulp was treated with capsaicin or vehicle in masseter muscle contraction or sham rats, following which the astroglial glutamine synthetase inhibitor methionine sulfoximine or Phosphate buffered saline (PBS) was applied. Astroglial activation was assessed via immunohistochemistry. Results The mechanical head-withdrawal threshold of the ipsilateral masseter muscle was significantly decreased in masseter muscle contraction rats than in sham rats. Genioglossus electromyography activity was significantly higher in masseter muscle contraction rats than sham rats. Glial fibrillary acidic protein-immunoreactive cell density was significantly higher in masseter muscle contraction rats than in sham rats. Administration of methionine sulfoximine induced no significant changes in the density of glial fibrillary acidic protein-immunoreactive cells relative to PBS treatment. However, mechanical head-withdrawal threshold was significantly higher in masseter muscle contraction rats than PBS-treated rats after methionine sulfoximine administration. Genioglossus electromyography activity following first molar tooth pulp capsaicin treatment was significantly lower in methionine sulfoximine-treated rats than in PBS-treated rats. In the ipsilateral region, the total number of phosphorylated extracellular signal-regulated protein kinase immunoreactive cells in the medullary dorsal horn was significantly smaller upon first molar tooth pulp capsaicin application in methionine sulfoximine-treated rats than in PBS-treated rats. Conclusions Our results suggest that masseter muscle contraction induces astroglial activation, and that this activation spreads from caudal to the obex in the medullary dorsal horn, resulting in enhanced neuronal excitability associated with astroglial glutamine synthesis in medullary dorsal horn neurons receiving inputs from the tooth pulp. These findings provide significant insight into the mechanisms underlying tooth pulp hypersensitivity associated with masseter muscle contraction.
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Affiliation(s)
- Tetsuro Watase
- Department of Anatomy, Nihon University School of Dentistry, Japan
- Division of Functional Morphology, Dental Research Center, Nihon University School of Dentistry, Japan
| | - Kohei Shimizu
- Department of Endodontics, Nihon University School of Dentistry, Japan
- Division of Advanced Dental Treatment, Dental Research Center, Nihon University School of Dentistry, Japan
- Kohei Shimizu, Department of Endodontics, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo 101-8310, Japan.
| | - Kinuyo Ohara
- Department of Endodontics, Nihon University School of Dentistry, Japan
| | - Hiroki Komiya
- Department of Endodontics, Nihon University School of Dentistry, Japan
| | - Kohei Kanno
- Department of Endodontics, Nihon University School of Dentistry, Japan
| | - Keisuke Hatori
- Department of Endodontics, Nihon University School of Dentistry, Japan
- Division of Advanced Dental Treatment, Dental Research Center, Nihon University School of Dentistry, Japan
| | - Noboru Noma
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry, Japan
- Division of Clinical Research, Dental Research Center, Nihon University School of Dentistry, Japan
| | - Kuniya Honda
- Department of Physiology, Nihon University School of Dentistry, Japan
| | - Yoshiyuki Tsuboi
- Division of Functional Morphology, Dental Research Center, Nihon University School of Dentistry, Japan
- Department of Physiology, Nihon University School of Dentistry, Japan
| | - Ayano Katagiri
- Department of Oral Physiology, Osaka University Graduate School of Dentistry
| | - Masamichi Shinoda
- Division of Functional Morphology, Dental Research Center, Nihon University School of Dentistry, Japan
- Department of Physiology, Nihon University School of Dentistry, Japan
| | - Bunnai Ogiso
- Department of Endodontics, Nihon University School of Dentistry, Japan
- Division of Advanced Dental Treatment, Dental Research Center, Nihon University School of Dentistry, Japan
| | - Koichi Iwata
- Division of Functional Morphology, Dental Research Center, Nihon University School of Dentistry, Japan
- Department of Physiology, Nihon University School of Dentistry, Japan
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Fahy BG, Chau DF. The Technology of Processed Electroencephalogram Monitoring Devices for Assessment of Depth of Anesthesia. Anesth Analg 2018; 126:111-117. [DOI: 10.1213/ane.0000000000002331] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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49
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Davis BM, Brenton J, Davis S, Shamsher E, Sisa C, Grgic L, Cordeiro MF. Assessing anesthetic activity through modulation of the membrane dipole potential. J Lipid Res 2017; 58:1962-1976. [PMID: 28818873 PMCID: PMC5625120 DOI: 10.1194/jlr.m073932] [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: 12/02/2016] [Revised: 08/09/2017] [Indexed: 12/21/2022] Open
Abstract
There is great individual variation in response to general anesthetics (GAs) leading to difficulties in optimal dosing and sometimes even accidental awareness during general anesthesia (AAGA). AAGA is a rare, but potentially devastating, complication affecting between 0.1% and 2% of patients undergoing surgery. The development of novel personalized screening techniques to accurately predict a patient’s response to GAs and the risk of AAGA remains an unmet clinical need. In the present study, we demonstrate the principle of using a fluorescent reporter of the membrane dipole potential, di-8-ANEPPs, as a novel method to monitor anesthetic activity using a well-described inducer/noninducer pair. The membrane dipole potential has previously been suggested to contribute a novel mechanism of anesthetic action. We show that the fluorescence ratio of di-8-ANEPPs changed in response to physiological concentrations of the anesthetic, 1-chloro-1,2,2-trifluorocyclobutane (F3), but not the structurally similar noninducer, 1,2-dichlorohexafluorocyclobutane (F6), to artificial membranes and in vitro retinal cell systems. Modulation of the membrane dipole provides an explanation to overcome the limitations associated with the alternative membrane-mediated mechanisms of GA action. Furthermore, by combining this technique with noninvasive retinal imaging technologies, we propose that this technique could provide a novel and noninvasive technique to monitor GA susceptibility and identify patients at risk of AAGA.
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Affiliation(s)
| | - Jonathan Brenton
- University College London Institute of Ophthalmology, London EC1V 9EL, United Kingdom
| | - Sterenn Davis
- University College London Institute of Ophthalmology, London EC1V 9EL, United Kingdom
| | - Ehtesham Shamsher
- University College London Institute of Ophthalmology, London EC1V 9EL, United Kingdom
| | - Claudia Sisa
- University College London Institute of Ophthalmology, London EC1V 9EL, United Kingdom
| | - Ljuban Grgic
- University College London Institute of Ophthalmology, London EC1V 9EL, United Kingdom
| | - M Francesca Cordeiro
- University College London Institute of Ophthalmology, London EC1V 9EL, United Kingdom .,Western Eye Hospital, Imperial College Healthcare National Health Service Trust, and Imperial College Ophthalmic Research Group, Imperial College London, London NW1 5QH, United Kingdom
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50
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Lee H, Noh GJ, Joo P, Choi BM, Silverstein BH, Kim M, Wang J, Jung WS, Kim S. Diversity of functional connectivity patterns is reduced in propofol-induced unconsciousness. Hum Brain Mapp 2017; 38:4980-4995. [PMID: 28670685 DOI: 10.1002/hbm.23708] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 05/22/2017] [Accepted: 06/19/2017] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Recent evidence suggests that the conscious brain is characterized by a diverse repertoire of functional connectivity patterns while the anesthetized brain shows stereotyped activity. However, classical time-averaged methods of connectivity dismiss dynamic and temporal characteristics of functional configurations. Here we demonstrate a new approach which characterizes time-varying patterns of functional connectivity at the subsecond time scale. METHODS We introduce phase-lag entropy (PLE), a measure of the diversity of temporal patterns in the phase relationships between two signals. The proposed measure was applied to multichannel electroencephalogram (EEG), which were recorded from two distinct experimental settings: (1) propofol was administrated at a constant infusion rate for 60 min (n = 96); (2) administration of propofol by a target effect-site concentration-controlled infusion with simultaneous assessment of the level of consciousness (n = 10). RESULTS From the first dataset, two substantial changes of the phase relationship during anesthesia was found: (1) the dynamics of the phase relationship between frontal channels became progressively less diverse and more stereotyped during unconsciousness, quantified as a reduction in PLE; and (2) the reduction in PLE was consistent across subjects. Furthermore, PLE provided better performance in the classification of states of consciousness than did phase-lag index, a classical time-averaged connectivity method. From the second dataset, PLE showed the highest agreement with the level of consciousness, compared to existing anesthetic depth indicators. CONCLUSIONS This study suggests that a scarcity of functional configurations is closely associated with anesthetically induced unconsciousness, and shows promise as a basis for a new consciousness monitoring system during general anesthesia. Hum Brain Mapp 38:4980-4995, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Heonsoo Lee
- Department of Physics, Pohang University of Science and Technology, Pohang, Korea
| | - Gyu-Jeong Noh
- Department of Clinical Pharmacology and Therapeutics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Pangyu Joo
- Department of Physics, Pohang University of Science and Technology, Pohang, Korea
| | - Byung-Moon Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Minkyung Kim
- Department of Physics, Pohang University of Science and Technology, Pohang, Korea
| | - Jisung Wang
- Department of Physics, Pohang University of Science and Technology, Pohang, Korea
| | - Woo-Sung Jung
- Department of Physics, Pohang University of Science and Technology, Pohang, Korea.,Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, Korea.,Asia Pacific Center for Theoretical Physics, Pohang, Korea
| | - Seunghwan Kim
- Department of Physics, Pohang University of Science and Technology, Pohang, Korea
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