Abstract
AbstractAnesthesia-induced altered arousal depends on drugs having their effect in specific brain regions. These effects are also reflected in autonomic nervous system (ANS) outflow dynamics. To this extent, instantaneous monitoring of ANS outflow, based on neurophysiological and computational modeling, may provide a more accurate assessment of the action of anesthetic agents on the cardiovascular system. This will aid anesthesia care providers in maintaining homeostatic equilibrium and help to minimize drug administration while maintaining antinociceptive effects. In previous studies, we established a point process paradigm for analyzing heartbeat dynamics and have successfully applied these methods to a wide range of cardiovascular data and protocols. We recently devised a novel instantaneous nonlinear assessment of ANS outflow, also suitable and effective for real-time monitoring of the fast hemodynamic and autonomic effects during induction and emergence from anesthesia. Our goal is to demonstrate that our framework is suitable for instantaneous monitoring of the ANS response during administration of a broad range of anesthetic drugs. Specifically, we compare the hemodynamic and autonomic effects in study participants undergoing propofol (PROP) and dexmedetomidine (DMED) administration. Our methods provide an instantaneous characterization of autonomic state at different stages of sedation and anesthesia by tracking autonomic dynamics at very high time-resolution. Our results suggest that refined methods for analyzing linear and nonlinear heartbeat dynamics during administration of specific anesthetic drugs are able to overcome nonstationary limitations as well as reducing inter-subject variability, thus providing a potential real-time monitoring approach for patients receiving anesthesia.
Highlights
Despite recent technological advances in anesthetic delivery and monitoring systems and the growing body of information on molecular mechanisms of anesthetic actions, most anesthesia care providers monitor drug-induced altered states of arousal with basic clinical signs
In order to validate the proposed algorithms' ability to track pharmacological interventions in the operating room (OR) or the intensive care unit (ICU), we focus on how specific features of our framework are able to characterize instantaneous signatures of the hemodynamic and autonomic effects of the anesthetics before and during loss of consciousness
Neural pathways are differently affected, and specific physiological signatures of sedation could potentially be disentangled through appropriate experimental protocols and accurate noninvasive physiological assessments
Summary
Despite recent technological advances in anesthetic delivery and monitoring systems and the growing body of information on molecular mechanisms of anesthetic actions, most anesthesia care providers monitor drug-induced altered states of arousal with basic clinical signs (e.g., heart rate, blood pressure). Due to the high prevalence of anesthesia-related morbidity, more precise monitoring tools are required. The administration of anesthetic agents can result in hypotension, hypoxia, and cardiac dysrhythmias. Post-operative recall of intraoperative events, including sleep disturbances, dreams, nightmares, flashbacks and anxiety, as well as post-traumatic stress disorder [1], is an important source of anesthesia-related morbidity. It is estimated that the incidence of awareness under anesthesia is experienced by 20,000 to 40,000 individuals a year in the United States [2]. Small surgical operations, as well as most nonsurgical procedures, do not require loss of consciousness and may be performed without discomfort using reduced doses of anesthetic agents than are currently used
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