Browsing by Author "Castro, Ana"
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- Automation in anesthesia: computer controlled propofol infusion and data acquisitionPublication . Bressan, Nadja; Castro, Ana; Braga, Carlos; Lages, Jose; Silva, Nuno R.; Portela, Paulo; Miranda, Pedro; Oliveira, Sergio; Mendes, Joaquim; Amorim, Pedro; Nunes, Catarina S.This work presents the improvement of a software for a clinical setup, the Anesthesia Synchronization Software (ASYS). The first version presented the data acquisition from cerebral monitors and a partial control with Target Controlled Infusion (TCI) system. Based on pharmacokinetic models, the effect-site and plasma concentrations can be related with the drug dose infused and vice versa. This later version comes with the implementation of the hemodynamic monitor always present in operating rooms and with the full TCI system developed to determine the infusion rates of the drug which are given as commands to the infusion pumps.
- EEG entropy monitoring of depth of anaesthesia: pharmacokinetic and dynamic modellingPublication . Castro, Ana; Bressan, Nadja; Antunes, Luís; Nunes, Catarina S.Because of the difficulty in analyzing raw electroencephalographic signal, several electroencephalographic monitors have been developed to aid anaesthetists on their task to maintain adequate anaesthesia. Spectral Entropy is used as a measure of electroencefalographic effects of drugs in human patients, and is a valuable tool to predict depth of anaesthesia. Monitors with implemented entropy algorithms, process the electroencephalogram (EEG) and are in current use at the operating room. In this study we used the EEG collected in rats and applied the Shannon entropy over the signal. The information obtained was used as an indicator of depth of anaesthesia. The main objective was to model the relation between the depth of anaesthesia in rats (entropy) and the propofol infusion rates, with the purpose of obtaining a closed-loop control for propofol infusions. Five adult rats were sedated with isoflurane, cannulated and equipped for the EEG collection. After the preparation, anaesthesia was induced with propofol infusions, using different infusion rates on each rat. The collected EEG (125Hz) was processed using an entropy algorithm developed in MATLAB R 7 that determined the entropy value at each second using the preceding 15s of signal. Pharmacokinetic models were fitted for each rat using bi and tri-compartmental models; the pharmacodynamic phase was also modelled for each rat. The relation between obtained propofol effect-site concentrations and the entropy values was modelled by a Hill Equation. The model obtained for the relation between infusion rates and entropy values was evaluated using the mean absolute deviation (MAD) and the relative mean square error (RMSE) for models comparative analysis.
- Effect of propofol and remifentanil on a somatosensory evoked potential indicator of pain perception intensity in volunteersPublication . Castro, Ana; Amorim, Pedro; Nunes, Catarina S.; Almeida, Fernando Gomes deSomatosensory evoked potentials (SEPs) have been linked to noxious activation and stimulus intensity. In this exploratory study we investigated the impact of anaesthetic drugs on SEPs and pain ratings, to assess their applicability as an objective measure of the nociception/anti-nociception balance. Following institutional approval and written informed consent, 10 healthy adult volunteers were enrolled (29.5 ± 9.1 years, 63.0 ± 8.9 kg and 171.4 ± 7.2). Median nerve electrical stimulation was adjusted according to volunteers' sensitive, motor and painful thresholds (PT). Baseline SEPs were registered, and remifentanil and propofol administered using a stair scheme TCI. For each drug combination a 1.3×PT stimulus was administered, and volunteers evaluated pain intensity in a numerical rating scale (0-10). SEPs' amplitudes and latencies were normalized by the baseline values, reducing volunteers' intervariability. Stimulation currents varied between 6-52 mA (1.3×PT) and pain ratings between 0 and 9. Cortical SEPs latencies were decreased for higher stimulus intensities (P < 0.01), accompanied by increased pain ratings (P < 0.01). An individually adjusted/normalized ratio based on cortical SEPs amplitude and interpeak latency is proposed([Formula: see text]): [Formula: see text] and NSR were significantly correlated in three out of nine subjects, and [Formula: see text] and remifentanil Ce were significantly correlated in two (low number of evaluation points). [Formula: see text] was shown to decrease with increasing doses of propofol and remifentanil (P < 0.05). The proposed metric was depressed by anaesthetics and reflected pain evaluations. Further research is necessary to increase the number of volunteers and drugs' combination, to assess its applicability during surgically adequate anesthetic leves.
- Foreseeing postoperative pain in neurosurgical patients: pupillometry predicts postoperative pain ratings: an observational studyPublication . Vide, Sérgio; Castro, Ana; Correia, Rui; Cabral, Tiago; Lima, Deolinda; Nunes, Catarina S.; Gambús, Pedro; Amorim, PedroPupillary reflex dilation (PRD) is triggered by noxious stimuli and diminished by opioid administration. In the postoperative period, PRD has been shown to be correlated with pain reporting and a useful tool to guide opioid administration. In this study we assessed whether pupillary measurements taken before extubation were related with the patient's reported pain in the Post-Anesthesia Care Unit (PACU) using the Numerical Rating Scale (NRS). Our objective was to evaluate the correlation of PRD and pupillary variables measured intraoperatively with postoperative pain under the same opioid concentration. This was a prospective observational study of 26 neurosurgical patients undergoing general anesthesia exclusively with propofol and remifentanil. A portable infrared pupillometer was used to provide an objective measure of pupil size and PRD (using the Pupillary Pain Index) before extubation. Pain ratings were obtained from patients after recovery of consciousness, while remifentanil was maintained at 2 ng/mL. A significant correlation was observed between NRS scores and pre-extubation PPI (rS = 0.62; P = 0.002), as well as between NRS scores and pupil diameter before tetanic stimulation PPI (rS = 0.56, P = 0.006). We also found a negative correlation between pupil diameter and age (rS = - 0.42, P = 0.04). The statistically significant correlation between pre-extubation PPI scores and NRS scores, as well as between the pupillary diameter before tetanic stimulation and NRS scores suggest the possibility of titrating analgesia at the end of the intraoperative period based on individual responses. This could allow clinicians to identify the ideal remifentanil concentration for the postoperative period.
- Hypnotic administration for anesthesia using sliding-mode controlPublication . Castro, Ana; Nunes, Catarina S.; Amorim, Pedro; Almeida, Fernando G.Nowadays general anesthesia is maintained using as the controller the human intervention, relying only on the quick and certain response of the anesthesiologist to the surrounding conditions, in order to provide the adequate state of anesthesia for the three main components - hypnosis, analgesia and paralysis. One of the most advantageous breakthroughs in anesthesia has been the appearance of depth of anesthesia monitors, assisting anesthesiologists in the hard job of knowing the hypnotic state of a patient. This information allows a way of closing the loop for administration of the hypnotic drug, and a more secure maintenance of hypnosis. The objective of this work was to apply sliding-mode control techniques to the model structure of the hypnotic in the human body (measured by the effect), and evaluate the robustness of this method to expected deviations from the average patient.
- Modeling state entropy of the EEG and auditory evoked potentials: hypnotic and analgesic interactionsPublication . Castro, Ana; Amorim, Pedro; Nunes, Catarina S.Because of the complexity of raw electroencephalogram (EEG), for the anesthesiologist it is very difficult to evaluate the patient’s hypnosis state. Because of this, several depth of anesthesia monitors have been developed, and are in current use at the operating room (OR). These monitors convert the information supplied by the EEG or derived signals into a simple, easy to understand index. Nowadays, general anesthesia is controlled only by the clinician, which decides what is the best drug combination for the patient, regarding all information given by monitors and sensors in the OR. In this work, we collected data from two study groups with auditory evoked potentials (AEP) monitoring, and Entropy (SE) monitoring. A model was fitted to the signals and the Hill equation parameters adjusted, in both study groups. The objective was to predict hypnosis indices, regarding only the drugs administered to a patient, and capture the initial individual patient characteristics that might influence the drugs interaction in the human body. Hypnotic and analgesic drugs interact in different ways throughout the anaesthesia stages. The models obtained captured the different dynamic interaction of drugs, during the induction and maintenance phases, demonstrating that the model must have incorporated all this information in order to perform satisfactorily. Other information like haemodynamic variables might be included in the search for the optimum model.
- A novel multivariate STeady-state index during general ANesthesia (STAN)Publication . Castro, Ana; Almeida, Fernando Gomes de; Amorim, Pedro; Nunes, Catarina S.The assessment of the adequacy of general anesthesia for surgery, namely the nociception/anti-nociception balance, has received wide attention from the scientific community. Monitoring systems based on the frontal EEG/EMG, or autonomic state reactions (e.g. heart rate and blood pressure) have been developed aiming to objectively assess this balance. In this study a new multivariate indicator of patients' steady-state during anesthesia (STAN) is proposed, based on wavelet analysis of signals linked to noxious activation. A clinical protocol was designed to analyze precise noxious stimuli (laryngoscopy/intubation, tetanic, and incision), under three different analgesic doses; patients were randomized to receive either remifentanil 2.0, 3.0 or 4.0 ng/ml. ECG, PPG, BP, BIS, EMG and [Formula: see text] were continuously recorded. ECG, PPG and BP were processed to extract beat-to-beat information, and [Formula: see text] curve used to estimate the respiration rate. A combined steady-state index based on wavelet analysis of these variables, was applied and compared between the three study groups and stimuli (Wilcoxon signed ranks, Kruskal-Wallis and Mann-Whitney tests). Following institutional approval and signing the informed consent thirty four patients were enrolled in this study (3 excluded due to signal loss during data collection). The BIS index of the EEG, frontal EMG, heart rate, BP, and PPG wave amplitude changed in response to different noxious stimuli. Laryngoscopy/intubation was the stimulus with the more pronounced response [Formula: see text]. These variables were used in the construction of the combined index STAN; STAN responded adequately to noxious stimuli, with a more pronounced response to laryngoscopy/intubation (18.5-43.1 %, [Formula: see text]), and the attenuation provided by the analgesic, detecting steady-state periods in the different physiological signals analyzed (approximately 50 % of the total study time). A new multivariate approach for the assessment of the patient steady-state during general anesthesia was developed. The proposed wavelet based multivariate index responds adequately to different noxious stimuli, and attenuation provided by the analgesic in a dose-dependent manner for each stimulus analyzed in this study.
- Synchronization software for automation in anesthesiaPublication . Bressan, Nadja; Castro, Ana; Bras, Susana; Oliveira, Helder P.; Ribeiro, Lenio; Ferreira, David A.; Antunes, Luis; Amorim, Pedro; Nunes, Catarina S.This work presents the development of a software for data acquisition and control (ASYS) on a clinical setup. Similar to the industrial Supervisory Control And Data Acquisition (SCADA) the software assembles a Target Controlled Infusion (TCI) monitoring and supervisory control data in real time from devices in a surgical room. The software is not a full controller since the TCI systems comprehend permanent interaction from the anesthesiologist. Based on pharmacokinetic models, the effect-site and plasma concentrations can be related with the drug dose infused and vice versa. The software determines the infusion rates of the drug which are given as commands to the infusion pumps. This software provides the anesthesiologist with a trustworthy tool for managing a safe and balanced anesthesia. Since it also incorporates the acquisition and display of patients brain signals.
- Towards the control of depth of anaesthesia: identification of patient variabilityPublication . Nunes, Catarina S.; Alonso, Hugo; Castro, Ana; Amorim, Pedro; Mendonca, TeresaDepth of anaesthesia (DOA) is usually assessed through the Bispectral Index (BIS) and State Entropy (SE), which derived EEG signals. Studying the effect of drug interaction on these signals is of great importance for the development of a suitable drug infusion system designed to control DOA. In this paper, two renowned pharmacokinetic (PK) models for the anaesthetic drug propofol are considered, and their influence on the fitting and prediction abilities of a drug interaction model for BIS and SE is assessed. This interaction model is fitted to the individual patient data during anaesthesia induction and tested for prediction during surgery. Two identification methods are considered for the fitting purpose: a hybrid method and a nonlinear least squares curve-fitting algorithm. The results obtained for 7 patients show that the choice of the PK model has influence on the overall performance of the interaction model; in particular, only one PK model leads to good results in the prediction phase. The choice of the identification method is equally important, being the hybrid method the better suited. The successful identification of patient variability here obtained is a key step towards the control of DOA.