Intraoperative monitoring of depth of anesthesia by automated EMG-analysis

通过自动肌电图分析术中监测麻醉深度

• 批准号: 271272504
• 负责人: Professor Dr. Julian Prell
• 金额: --
• 依托单位: Universitätsklinik und Poliklinik für Neurochirurgie
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2015
• 资助国家: 德国
• 起止时间: 2014-12-31 至 2018-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/271272504?language=en
• 关键词: Intraoperative; monitoring; depth; anesthesia; automated

The observation of a correlation between EEG-activity and concentrations of anaesthetic and analgetic agents led to the development of processed EEG-monoparameters. Amount these, the BIS (bispectral index) has come to widespread use. However, there is ongoing controversy regarding this method. While a significant reduction of intraoperative awareness has been demonstrated in the B-aware-trial, these results were not reproducible in the B-unaware-trial. Our group has investigated automated analysis of processed intraoperative cranial nerve EMG data for more than 10 years. During surgical procedures in which these techniques were developed and tested, spontaneous episodes of massive EMG-activity, mainly in the muscles of throat, tongue and pharynx, have been observed. Minutes after the beginning of these episodes, considerable patient movement would occur on several occasions. Thus, it was hypothesized that the activation of these muscles indicates the initiation of protective reflexes, and that the resulting EMG-activity might serve as a warning parameter. A pilot study was conducted, and EMG from the muscles of throat, tongue and pharynx was quantified. In a parallel fashion, the BIS was assessed. With these data, the time interval between extubation and clear rise of the monitoring parameters (BIS and EMG) was compared. A median time interval of 5.9min was found for the BIS, while the EMG-parameter would rise 12.3min before extubation in median. As a result, a significantly longer warning-intervall was calculated for the EMG-parameter with the Mann-Whitney-test (p = 0.026). Observations made during this study and contemporary literature suggest that these findings should in principle be transferable to facial nerve EMG, which may be assessed in a much more simple way in routine practice. The goal of the planned project is the development and evaluation of a fully automated quantitative system, which relies on facial nerve EMG as a warning parameter indicating arousal reactions and pending patient movement. In order to evaluate this system, the resulting warning parameter is to be correlated with the BIS and the following additional parameters: a.) PRST-score b.) Depth of analgesia (ANI-monitor) c.) Pharmacological depth of analgesia: Calculated effect compartment concentration for utilized opiate d.) Pharmacological depth of hypnosis: Calculated effect compartment concentration for Propofol. In succession of this project, these results may be used for a prospective evaluation of variations in the EMG-parameter with constant surgical stimulus under varying effect compartment concentrations of opiates.

EEG活性和麻醉剂和抗凝剂浓度之间的相关性的观察导致了处理EEG单参数的发展。其中，脑电双频指数（BIS）已得到广泛应用。然而，关于这种方法一直存在争议。虽然在B-感知试验中证明了术中感知的显著降低，但这些结果在B-感知试验中不可重现。我们的小组已经研究了10多年的术中颅神经肌电图数据处理的自动分析。在开发和测试这些技术的外科手术过程中，已经观察到主要在咽喉、舌和咽的肌肉中的大量EMG活动的自发发作。在这些事件开始后的几分钟内，会多次发生相当大的患者移动。因此，假设这些肌肉的激活指示保护性反射的启动，并且由此产生的EMG活动可以用作警告参数。进行了初步研究，并从喉咙，舌头和咽部的肌肉肌电图进行了量化。以平行的方式，评估BIS。比较两组患者拔管后BIS、EMG明显升高的时间。拔管前BIS的平均上升时间为5.9min，而EMG参数的平均上升时间为12.3min。因此，使用Mann-Whitney检验计算EMG参数的警告间期显著更长（p = 0.026）。在这项研究和当代文献中的观察表明，这些发现原则上应该转移到面神经肌电图，这可能是在一个更简单的方式在日常实践中进行评估。该计划项目的目标是开发和评估一个全自动定量系统，该系统依赖于面部神经EMG作为指示唤醒反应和待处理患者运动的警告参数。为了评估该系统，所得到的警告参数将与BIS和以下附加参数相关：PRST评分B.）镇痛深度（ANI监测仪）c.）镇痛的药理学深度：所用阿片剂的计算效应室浓度d.）催眠的药理学深度：计算丙泊酚的效应室浓度。在该项目的继承，这些结果可用于在不同的效应室浓度的阿片类药物与恒定的手术刺激的EMG参数的变化的前瞻性评价。