A review of the utility of EEG depth of anaesthesia monitors in the paediatric intensive care environment

McKeever, Stephen; Johnston, Linda; Davidson, Andrew

doi:10.1016/j.iccn.2012.01.010

Cited by 5 publications

(2 citation statements)

References 53 publications

(124 reference statements)

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“…To-date, ongoing monitoring of brain systems during the perisurgical period has been done using EEG-based systems to evaluate depth of anesthesia 52 – 54 There are no studies that evaluate pain/nociception across the perisurgical period that can provide insights into how brain states may predict a patient’s responsivity to surgically induced processes that may produce central sensitization and consequently enhanced postoperative pain levels and potentially even CPSP 13 , 55 . Here we provide further support for measures of mFPC and S1 changes that correlate with responses in awake individuals, suggesting that even under general inhalational anesthesia similar pain pathways are activated by surgical induced nociceptive drive.…”

Section: Discussionmentioning

confidence: 99%

Can pain under anesthesia be measured? Pain-related brain function using functional near-infrared spectroscopy during knee surgery

et al. 2023

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Significance: Quantitative measurement of perisurgical brain function may provide insights into the processes contributing to acute and chronic postsurgical pain.Aim: We evaluate the hemodynamic changes in the prefrontal cortex (medial frontopolar cortex/ mFPC and lateral prefrontal cortex) and the primary somatosensory cortex/S1 using functional near-infrared spectroscopy (fNIRS) in 18 patients (18.2 AE 3.3 years, 11 females) undergoing knee arthroscopy.Approach: We examined the (a) hemodynamic response to surgery and (b) the relationship between surgery-modulated cortical connectivity (using beta-series correlation) and acute postoperative pain levels using Pearson's r correlation with 10,000 permutations. Results:We show a functional dissociation between mFPC and S1 in response to surgery, where mFPC deactivates, and S1 activates following a procedure. Furthermore, the connectivity between (a) left mFPC and right S1 (original r ¼ −0.683, p permutation ¼ 0.001), (b) right mFPC and right S1 (original r ¼ −0.633, p permutation ¼ 0.002), and (c) left mFPC and right S1 (original r ¼ −0.695, p permutation ¼ 0.0002) during surgery were negatively associated with acute postoperative pain levels.Conclusions: Our findings suggest that greater functional dissociation between mFPC and S1 is likely the result of inadequately controlled nociceptive barrage during surgery leading to more significant postoperative pain. It also supports the utility of fNIRS during the perioperative state for pain monitoring and patient risk assessment for chronic pain.

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Section: Discussionmentioning

confidence: 99%

Can pain under anesthesia be measured? Pain-related brain function using functional near-infrared spectroscopy during knee surgery

et al. 2023

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“…Near‐infrared spectroscopy (NIRS) and electroencephalogram recordings demonstrate alterations in cortical activity following heel lance for blood sampling. Postnatal age, sleep state, opioid analgesia, and previous experience can also influence the pattern, degree, and latency of response .…”

Section: Pain Mechanisms In the Neonatal Periodmentioning

confidence: 99%

Neonatal pain

Walker

2013

Pediatric Anesthesia

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Effective management of procedural and postoperative pain in neonates is required to minimize acute physiological and behavioral distress and may also improve acute and long-term outcomes. Painful stimuli activate nociceptive pathways, from the periphery to the cortex, in neonates and behavioral responses form the basis for validated pain assessment tools. However, there is an increasing awareness of the need to not only reduce acute behavioral responses to pain in neonates, but also to protect the developing nervous system from persistent sensitization of pain pathways and potential damaging effects of altered neural activity on central nervous system development. Analgesic requirements are influenced by age-related changes in both pharmacokinetic and pharmacodynamic response, and increasing data are available to guide safe and effective dosing with opioids and paracetamol. Regional analgesic techniques provide effective perioperative analgesia, but higher complication rates in neonates emphasize the importance of monitoring and choice of the most appropriate drug and dose. There have been significant improvements in the understanding and management of neonatal pain, but additional research evidence will further reduce the need to extrapolate data from older age groups. Translation into improved clinical care will continue to depend on an integrated approach to implementation that encompasses assessment and titration against individual response, education and training, and audit and feedback.

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Safety and Monitoring During Pediatric ICU Sedation

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2020

Sedation and Analgesia for the Pediatric Intensivist

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A review of the utility of EEG depth of anaesthesia monitors in the paediatric intensive care environment

Cited by 5 publications

References 53 publications

Can pain under anesthesia be measured? Pain-related brain function using functional near-infrared spectroscopy during knee surgery

Can pain under anesthesia be measured? Pain-related brain function using functional near-infrared spectroscopy during knee surgery

Neonatal pain

Safety and Monitoring During Pediatric ICU Sedation

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