Monitoring anesthesia using simultaneous functional Near Infrared Spectroscopy and Electroencephalography

Nair, Vidhya Vijayakrishnan; Kish, Brianna R; Yang, Ho-Ching; Guo, Hang; Tong, Yunjie; Liang, Zhenhu

doi:10.1016/j.clinph.2021.03.025

Cited by 14 publications

(8 citation statements)

References 61 publications

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“…A total of 304 unique articles were screened, 73 underwent full-text review and 59 were included. 11–68 (Supplemental Digital Content 1, Search Strategy, http://links.lww.com/AA/E81.) There were 13 review articles, 12–24 10 of which discussed the role and limitations of EEG monitoring during pediatric anesthesia, 12–21 including 4 relating to cardiac anesthesia.…”

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confidence: 99%

“…11,27–29 Eight observational studies 9,10,31–35 demonstrated usefulness of EEG-guided anesthesia in children, and 32 observational studies described anesthesia-induced changes in children’s brains. 37–68 (Supplemental Digital Content 2, Table, http://links.lww.com/AA/E82, provides a summary and key findings of the 59 papers that underwent full-text review.) Importantly, there are no published guidelines on how the EEG can be used to titrate anesthetic doses in children during different clinical scenarios.…”

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confidence: 99%

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A Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children

Bong

Balanza

Khoo

et al. 2023

Anesthesia &Amp; Analgesia

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The major therapeutic end points of general anesthesia include hypnosis, amnesia, and immobility. There is a complex relationship between general anesthesia, responsiveness, hemodynamic stability, and reaction to noxious stimuli. This complexity is compounded in pediatric anesthesia, where clinicians manage children from a wide range of ages, developmental stages, and body sizes, with their concomitant differences in physiology and pharmacology. This renders anesthetic requirements difficult to predict based solely on a child’s age, body weight, and vital signs. Electroencephalogram (EEG) monitoring provides a window into children’s brain states and may be useful in guiding clinical anesthesia management. However, many clinicians are unfamiliar with EEG monitoring in children. Young children’s EEGs differ substantially from those of older children and adults, and there is a lack of evidence-based guidance on how and when to use the EEG for anesthesia care in children. This narrative review begins by summarizing what is known about EEG monitoring in pediatric anesthesia care. A key knowledge gap in the literature relates to a lack of practical information illustrating the utility of the EEG in clinical management. To address this gap, this narrative review illustrates how the EEG spectrogram can be used to visualize, in real time, brain responses to anesthetic drugs in relation to hemodynamic stability, surgical stimulation, and other interventions such as cardiopulmonary bypass. This review discusses anesthetic management principles in a variety of clinical scenarios, including infants, children with altered conscious levels, children with atypical neurodevelopment, children with hemodynamic instability, children undergoing total intravenous anesthesia, and those undergoing cardiopulmonary bypass. Each scenario is accompanied by practical illustrations of how the EEG can be visualized to help titrate anesthetic dosage to avoid undersedation or oversedation when patients experience hypotension or other physiological challenges, when surgical stimulation increases, and when a child’s anesthetic requirements are otherwise less predictable. Overall, this review illustrates how well-established clinical management principles in children can be significantly complemented by the addition of EEG monitoring, thus enabling personalized anesthesia care to enhance patient safety and experience.

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confidence: 99%

A Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children

Bong

Balanza

Khoo

et al. 2023

Anesthesia &Amp; Analgesia

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“…Pearson correlation, partial correlation, and simple linear regression are commonly used measures for assessing the relationship between the event-related potential pattern in EEG and hemodynamic changes in fNIRS [ 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 ]. Several studies assessed the relationship between EEG and fNIRS signal through cross-correlation analysis and canonical correlation analysis (CCA) [ 111 , 112 , 113 , 114 ]. Compared to the Pearson correlation method, cross-correlation can capture the delayed response of the hemodynamic compensation phenomenon after neural firing, while the CCA is a statistical method to identify a linear relationship between the two modality data sets by determining the inter-subject co-variances.…”

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confidence: 99%

Concurrent fNIRS and EEG for Brain Function Investigation: A Systematic, Methodology-Focused Review

Yang

Fang

et al. 2022

Sensors

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Electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) stand as state-of-the-art techniques for non-invasive functional neuroimaging. On a unimodal basis, EEG has poor spatial resolution while presenting high temporal resolution. In contrast, fNIRS offers better spatial resolution, though it is constrained by its poor temporal resolution. One important merit shared by the EEG and fNIRS is that both modalities have favorable portability and could be integrated into a compatible experimental setup, providing a compelling ground for the development of a multimodal fNIRS–EEG integration analysis approach. Despite a growing number of studies using concurrent fNIRS-EEG designs reported in recent years, the methodological reference of past studies remains unclear. To fill this knowledge gap, this review critically summarizes the status of analysis methods currently used in concurrent fNIRS–EEG studies, providing an up-to-date overview and guideline for future projects to conduct concurrent fNIRS–EEG studies. A literature search was conducted using PubMed and Web of Science through 31 August 2021. After screening and qualification assessment, 92 studies involving concurrent fNIRS–EEG data recordings and analyses were included in the final methodological review. Specifically, three methodological categories of concurrent fNIRS–EEG data analyses, including EEG-informed fNIRS analyses, fNIRS-informed EEG analyses, and parallel fNIRS–EEG analyses, were identified and explained with detailed description. Finally, we highlighted current challenges and potential directions in concurrent fNIRS–EEG data analyses in future research.

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“…However, fNIRS records and processes the changes at a higher frequency in smaller areas which enables it to detect regional activation and deactivation of neuronal activity. 19 It has been used to assess nociception during painful stimuli and surgical incisions under anesthesia. 20,21 Several studies [22][23][24] have investigated the use of fNIRS to monitor brain activity during emergence from anesthesia.…”

Section: Ta B L E 2 Correlation Table Between the Various Baseline An...mentioning

confidence: 99%

Functional near‐infrared spectroscopy guided mapping of frontal cortex, a novel modality for assessing emergence delirium in children: A prospective observational study

Shanmugam,

Verma,

Sarkar

et al. 2023

Pediatric Anesthesia

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IntroductionDespite an 18%–30% prevalence, there is no consensus regarding pathogenesis of emergence delirium after anesthesia in children. Functional near‐infrared spectroscopy (fNIRS) is an optical neuroimaging modality that relies on blood oxygen level‐dependent response, translating to a mean increase in oxyhemoglobin and a decrease in deoxyhemoglobin. We aimed to correlate the emergence delirium in the postoperative period with the changes in the frontal cortex utilizing fNIRS reading primarily and also with blood glucose, serum electrolytes, and preoperative anxiety scores.MethodsA total of 145 ASA I and II children aged 2–5 years, undergoing ocular examination under anesthesia, were recruited by recording the modified Yale Preoperative Anxiety Score after acquiring the Institute Ethics Committee approval and written informed parental consent. Induction and maintenance were done with O2, N2O, and Sevoflurane. The emergence delirium was assessed using the PAED score in the postoperative period. The frontal cortex fNIRS recordings were taken throughout anesthesia.ResultsA total of 59 children (40.7%) had emergence delirium. The ED+ group had a significant activation left superior frontal cortex (t = 2.26E+00; p = .02) and right middle frontal cortex (t = 2.27E+00; p = .02) during induction, significant depression in the left middle frontal (t = −2.22E+00; p = .02), left superior frontal and bilateral medial (t = −3.01E+00; p = .003), right superior frontal and bilateral medial (t = −2.44E+00; p = .015), bilateral medial and superior (t = −3.03E+00; p = .003), and right middle frontal cortex (t = −2.90E+00; p = .004) during the combined phase of maintenance, and significant activation in cortical activity in the left superior frontal cortex (t = 2.01E+00; p = .0047) during the emergence in comparison with the ED‐ group.ConclusionThere is significant difference in the change in oxyhemoglobin concentration during induction, maintenance, and emergence in specific frontal brain regions between children with and without emergence delirium.

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Monitoring anesthesia using simultaneous functional Near Infrared Spectroscopy and Electroencephalography

Cited by 14 publications

References 61 publications

A Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children

A Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children

Concurrent fNIRS and EEG for Brain Function Investigation: A Systematic, Methodology-Focused Review

Functional near‐infrared spectroscopy guided mapping of frontal cortex, a novel modality for assessing emergence delirium in children: A prospective observational study

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