|
|
Effect of functional near-infrared spectroscopy in pain assessment under general anesthesia |
JIN Chenyan1, GUO Hang2, LI Qinghua1, LI Yajun1, CHENG Yafei1, MA Yaqun1,2 |
1. College of Anesthesiology, Shanxi Medical University, Taiyuan 030001, China; 2. Department of Anesthesiology, the Seventh Medical Center of PLA General Hospital, Beijing 100010, China |
|
|
Abstract Objective To explore the effect of functional near-infrared spectroscopy (fNIRS) in pain assessment under general anesthesia. Methods This prospective study included 45 children aged 0-14 years who underwent hypospadias repair or cryptic penile correction in the Seventh Medical Center of PLA General Hospital from November 2021 to September 2022. They were divided into general anesthesia group (G group, n=30) and general anesthesia+dorsal penile nerve block group(N group, n=15) according to whether or not they underwent dorsal penile nerve block. Continuous wave functional near infrared spectroscopy imaging equipment was used to collect the blood oxygen parameters and heart rate of the left prefrontal brain tissue from 5 min before skin resection to 5 min after skin resection. The mean value and peak value of blood oxygen parameters and heart rate of the left prefrontal brain tissue before and after skin resection were compared. Results Compared with baseline before skin resection (T1), the left prefrontal cortex of group G was activated after skin resection, the blood oxygen parameters of brain tissue all reached the peak within 3 s (T2), and the mean concentration of oxygenated hemoglobin, deoxyhemoglobin, total hemoglobin and average heart rate increased significantly at T2, with statistical significance (P<0.05). However, compared with baseline before skin resection (T1), the left prefrontal cortex of group N was not significantly activated after resection, and there were no significant changes in the average oxygenated hemoglobin concentration, the average deoxyhemoglobin concentration, the average total hemoglobin concentration and the average heart rate at T2, with no statistical significance. After G group receiving the stimulation of skin resection, compared with the time when the heart rate reached the peak, the blood oxygen parameter of the left prefrontal brain tissue reached the peak time earlier than the heart rate [(2.100±0.845)s], in which the Deoxy-Hb concentration [(1.723±0.783) s, P=0.041] and Total-Hb concentration [(1.763±0.770) s, P=0.028] had a statistically significant difference in the peak time. Conclusions fNIRScan be used to evaluate pain in children under general anesthesia. Compared with conventional physiological indicators, fNIRS is more sensitive and has great potential to optimize clinical pain assessment and management.
|
Received: 06 December 2022
|
|
|
|
|
[1] |
Ching S,Brown E N. Modeling the dynamical effects of anesthesia on brain circuits[J].Curr Opin Neurobiol,2014,25:116-122.
|
[2] |
Peters A, McEwen B S, Friston K. Uncertainty and stress: why it causes diseases and how it is mastered by the brain[J].Prog Neurobiol,2017,156:164-188.
|
[3] |
Hall M,Kidgell D,Perraton L, et al.Pain induced changes in brain oxyhemoglobin: a systematic review and meta-analysis of functional NIRS studies[J].Pain Med,2021,22(6):1399-1410.
|
[4] |
Ong W Y, Stohler C S, Herr D R.Role of the prefrontal cortex in pain processing[J]. Mol Neurobiol, 2019, 56(2):1137-1166.
|
[5] |
Attwell D, Iadecola C. The neural basis of functional brain imaging signals[J].Trends Neurosci,2002,25(12):621-625.
|
[6] |
Gratton E,Toronov V, Wolf U, et al.Measurement of brain activity by near-infrared light[J].J Biomed Opt,2005,10(1):11008.
|
[7] |
Segarra M,Aburto M R, Hefendehl J, et al. Neurovascular interactions in the nervous system[J].Annu Rev Cell Dev Biol,2019,35:615-635.
|
[8] |
Bartocci M, Bergqvist L L, Lagercrantz H, et al. Pain activates cortical areas in the preterm newborn brain[J]. Pain, 2006, 122(1-2):109-117.
|
[9] |
Ozdemir H,Bilgen H,Gokulu G, et al.Does repeated painful stimuli change cerebral near-infrared spectroscopy response in healthy, term, large for gestational age newborns?[J].Clin J Pain,2020,36(2):110-116.
|
[10] |
Dix L M L, Shepherd K, Polglase G R, et al. The cerebral hemodynamic response to pain in preterm infants with fetal growth restriction[J].Front Pediatr,2020,8: 268.
|
[11] |
Roué J M, Rioualen S, Gendras J, et al. Multi-modal pain assessment: are near-infrared spectroscopy, skin conductance, salivary cortisol, physiologic parameters, and neonatal facial coding system interrelated during venepuncture in healthy, term neonates?[J].J Pain Res,2018,11:2257-2267.
|
[12] |
Browe B M, Olsen A R, Ramirez C, et al. The naked mole-rat has a functional purinergic pain pathway despite having a non-functional peptidergic pain pathway[J].Neurobiol Pain, 2020, 8: 100047.
|
[13] |
Lee G I, Neumeister M W. Pain: pathways and physiology [J]. Clin Plast Surg, 2020, 47(2):173-180.
|
[14] |
Benarroch E E. Pain-autonomic interactions [J].Neurol Sci, 2006, 27 (Suppl 2): S130-133.
|
[15] |
Lamotte G, Shouman K, Benarroch E E. Stress and central autonomic network[J]. Auton Neurosci, 2021, 235: 102870.
|
[16] |
Yücel M A,Aasted C M, Petkov M P, et al. Specificity of hemodynamic brain responses to painful stimuli: a functional near-infrared spectroscopy study[J]. Sci Rep,2015, 5: 9469.
|
[17] |
Yennu A,Tian F, Gatchel R J, et al. Prefrontal hemodynamic mapping by functional near-infrared spectroscopy in response to thermal stimulations over three body sites[J].Neurophotonics,2016,3(4):045008.
|
[18] |
Cheng J C, Bosma R L, Hemington K S, et al.Slow-5 dynamic functional connectivity reflects the capacity to sustain cognitive performance during pain[J].Neuroimage,2017,157: 61-68.
|
[19] |
Yuan I, Nelson O, Barr G A, et al. Functional near-infrared spectroscopy to assess pain in neonatal circumcisions[J].Paediatr Anaesth, 2022,32(3):404-412.
|
[20] |
杨 伟.阴茎背神经阻滞在小儿尿道下裂手术麻醉中的应用[J].实用医院临床杂志,2016,13(2): 121-122.
|
[21] |
Hosford P S,Gourine A V.What is the key mediator of the neurovascular coupling response?[J].Neurosci Biobehav Rev,2019,96:174-181.
|
[22] |
Hillman E M.Coupling mechanism and significance of the BOLD signal: a status report[J].Annu Rev Neurosci,2014,37:161-181.
|
[23] |
Rathee D,Cecotti H,Prasad G.Propofol-induced sedation diminishes the strength of frontal-parietal-occipital EEG network[J]. Annu Int Conf IEEE Eng Med Biol Soc,2017, 2017: 4463-4466.
|
[24] |
Guldenmund P,Gantner I S, Baquero K, et al.Propofol-induced frontal cortex disconnection: a study of resting-state networks, total brain connectivity, and mean BOLD signal oscillation frequencies[J].Brain Connect, 2016, 6(3): 225-237.
|
[25] |
Lee U, Ku S, Noh G, et al. Disruption of frontal-parietal communication by ketamine, propofol, and sevoflurane[J]. Anesthesiology, 2013, 118(6):1264-1275.
|
[26] |
Peng K,Yücel M A, Steele S C, et al. Morphine attenuates fNIRS signal associated with painful stimuli in the medial frontopolar cortex (medial BA 10)[J]. Front Hum Neurosci, 2018,12: 394.
|
[27] |
Schmithorst V J, Vannest J, Lee G, et al.Evidence that neurovascular coupling underlying the BOLD effect increases with age during childhood[J]. Hum Brain Mapp, 2015, 36(1):1-15.
|
[1] |
. [J]. Med. J. Chin. Peop. Armed Poli. Forc., 2023, 34(3): 260-263. |
|
|
|
|