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Hypotension prediction index together with cerebral oxygenation in guiding intraoperative hemodynamic management: a case report

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The Journal of Biomedical Research 2022年第1期36卷 73-77页

作者： Yun Li Janet Phan Azaam Mamoor Hong Liu Department of Anesthesiology the Second Hospital of Anhui Medical UniversityHefeiAnhui 230601China Department of Anesthesiology and Pain Medicine University of California Davis HealthSacramentoCA 95817USA California Northstate University College of Medicine SacramentoCA 95757USA

Intraoperative hypotension happens in everyday clinical practice. It was suggested to have a strong association with adverse postoperative outcomes. Hypotension prediction index(HPI) was developed to predict intraoperative hypotension(mean arterial pressure oxygenation during hypotension. A cerebral oxygenation monitor provides clinicians with the values of organ oxygenation. We reported a case that the cerebral oxygenation monitor was used together with HPI to guide intraoperative blood pressure management. We found that cerebral oxygenation was maintained in the event of hypotension during surgery. The patient had no intraoperative or postoperative adverse outcomes despite the hypotension. We believe this can provide an individualized intraoperative blood pressure management to avoid over-or under-treating hypotension.

关键词： hypotension prediction index cerebral oxygenation hemodynamic intraoperative

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Assessment of cerebral oxygenation response to hemodialysis using near-infrared spectroscopy (NIRS):Challenges and solutions

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Journal of Innovative Optical Health Sciences 2021年第6期4卷 55-70页

作者： Ardy Wong Lucy Robinson Seena Soroush Aditi Suresh Dia Yang Kelechi Madu Meera N.Harhay Kambiz Pourrezaei Drexel University School of Bioengineering Philadelphia Pennsylvania Department of Epidemiology&Biostatistics Drexel University Dornsife School of Public Health Philadelphia Pennsylvania Drexel University College of Arts and Sciences Philadelphia Pennsylvania Department of Medicine Drexel University College of Medicine Philadelphia Pennsylvania Tower Health Transplant Institute Tower Health System West Reading Pennsylvania

To date,the clinical use of functional near-infrared spectroscopy(NIRS)to detect cerebral ischemia has been largely limited to surgical settings,where motion artifacts are minimal.In this study,we present novel techniques to address the challenges of using NIRS to monitor ambu-latory patients with kidney disease during approximately eight hours of hemodialysis(HD)treatment.People with end-stage kidney disease who require HD are at higher risk for cognitive impairment and dementia than age-matched controls.Recent studies have suggested that HD-related declines in cerebral blood flow might explain some of the adverse outcomes of HD treatment.However,there are currently no established paradigms for monitoring cerebral per-fusion in real-time during HD treatment.In this study,we used NIRS to assess cerebral hemo-dynamic responses among 95 prevalent HD patients during two consecutive HD treatments.We observed substantial signal attenuation in our predominantly Black patient cohort that required probe modifications.We also observed consistent motion artifacts that we addressed by devel-oping a novel NIRS methodology,called the HD cerebral oxygen demand algorithm(HD-CODA),to identify episodes when cerebral oxygen demand might be outpacing supply during HD treatment.We then examined the association between a summary measure of time spent in cerebral deoxygenation,derived using the HD-CODA,and hemodynamic and treatment-related variables.We found that this summary measure was associated with intradialytic mean arterial pressure,heart rate,and volume removal.Future studies should use the HD-CODA to implement studies of real-time NIRS monitoring for incident dialysis patients,over longer time frames,and in other dialysis modalities.

关键词： Motion artifact removal cerebral oxygenation end-stage kidney disease near-infrared spectroscopy

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Effects of fentanyl and sucrose on pain in retinopathy examinations with pain scale,near-infrared spectroscopy,and ultrasonography:a randomized trial

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World Journal of Pediatrics 2023年第9期19卷 873-882页

作者： Nursu Kara Didem Arman Zeynep Seymen Adem Gül Serdar Cömert Department of Pediatrics Division of NeonatologyUniversity of Health Sciences Istanbul Research and Training HospitalIstanbulTurkey Department of Opthalmology University of Health Sciences Istanbul Research and Training HospitalIstanbulTurkey

Background This study aimed to compare the efficacy of intravenous,intranasal fentanyl and oral sucrose in reducing the pain response during retinopathy of prematurity examinations using premature infant pain profile(PIPP)scores.Method The study included 42 infants who underwent retinopathy screening examinations.The infants were divided into three groups:oral sucrose,intranasal fentanyl,and intravenous fentanyl.Vital signs(heart rate,arterial oxygen saturation,and mean arterial pressure)were recorded.The PIPP was used to determine pain severity.cerebral oxygenation and middle cerebral artery blood flow were evaluated using near-infrared spectroscopy and Doppler ultrasonography,respectively.The data obtained were compared between groups.Results There was no significant difference between the three groups regarding postconceptional and postnatal ages or birth weights and weight at the time of examination.All babies had moderate pain during the examination.No correlation was observed between analgesia method and pain scores(P=0.159).In all three groups,heart rate and mean arterial pressure increased,whereas oxygen saturation decreased during the exam compared with pre-examination values.However,heart rate(HR),mean arterial pressure(MAP)and arterial oxygen saturation(sPO2)values did not differ between groups(HR,P=0.150;MAP,P=0.245;sPO2,P=0.140).The cerebral oxygenation(rSO2)values between the three groups were found to be similar[rSO2:P=0.545,P=0.247,P=0.803;fractional tissue oxygen extraction(FTOE):P=0.553,P=0.278].Regarding cerebral blood flow values,we also did not find any difference between the three groups[mean blood flow velocity(Vmean):P=0.569,P=0.975;maximum flow velocity(Vmax):P=0.820,P=0.997].Conclusions Intravenous and intranasal fentanyl and oral sucrose were not superior to each other in preventing pain during the examination for retinopathy of prematurity(ROP).Sucrose may be a good alternative for pain control during ROP examination.Our findings suggest that ROP exam may not affect cerebral oxygenatio

关键词： Analgesia cerebral blood flow cerebral oxygenation Neonate Retinopathy of prematurity

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