MONITORING

DEPTH OF
ANESTHESIA
Oscar Leonardo Mosquera

AGENDA
Introduction
EEG and standard monitoring
Cerebral Oximetry
FMRI

Simultaneous Electroencephalography and Functional

Magnetic Resonance Imaging of General Anesthesia.

Purdon et al., Disorders of consciousness:Ann. N.Y.
Acad. Sci. 1157: 6170 (2009).

Combined fMRI and EEG exploits simultaneously the high

spatial resolution of fMRI and the high temporal resolution

of EEG
Rapid prototyping and hardware-in-the-loop simulation.
Speedgoat's real-time systems

ELECTROENCEPHALOGRAM
An electroencephalogram (EEG) is a test to

measurethe electrical activity of the brain.

Brain electrical activity has a certain number of

waves per second (frequencies) that are normal for

different levels of alertness.

For example, brain waves are faster when you are

awake, and slower in certain stages of sleep.

Complexity of the EEG waveform also changes during

general anesthesia.

EEG AND STANDARD MONITORING AT

CLNICA UNIVERSIDAD DE LA SABANA

CEREBRAL OXIMETRY

PRINCIPLE: NIRS

Biological Spectroscopic Window

exists at the wavelength range 660-940 nm
because only a few chromophores like Hb and HbO 2
strongly absorb light in this spectra range,
allowing light to penetrate tissue to a great
distance.
Absorption of this light due to
other biological compounds and tissues such as
water, lipids, skin, and bone
is lower in magnitude,
and these biological compounds generally have a
flat absorption spectra,

*Silvay G, Weinreich A, Owitz S. et al. The cerebral function monitoring during open-heart surgery.
Herz. 1978;3:270275
McCormick PW, Stewart M, Ray P. et al. Measurement of regional cerebrovascular haemoglobin
oxygen saturation in cats using optical spectroscopy. Neurological Res. 1991;13:6570.

principle...
In order to guarantee that only cerebral oxygen

saturation is being measured most commercially

available oximeters minimize extracerebral
contamination by equipping the sensors with 2 light
detectors located at fixed distances from the light
source.

By simply subtracting the measurements obtained from

the brain detector from the scalp detector,

extracerebral contamination can be minimized.

Distal Detector

Proximal
Detector

LED Emitter

Localized Area of Measurement

Hongo K, Kobayashi S, Okudera H, Hokama M, Nakagawa F. Noninvasive cerebral optical spectroscopy:
Depth-resolved measurements of cerebral haemodynamics using indocyanine green. Neurol Res. 1995;17(2):89-93.

Distal Detector

Proximal
Detector
LED Emitter

Localized Area of Measurement

Hongo K, Kobayashi S, Okudera H, Hokama M, Nakagawa F. Noninvasive cerebral optical spectroscopy:
Depth-resolved measurements of cerebral haemodynamics using indocyanine green. Neurol Res. 1995;17(2):89-93.

How deep does it

measures?
Measures 2.5 3cm
beneath the sensor.
Distal Detector

The differences in
thickness of skull;

Proximal
Detector

LED Emitter

Localized Area of Measurement

Hongo K, Kobayashi S, Okudera H, Hokama M, Nakagawa F. Noninvasive cerebral optical spectroscopy:
Depth-resolved measurements of cerebral haemodynamics using indocyanine green. Neurol Res. 1995;17(2):89-93.

and the skin

pigmentation do not
modify the readings.

FUNCTIONAL MAGNETIC
RESONANCE IMAGE
Uses a standard MRI scanner
Acquires a series of images

(numbers)

Measures changes in blood

oxygenation

Use non-invasive, non-ionizing

radiation

Can be repeated many times; can be

used for a wide range of subjects

Combines good spatial and

reasonable temporal resolution

BLOOD OXYGEN LEVEL

DEPENDENT CONTRAST (BOLD)
(OGAWA ET AL. 1990)

The most common technique used in fMRI.

Takes advantage of the magnetic susceptibility of

oxyhemoglobin and deoxyhemoglobin (Pauling 1936).

Deoxy Hb has a higher precess magnitization decay rate
than does oxy Hb.

During periods of neuronal activity, local blood flow and volume increase with little or no
change in oxygen consumption. As a consequence, the oxygen content of the venous blood
is elevated, resulting in an increase in the MR signal.

An fMRI picture of the brain is made up of

thousands of boxes, called voxels
Inside each voxel are thousands of neurons,
when a lot of these neurons start to fire, the
body rushes in oxygen to help, as the bloox
oxygen level increases, the voxels get
redder
The f MRI is measuring a BOLD signal
because the color is
Blood Oxygen Level Dependent
The f MRI machine can detect the color
change because blood with a lot of oxygen
is less attracted to magnets tan blood
without much oxygen

 Combining fMRIandEEGwouldmake it pos-sible to exploit simultaneously

the high spatial resolution of fMRI and the high temporal res-olution of
EEG25,26

Further- more, combining fMRI with EEG offers the potential to relate the

large body of information in the anesthesiology literature on EEGpattern

changes under general anesthesia to changes in neural activity in specific

TECHNICAL AND SAFETY

PROBLEMS TO SOLVE
MRI employs powerful static magnetic, gradient magnetic, and radiofrequency fields,

the EEG acquisition system and electrodes must be designed and constructed to minimize
physical interactions with these fields that can result in subject injury or compromise data
quality.

The same standards of physiological monitoring for general anesthesia administered in the

operating room, which includes blood pressure, heart rate, oxygen saturation, oxygen delivery, and tidal carbon dioxide, must be maintained during these studies.

All of the anesthesia equipment, including the anesthesia machine, must be MRI

compatible.

Airway management and ventilation must be carried out while the subject is being

imaged under general anesthesia with the same standards of care as in the operating
room.

Prior the start of each study, an evacuation drill was conducted to ensure that, in the event

of an emergency, the subject could be removed from the scanner within approximately 90
seconds

STUDY
DESIGN

 Functional imagin methods have only recently been applied to the problema of

general anesthesia.

Studies using positrn emission tomography (PET) to measure aneshtesia induce

changes in regional cerebral blood flow (rCBF), or regional glucose metabolism

(rGMR) revealed dramatic reductions in rCBF and rGMR globally across the entire
brain after loss of consciousness, but comparatively smaller interregional
differences that made it difficult to identify specific sites of anesthetic action.

Cerebrovascular confounds pose a serious challenge in fMRI studies of GA.

Inhaled anesthetic are potent cerebral vasodilators, increasing cerebral blood flow
by 20 to 40%, potentially saturating the BOLD fMRI response.

To minimize cerebrovascular confounds, we have chosen to study the drug

propofol, which has been shown to preserve cerebral flow metabolism. Among
inhaled aneshtetic, sevofluorane has similar properties.

RAPID PROTOTYPING AND

HARDWARE-IN-THE-LOOP
SIMULATION.

CONNECT WITH YOUR

HARDWARE

REAL TIME APPLICATIONS

REAL TIME TARGET

MACHINES

THANK YOU