Developing Active Stimulation and Monitoring Technologies to Optimize Pain and Nociception Management During Regional Anesthesia, General Anesthesia, and Post-Operative Care

开发主动刺激和监测技术，以优化区域麻醉、全身麻醉和术后护理期间的疼痛和伤害感受管理

• 批准号: 10604993
• 负责人: Tuan Le Mau
• 金额: $ 47.44万
• 依托单位: PASCALL SYSTEMS, INCORPORATED
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-19 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10604993
• 关键词: Absence of pain sensation; Acute; Algorithmic Analysis; Analgesics; Anesthesia procedures; Anesthetics; Antihypertensive Agents; Blood Pressure; Code; Conduction Anesthesia; Confidence Intervals; Conscious; Data; Devices; Dose; Electric Stimulation; Electrodes; Electroencephalography; Engineering; Event; Event-Related Potentials; General Anesthesia; Guidelines; Heart Rate; Hemorrhage; Human Volunteers; Knowledge; Marketing; Measures; Methods; Monitor; Nociception; Operative Surgical Procedures; Opiate Addiction; Opioid; Opioid Analgesics; Pain; Pain Measurement; Pain management; Patients; Persistent pain; Pharmaceutical Preparations; Phase; Postoperative Care; Postoperative Pain; Predisposition; Propofol; Regulatory Pathway; Scalp structure; Sedation procedure; Signal Transduction; Small Business Technology Transfer Research; Stimulus; Substance abuse problem; System; Techniques; Technology; Time; United States; Work; base; chronic pain; human data; improved; intense pain; new technology; novel; pain score; remifentanil; response; sensor; software development; tool; usability

Project Summary Surgery and acute post-operative pain are major contributors to persistent pain, chronic pain, and opioid dependence. Currently, there are no products on the market in the United States that can be used to monitor surgical nociception. Existing products use indicators that are susceptible to intraoperative influences such as blood loss, anesthetic drugs and antihypertensives. This leaves anesthesiologists to guess whether or not the analgesic therapies they are providing will be effective at managing intra-operative nociception and subsequent post-operative pain. A significant fraction of surgeries also rely on regional anesthesia techniques, and, these techniques are not foolproof, and may fail during surgery, leading to potentially uncontrolled postoperative pain that is apparent only when the patient recovers consciousness after surgery in intense pain. As it stands, anesthesiologists have no way to directly assess the ongoing efficacy of their regional blocks, leading to unreliable nociception and pain management. Therefore, improved methods to monitor surgical nociception are clearly needed. This project proposes to develop new technology that makes it possible for the first time to use event-related potentials (ERPs) to actively assess pain and analgesia during general and regional anesthesia. ERPs are generated by painful stimuli and can be measured at the scalp by averaging waveforms from repeated stimuli generated by a variety of methods including electrical stimulation. ERPs are challenging if not impossible to use for anesthesia monitoring because they are very small, between ~1 to 10 microvolts, and are overshadowed by background electroencephalogram oscillations that are 10- to 100-fold larger in amplitude during general anesthesia or sedation. Recently, we developed a novel technology for processing ERPs that increases their precision ~150-fold even in the presence of orders-of-magnitude larger background oscillations. Using this knowledge, we propose to develop this technology for commercial use in a “Fast-Track” STTR project.

项目概要 手术和术后急性疼痛是持续性疼痛、慢性疼痛和阿片类药物的主要原因 目前美国市场上还没有可以用来监测的产品。 现有产品使用易受术中影响的指标，例如 失血、麻醉药物和抗高血压药物这让麻醉师们猜测是否会发生这种情况。 他们提供的镇痛疗法将有效控制术中伤害感受和随后的疼痛 很大一部分手术也依赖于局部麻醉技术，并且这些技术。 技术并非万无一失，并且可能在手术过程中失败，导致术后疼痛可能不受控制 只有当病人在手术后在剧烈疼痛中恢复意识时才会明显。 麻醉师无法直接评估其区域区块的持续疗效，从而导致 不可靠的伤害感受和疼痛管理因此，需要改进监测手术伤害感受的方法。 该项目建议开发新技术，使其首次得以使用。 事件相关电位（ERP）可在全身麻醉和区域麻醉期间主动评估疼痛和镇痛。 ERP 是由疼痛刺激产生的，可以通过重复重复波形的平均来在头皮上进行测量。 通过包括电刺激在内的多种方法产生的刺激即使不是不可能，也是具有挑战性的。 用于麻醉监测，因为它们非常小，在 ~1 到 10 微伏之间，并且 被振幅大 10 至 100 倍的背景脑电图振荡所掩盖 最近，我们开发了一种用于处理 ERP 的新技术。 即使存在多个数量级的背景振荡，其精度也能提高约 150 倍。 利用这些知识，我们建议在“快速通道”STTR 项目中开发这项技术以用于商业用途。