The Transactions of The Korean Institute of Electrical Engineers (전기학회논문지)

The Korean Institute of Electrical Engineers (대한전기학회)
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Postoperative Pain Assessment based on Derivative Waveform of Photoplethysmogram

광용적맥파 미분 파형 기반 수술 후 통증 평가 가능성 고찰

  • Seok, Hyeon Seok (Dept. of Biomedical Engineering, Chonnam National University) ;
  • Shin, Hangsik (Dept. of Biomedical Engineering, Chonnam National University)
  • Received : 2018.06.04
  • Accepted : 2018.06.27
  • Published : 2018.07.01
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Abstract

In this study, we developed novel indicators to assess postoperative pain based on PPG derivative waveform. As the candidate indicator of postoperative pain assessment, the time from the start of beating to the n-th peak($T_n$) and the n-th peak amplitude($A_n$) of the PPG derivative were selected. In order to verify derived indicators, each candidate indicator was derived from the PPG of 78 subjects before and after surgery, and it was confirmed whether significant changes were observed after surgery. Logistic classification was performed with each proposed indicator to calculate the pain classification accuracy, then the classification performance was compared with SPI(Surgical Pleth Index, GE Healthcare, Chicago, US). The results showed that there were significant differences(p < 0.01) in all indicators except for $T_3$ and $A_3$. The coefficient of variation(CV) of every time-related indicators were lower than the CV of SPI(30.43%), however, the CV in amplitude-related parameters were higher than that of SPI. Among the candidate indicators, amplitude of the first peak, $A_1$, showed that highest accuracy in post-operative pain classification, 68.72%, and it is 15.53% higher than SPI.

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References

  1. M. Elgendi, "On the analysis of fingertip photoplethysmogram signals", Current cardiology reviews, vol. 8, no. 1, pp. 14-25, 2012. https://doi.org/10.2174/157340312801215782
  2. I. Bergmann et al., "Surgical pleth index-guided remifentanil administration reduces remifentanil and propofol consumption and shortens recovery times in outpatient anaesthesia", British journal of anaesthesia, vol. 110, no. 4, pp. 622-628, 2012. https://doi.org/10.1093/bja/aes426
  3. C. Apfel et al., "Evidence-based analysis of risk factors for postoperative nausea and vomiting", British journal of anaesthesia, vol. 109, no. 5, pp. 742-753, 2012. https://doi.org/10.1093/bja/aes276
  4. A. M. Carlsson, "Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale", Pain, vol. 16, no. 1, pp. 87-101, 1983. https://doi.org/10.1016/0304-3959(83)90088-X
  5. P. E. Bijur, C. T. Latimer, and E. J. Gallagher, "Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department", Academic Emergency Medicine, vol. 10, no. 4, pp. 390-392, 2003. https://doi.org/10.1197/aemj.10.4.390
  6. L. J. DeLoach, M. S. Higgins, A. B. Caplan, and J. L. Stiff, "The visual analog scale in the immediate postoperative period: intrasubject variability and correlation with a numeric scale", Anesthesia & Analgesia, vol. 86, no. 1, pp. 102-106, 1998. https://doi.org/10.1213/00000539-199801000-00020
  7. M. Luginbuhl, H. Ypparila-Wolters, M. Rufenacht, S. Petersen-Felix, and I. Korhonen, "Heart rate variability does not discriminate between different levels of haemodynamic responsiveness during surgical anaesthesia", British journal of anaesthesia, vol. 98, no. 6, pp. 728-736, 2007. https://doi.org/10.1093/bja/aem085
  8. D. M. Mathews, L. Clark, J. Johansen, E. Matute, and C. V. Seshagiri, "Increases in electroencephalogram and electromyogram variability are associated with an increased incidence of intraoperative somatic response", Anesthesia & Analgesia, vol. 114, no. 4, pp. 759-770, 2012. https://doi.org/10.1213/ANE.0b013e3182455ac2
  9. P. Wheeler, W. E. Hoffman, V. L. Baughman, and H. Koenig, "Response entropy increases during painful stimulation", Journal of neurosurgical anesthesiology, vol. 17, no. 2, pp. 86-90, 2005. https://doi.org/10.1097/01.ana.0000151408.62650.b5
  10. M. Huiku et al., "Assessment of surgical stress during general anaesthesia", British journal of anaesthesia, vol. 98, no. 4, pp. 447-455, 2007. https://doi.org/10.1093/bja/aem004
  11. M. Huiku, L. Kamppari, and M. H. Viertio-Oja, "Surgical Plethysmographic Index (SPI) in Anesthesia Practice", GE Healthcare, 2014.
  12. T. Ledowski, D. Sommerfield, L. Slevin, J. Conrad, and B. von Ungern-Sternberg, "Surgical pleth index: prediction of postoperative pain in children?", BJA: British Journal of Anaesthesia, vol. 119, no. 5, pp. 979-983, 2017. https://doi.org/10.1093/bja/aex300
  13. T. Ledowski, B. Ang, T. Schmarbeck, and J. Rhodes, "Monitoring of sympathetic tone to assess postoperative pain: skin conductance vs surgical stress index", Anaesthesia, vol. 64, no. 7, pp. 727-731, 2009. https://doi.org/10.1111/j.1365-2044.2008.05834.x
  14. H. Kallio, L. Lindberg, A. Majander, K. Uutela, M. Niskanen, and M. Paloheimo, "Measurement of surgical stress in anaesthetized children", British journal of anaesthesia, vol. 101, no. 3, pp. 383-389, 2008. https://doi.org/10.1093/bja/aen204
  15. J. Allen, "Photoplethysmography and its application in clinical physiological measurement", Physiological measurement, vol. 28, no. 3, p. R1, 2007. https://doi.org/10.1088/0967-3334/28/3/R01
  16. K. H. Shelley, "Photoplethysmography: beyond the calculation of arterial oxygen saturation and heart rate", Anesthesia & Analgesia, vol. 105, no. 6, pp. S31-S36, 2007. https://doi.org/10.1213/01.ane.0000269512.82836.c9
  17. A. K. Jaryal, N. Selvaraj, J. Santhosh, S. Anand, and K. K. Deepak, "Monitoring of cardiovascular reactivity to cold stress using digital volume pulse characteristics in health and diabetes", Journal of clinical monitoring and computing, vol. 23, no. 2, p. 123, 2009. https://doi.org/10.1007/s10877-009-9174-z
  18. Y. L. Yang, H. S. Seok, and H. Shin, "Analysis of systolic and diastolic waveform characteristic of photoplethysmogram according to the surgical pain", Information and Control Symposium, pp. 36-37, 2017.
  19. H. S. Seok and H. S. Shin, "Investigation of the pulse to pulse interval and amplitude variation of photoplethysmogram as a pain assessment parameter during anesthesia", Journal of Korean Institute of Intelligent Systems, 2018 (accepted)
  20. H. S. Shin, C. Lee, and M. Lee, "Adaptive threshold method for the peak detection of photoplethysmographic waveform", Computers in biology and medicine, vol. 39, no. 12, pp. 1145-1152, 2009. https://doi.org/10.1016/j.compbiomed.2009.10.006
  21. W. F. Jackson, "Ion channels and vascular tone", Hypertension, vol. 35, no. 1, pp. 173-178, 2000. https://doi.org/10.1161/01.HYP.35.1.173
  22. T. Bennett, Nervous Control of Blood Vessels: The Autonomic Nervous System. Taylor & Francis, 1996.
  23. C. J. Woolf and R. J. Mannion, "Neuropathic pain: aetiology, symptoms, mechanisms, and management", The lancet, vol. 353, no. 9168, pp. 1959-1964, 1999. https://doi.org/10.1016/S0140-6736(99)01307-0
  24. Kennedy, Harold L., et al. "Beta-blocker therapy in the cardiac arrhythmia suppression trial", American Journal of Cardiology, vol. 74, no. 7 pp. 674-680, 1994. https://doi.org/10.1016/0002-9149(94)90308-5
  25. M. R. Rosenzweig, S. M. Breedlove, and A. L. Leiman, Biological psychology: An introduction to behavioral, cognitive, and clinical neuroscience. Sinauer Associates, 2002.