Advances in Neuroimaging and Monitoring to Defend Cerebral Perfusion in Noncardiac Surgery

Perioperative stroke

Ischaemic or haemorrhagic perioperative stroke (that is, stroke occurring during or within 30 days following surgery) can be a devastating complication following surgery. Incidence is reported in the 0.1-0.7% range in adults undergoing non-cardiac and non-neurological surgery, in the 1-5% range in patients undergoing cardiac surgery and in the 1-10% range following neurological surgery. However, higher rates have been reported when patients are actively assessed and in high-risk populations. Prognosis is significantly worse than stroke occurring in the community, with double the 30-day mortality, greater disability and diminished quality of life among survivors. Considering the annual volume of surgeries performed worldwide, perioperative stroke represents a substantial burden. Despite notable differences in aetiology, patient populations and clinical settings, existing clinical recommendations for perioperative stroke are extrapolated mainly from stroke in the community. Perioperative in-hospital stroke is unique with respect to the stroke occurring in other settings, and it is essential to apply evidence from other settings with caution and to identify existing knowledge gaps in order to effectively guide patient care and future research.

Biophotonics as a new application in optical technology: A bibliometric analysis

Biophotonics procures wide practicability in life sciences and medicines. The contribution of biophotonics is well recognized in various Nobel Prizes. Therefore, this paper aims to conduct a bibliometric analysis of biophotonics publications. The scientific database used is the Web of Science database. Harzing's Publish or Perish and VOSviewer are the bibliometric tools used in this analysis. This study found an increasing trend in the number of publications in recent years as the number of publications peaked at 347 publications in 2020. Most of the documents are articles (3361 publications) and proceeding papers (1632 publications). The top three subject areas are Optics (3206 publications), Engineering (1706 publications) and Radiology, Nuclear Medicine, and Medical Imaging (1346 publications). The United States has the highest number of publications (2041 publications) and citation impact (38.07 citations per publication; h-index: 125). The top three publication titles are Proceedings of SPIE (920 publications), Journal of Biomedical Optics (599 publications), and Proceedings of the Society of Photo Optical Instrumentation Engineers SPIE (245 publications). The potential areas for future research include to overcome the optical penetration depth issue and to develop publicly available biosensors for the detection of common diseases.

Change in cerebral circulation during the induction of anesthesia with remimazolam

PURPOSE

Remimazolam is a new ultra-short-acting benzodiazepine with unknown effects on cerebral circulation. We measured total cerebral hemoglobin concentrations, which reflect cerebral blood volume (CBV), and cerebral oxygen saturation, using time-domain near-infrared spectroscopy, which can measure the absolute values of cerebral hemoglobin concentrations. We also measured cerebral blood flow velocity (CBFV) in the middle cerebral artery using transcranial Doppler as an indicator of cerebral blood flow (CBF). We did so to examine the effect of remimazolam on cerebral circulation in humans, as assessed CBV, CBF, and cerebral oxygen saturation.

METHODS

This was a prospective, observational study. Fifteen patients without serious complications scheduled for general anesthesia were recruited. We measured total cerebral hemoglobin concentrations, CBFV, and cerebral oxygen saturation throughout the anesthetic induction course with remimazolam.

RESULTS

Total cerebral hemoglobin concentrations did not change during the process (p = 0.51). In contrast, the mean CBFV was reduced by 11% (significant, p = 0.04). The drop in mean blood pressure following the induction of anesthesia was 17%; however, it was within the range of cerebrovascular autoregulation. Moreover, cerebral oxygen saturation increased by 4% (statistically significant, p < 0.01).

CONCLUSIONS

We found that anesthetic induction with remimazolam did not alter CBV and reduced CBF in uncomplicated patients.