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Schnetz MP, Reon BJ, Ibinson JW, Kaynar M, Mahajan A, Vogt KM. Bispectral Index Changes Following Boluses of Commonly Used Intravenous Medications During Volatile Anesthesia Identified From Retrospective Data. Anesth Analg 2024; 138:635-644. [PMID: 37582055 PMCID: PMC10867275 DOI: 10.1213/ane.0000000000006633] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
BACKGROUND Although patients are commonly monitored for depth of anesthesia, it is unclear to what extent administration of intravenous anesthetic medications may affect calculated bispectral (BIS) index values under general anesthesia. METHODS In a retrospective analysis of electronic anesthesia records from an academic medical center, we examined BIS index changes associated with 14 different intravenous medications, as administered in routine practice, during volatile-based anesthesia using a novel screening approach. Discrete-time windows were identified in which only a single drug bolus was administered, and subsequent changes in the BIS index, concentration of volatile anesthetic, and arterial pressure were analyzed. Our primary outcome was change in BIS index, following drug administration. Adjusted 95% confidence intervals were compared to predetermined thresholds for clinical significance. Secondary sensitivity analyses examined the same outcomes, with available data separated according to differences in baseline volatile anesthetic concentrations, doses of the administered medications, and length of time window. RESULTS The study cohort was comprised of data from 20,170 distinct cases, 54.7% of patients were men, with a median age of 55. In the primary analysis, ketamine at a median dose of 20 mg was associated with a median (confidence limits) increase in BIS index of 3.8 (2.5-5.0). Midazolam (median dose 2 mg) was associated with a median decrease in BIS index of 3.0 (1.5-4.5). Neither of these drug administrations occurred during time periods associated with changes in volatile anesthetic concentration. Analysis for dexmedetomidine was confounded by concomitant decreases in volatile anesthetic concentration. No other medication analyzed, including propofol and common opioids, was associated with a significant change in BIS index. Secondary analyses revealed that similar BIS index changes occurred when midazolam and ketamine were administered at different volatile anesthetic concentrations and different doses, and these changes persisted 11 to 20 minutes postadministration. CONCLUSIONS Modest, but persistent changes in BIS index occurred following doses of ketamine (increase) and midazolam (decrease) during periods of stable volatile anesthetic administration.
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Affiliation(s)
- Michael P. Schnetz
- Anesthesiology and Perioperative Medicine, School of Medicine, University of Pittsburgh; Pittsburgh, PA, USA
| | - Brian J. Reon
- Anesthesiology and Perioperative Medicine, School of Medicine, University of Pittsburgh; Pittsburgh, PA, USA
| | - James W. Ibinson
- Anesthesiology and Perioperative Medicine, School of Medicine, University of Pittsburgh; Pittsburgh, PA, USA
- Clinical and Translational Science Institute, University of Pittsburgh; Pittsburgh, PA, USA
| | - Murat Kaynar
- Anesthesiology and Perioperative Medicine, School of Medicine, University of Pittsburgh; Pittsburgh, PA, USA
- Critical Care Medicine, School of Medicine, University of Pittsburgh; Pittsburgh, PA, USA
| | - Aman Mahajan
- Anesthesiology and Perioperative Medicine, School of Medicine, University of Pittsburgh; Pittsburgh, PA, USA
- Biomedical Informatics, School of Medicine, University of Pittsburgh; Pittsburgh, PA, USA
- Bioengineering, Swanson School of Engineering, University of Pittsburgh; Pittsburgh, PA, USA
| | - Keith M. Vogt
- Anesthesiology and Perioperative Medicine, School of Medicine, University of Pittsburgh; Pittsburgh, PA, USA
- Clinical and Translational Science Institute, University of Pittsburgh; Pittsburgh, PA, USA
- Bioengineering, Swanson School of Engineering, University of Pittsburgh; Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, University of Pittsburgh; Pittsburgh, PA, USA
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2
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Vogt KM, Ibinson JW, Burlew AC, Smith CT, Aizenstein HJ, Fiez JA. Brain connectivity under light sedation with midazolam and ketamine during task performance and the periodic experience of pain: Examining concordance between different approaches for seed-based connectivity analysis. Brain Imaging Behav 2023; 17:519-529. [PMID: 37166623 PMCID: PMC10543548 DOI: 10.1007/s11682-023-00782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2023] [Indexed: 05/12/2023]
Abstract
This work focused on functional connectivity changes under midazolam and ketamine sedation during performance of a memory task, with the periodic experience of pain. To maximize ability to compare to previous and future work, we performed secondary region of interest (ROI)-to-ROI functional connectivity analyses on these data, using two granularities of scale for ROIs. These findings are compared to the results of a previous seed-to-voxel analysis methodology, employed in the primary analysis. Healthy adult volunteers participated in this randomized crossover 3 T functional MRI study under no drug, followed by subanesthetic doses of midazolam or ketamine achieving minimal sedation. Periodic painful stimulation was delivered while subjects repeatedly performed a memory-encoding task. Atlas-based and network-level ROIs were used from within Conn Toolbox (ver 18). Timing of experimental task events was regressed from the data to assess drug-induced changes in background connectivity, using ROI-to-ROI methodology. Compared to saline, ROI-to-ROI connectivity changes under ketamine did not survive correction for multiple comparisons, thus data presented is from 16 subjects in a paired analysis between saline and midazolam. In both ROI-to-ROI analyses, the predominant direction of change was towards increased connectivity under midazolam, compared to saline. These connectivity increases occurred between functionally-distinct brain areas, with a posterior-predominant spatial distribution that included many long-range connectivity changes. During performance of an experimental task that involved periodic painful stimulation, compared to saline, low-dose midazolam was associated with robust increases in functional connectivity. This finding was concordant across different seed-based analyses for midazolam, but not ketamine. The neuroimaging drug trial from which this data was drawn was pre-registered (NCT-02515890) prior to enrollment of the first subject.
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Affiliation(s)
- Keith M Vogt
- Department of Anesthesiology and Perioperative Medicine, School of Medicine, University of Pittsburgh, 3459 Fifth Avenue, UPMC Montefiore - Suite 467, Pittsburgh, PA, 15213, USA.
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA.
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.
| | - James W Ibinson
- Department of Anesthesiology and Perioperative Medicine, School of Medicine, University of Pittsburgh, 3459 Fifth Avenue, UPMC Montefiore - Suite 467, Pittsburgh, PA, 15213, USA
- Department of Anesthesiology, Surgical Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alex C Burlew
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - C Tyler Smith
- Department of Anesthesiology and Perioperative Medicine, School of Medicine, University of Pittsburgh, 3459 Fifth Avenue, UPMC Montefiore - Suite 467, Pittsburgh, PA, 15213, USA
| | - Howard J Aizenstein
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Julie A Fiez
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
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3
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Norton CM, Ibinson JW, Pcola SJ, Popov V, Tremel JJ, Reder LM, Fiez JA, Vogt KM. Neutral auditory words immediately followed by painful electric shock may show reduced next-day recollection. Exp Brain Res 2022; 240:2939-2951. [PMID: 36152053 PMCID: PMC10190200 DOI: 10.1007/s00221-022-06467-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/18/2022] [Indexed: 11/27/2022]
Abstract
In this study, we investigated the effect of experimentally delivered acute pain on memory. Twenty-five participants participated in experimental sessions on consecutive days. The first session involved a categorization task to encourage memory encoding. There were two conditions, presented in randomized order, in which participants listened to a series of words, which were repeated three times. In one condition, one-third of the word items were immediately followed by a painful electrical shock. This word-shock pairing was consistent across repetition and the pain-paired items were presented unpredictably. In the other condition, all word items were not associated with pain. Response times over these repeated presentations were assessed for differences. Explicit memory was tested the following day, employing a Remember-Know assessment of word recognition, with no shocks employed. We found evidence that recollection may be reduced for pain-paired words, as the proportion of correct Remember responses (out of total correct responses) was significantly lower. There were no significant reductions in memory for non-pain items that followed painful stimulation after a period of several seconds. Consistent with the experience of pain consuming working memory resources, we theorize that painful shocks interrupt memory encoding for the immediately preceding experimental items, due to a shift in attention away from the word item.
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Affiliation(s)
- Caroline M Norton
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, School of Medicine, 3459 Fifth Avenue, Suite 467, Pittsburgh, PA, 15213, USA
| | - James W Ibinson
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, School of Medicine, 3459 Fifth Avenue, Suite 467, Pittsburgh, PA, 15213, USA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Samantha J Pcola
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, School of Medicine, 3459 Fifth Avenue, Suite 467, Pittsburgh, PA, 15213, USA
| | - Vencislav Popov
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Joshua J Tremel
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lynne M Reder
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Julie A Fiez
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
| | - Keith M Vogt
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, School of Medicine, 3459 Fifth Avenue, Suite 467, Pittsburgh, PA, 15213, USA.
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA.
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
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Vogt KM, Pryor KO. Anesthesia and the neurobiology of fear and posttraumatic stress disorder. Curr Opin Anaesthesiol 2022; 35:593-599. [PMID: 35993581 PMCID: PMC9469898 DOI: 10.1097/aco.0000000000001176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW Dysfunction of fear memory systems underlie a cluster of clinically important and highly prevalent psychological morbidities seen in perioperative and critical care patients, most archetypally posttraumatic stress disorder (PTSD). Several sedative-hypnotics and analgesics are known to modulate fear systems, and it is theoretically plausible that clinical decisions of the anesthesiologist could impact psychological outcomes. This review aims to provide a focused synthesis of relevant literature from multiple fields of research. RECENT FINDINGS There is evidence in some contexts that unconscious fear memory systems are less sensitive to anesthetics than are conscious memory systems. Opiates may suppress the activation of fear systems and have benefit in the prevention of PTSD following trauma. There is inconsistent evidence that the use of propofol and benzodiazepines for sedation following trauma may potentiate the development of PTSD relative to other drugs. The benefits of ketamine seen in the treatment of major depression are not clearly replicated in PTSD-cluster psychopathologies, and its effects on fear processes are complex. SUMMARY There are multiple theoretical mechanisms by which anesthetic drugs can modulate fear systems and clinically important fear-based psychopathologies. The current state of research provides some evidence to support further hypothesis investigation. However, the absence of effectiveness studies and the inconsistent signals from smaller studies provide insufficient evidence to currently offer firm clinical guidance.
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Affiliation(s)
- Keith M. Vogt
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, School of Medicine
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh
- Center for the Neural Basis of Cognition
- Clinical and Translational Science Institute, University of Pittsburgh
| | - Kane O. Pryor
- Department of Anesthesiology, Weill Cornell Medicine
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Mathis MR, Schonberger RB, Whitlock EL, Vogt KM, Lagorio JE, Jones KA, Conroy JM, Kheterpal S. Opportunities Beyond the Anesthesiology Department: Broader Impact Through Broader Thinking. Anesth Analg 2022; 134:242-252. [PMID: 33684091 PMCID: PMC8423864 DOI: 10.1213/ane.0000000000005428] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Ensuring a productive clinical and research workforce requires bringing together physicians and communities to improve health, by strategic targeting of initiatives with clear and significant public health relevance. Within anesthesiology, the traditional perspective of the field's health impact has focused on providing safe and effective intraoperative care, managing critical illness, and treating acute and chronic pain. However, there are limitations to such a framework for anesthesiology's public health impact, including the transient nature of acute care episodes such as the intraoperative period and critical illness, and a historical focus on analgesia alone-rather than the complex psychosocial milieu-for pain management. Due to the often episodic nature of anesthesiologists' interactions with patients, it remains challenging for anesthesiologists to achieve their full potential for broad impact and leadership within increasingly integrated health systems. To unlock this potential, anesthesiologists should cultivate new clinical, research, and administrative roles within the health system-transcending traditional missions, seeking interdepartmental collaborations, and taking measures to elevate anesthesiologists as dynamic and trusted leaders. This special article examines 3 core themes for how anesthesiologists can enhance their impact within the health care system and pursue new collaborative health missions with nonanesthesiologist clinicians, researchers, and administrative leaders. These themes include (1) reframing of traditional anesthesiologist missions toward a broader health system-wide context; (2) leveraging departmental and institutional support for professional career development; and (3) strategically prioritizing leadership attributes to enhance system-wide anesthesiologist contributions to improving overall patient health.
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Affiliation(s)
- Michael R. Mathis
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Elizabeth L. Whitlock
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - Keith M. Vogt
- Departments of Anesthesiology & Perioperative Medicine and Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - John E. Lagorio
- Department of Anesthesiology, Mercy Health, Muskegon, MI, USA
| | - Keith A. Jones
- Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joanne M. Conroy
- Department of Anesthesiology, Dartmouth Geisel School of Medicine, Hanover NH, USA
| | - Sachin Kheterpal
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
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Vogt KM, Citro AT, Adams PS, Metro DG, Sakai T. Early immersion in a dedicated one-month Anesthesiology Professional Practice rotation for Post-Graduate Year-1 interns is associated with an increase in scholarly activity during residency. J Clin Anesth 2022; 76:110566. [PMID: 34695751 PMCID: PMC8904148 DOI: 10.1016/j.jclinane.2021.110566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/23/2021] [Accepted: 10/17/2021] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVE Despite the Accreditation Council for Graduate Medical Education scholarly activity requirement, incorporating education on scholarly fundamentals into residency is challenging. We designed and implemented an academic non-clinical rotation for Post Graduate Year-1 (PGY-1) interns and its association with subsequent resident scholarly productivity was determined. We hypothesized that early immersion in such a rotation would be associated with increased scholarly activity during residency. DESIGN Retrospective educational comparative study, of two cohorts of anesthesiology residents in the graduating classes of 2015-2020. SETTING Large anesthesiology residency program at a U.S. academic medical center. INTERVENTION A one-month academic rotation titled Anesthesia Professional Practice for PGY-1 interns has been implemented since 2014. The rotation curriculum broadly covers important topics for scholarly projects and provides introductions to academic faculty and institutional resources. MEASUREMENTS The scholarly products (abstracts, publications, book chapters, research protocols, and grant applications) were quantified using Scholarly Activity Points, a previously described metric that accounts for significance and the resident's contribution. Total Scholarly Activity Points for each resident and number of publications prior to residency were determined for both cohorts. Segmented regression was employed with Scholarly Activity Points as the outcome; participation in the early immersion rotation and prior publications were used as input variables. MAIN RESULTS Resident participation in the early immersion rotation was significantly associated with higher Scholarly Activity Points. The confounding variable of pre-residency publication count was not significantly correlated to this increase. CONCLUSIONS Immersion in a one-month academic program during PGY-1 internship may contribute to increased scholarly productivity during residency.
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Affiliation(s)
- Keith M. Vogt
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh,Center for the Neural Basis of Cognition
| | - Ally T. Citro
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine
| | - Philip S. Adams
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine
| | - David G. Metro
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine
| | - Tetsuro Sakai
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine,Clinical and Translational Science Institute, University of Pittsburgh,McGowan Institute of Regenerative Medicine, University of Pittsburgh,Corresponding author: Tetsuro Sakai, Address: 3459 Fifth Avenue, UPMC Montefiore - Suite 469.4, Pittsburgh, PA 15213, Phone: (412)-648-6943,
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7
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Vlisides PE, Vogt KM, Pal D, Schnell E, Armstead WM, Brambrink AM, Kuo P, Nelson P, Vacas S, Goettel N, Aglio LS, Farag E, Gorji R, García PS, Koerner IP. Roadmap for Conducting Neuroscience Research in the COVID-19 Era and Beyond: Recommendations From the SNACC Research Committee. J Neurosurg Anesthesiol 2021; 33:100-106. [PMID: 33660699 PMCID: PMC8310904 DOI: 10.1097/ana.0000000000000758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/28/2020] [Indexed: 12/22/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has impacted many aspects of neuroscience research. At the 2020 Society of Neuroscience in Anesthesiology and Critical Care (SNACC) Annual Meeting, the SNACC Research Committee met virtually to discuss research challenges encountered during the COVID-19 pandemic along with possible strategies for facilitating research activities. These challenges and recommendations are included in this Consensus Statement. The objectives are to: (1) provide an overview of the disruptions and challenges to neuroscience research caused by the COVID-19 pandemic, and; (2) put forth a set of consensus recommendations for strengthening research sustainability during and beyond the current pandemic. Specific recommendations are highlighted for adapting laboratory and human subject study activities to optimize safety. Complementary research activities are also outlined for both laboratory and clinical researchers if specific investigations are impossible because of regulatory or societal changes. The role of virtual platforms is discussed with respect to fostering new collaborations, scheduling research meetings, and holding conferences such that scientific collaboration and exchange of ideas can continue. Our hope is for these recommendations to serve as a valuable resource for investigators in the neurosciences and other research disciplines for current and future research disruptions.
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Affiliation(s)
- Phillip E. Vlisides
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI USA
- Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI USA
| | - Keith M. Vogt
- Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
- Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA USA
| | - Dinesh Pal
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI USA
- Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI USA
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI USA
| | - Eric Schnell
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, OR USA
| | - William M. Armstead
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Ansgar M. Brambrink
- Department of Anesthesiology, Columbia University Medical Center/New York Presbyterian Hospital, New York, NY USA
| | - Philip Kuo
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY USA
| | - Priscilla Nelson
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY USA
| | - Susana Vacas
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, CA USA
| | - Nicolai Goettel
- Department of Anesthesia, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Linda S. Aglio
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Ehab Farag
- Department of Anesthesiology and Pain Medicine, Cleveland Clinic, Cleveland, OH USA
| | - Reza Gorji
- Department of Anesthesiology, Upstate Medical Center, Syracuse, NY USA
| | - Paul S. García
- Department of Anesthesiology, Columbia University Medical Center/New York Presbyterian Hospital, New York, NY USA
| | - Ines P. Koerner
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, OR USA
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Citro AT, Norton CM, Pcola SJ, Vogt KM. Psychometric and electrodermal activity data from an experimental paradigm of memory encoding with some items periodically followed by painful electric shock. Data Brief 2020; 31:105669. [PMID: 32478149 PMCID: PMC7251766 DOI: 10.1016/j.dib.2020.105669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/20/2020] [Accepted: 04/29/2020] [Indexed: 12/04/2022] Open
Abstract
How pain influences explicit memory is an active area of investigation, and next-day recognition was the primary outcome of this experiment. The data reported here were secondary measures of psychometrics to quantify interindividual variability between subjects and measure electrodermal activity (EDA) changes in response to experimental stimuli. Reliable EDA responses following painful electric shocks were obtained in the Learning portion of the experiment. During next-day testing, however, no reliable EDA responses were elicited, including to previously pain-paired experimental items.
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Affiliation(s)
- Ally T. Citro
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Caroline M. Norton
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Samantha J. Pcola
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Keith M. Vogt
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
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9
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Deis AS, Schnetz MP, Ibinson JW, Vogt KM. Retrospective analysis of cases of intraoperative awareness in a large multi-hospital health system reported in the early postoperative period. BMC Anesthesiol 2020; 20:62. [PMID: 32151241 PMCID: PMC7061486 DOI: 10.1186/s12871-020-00974-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 02/28/2020] [Indexed: 12/17/2022] Open
Abstract
Background Awareness with recall under general anesthesia remains a rare but important issue that warrants further study. Methods We present a series of seven cases of awareness that were identified from provider-reported adverse event data from the electronic anesthesia records of 647,000 general anesthetics. Results The low number of identified cases suggests an under-reporting bias. Themes that emerge from this small series can serve as important reminders to anesthesia providers to ensure delivery of an adequate anesthetic for each patient. Commonalities between a majority of our identified anesthetic awareness cases include: obesity, use of total intravenous anesthesia, use of neuromuscular blockade, and either a lack of processed electroencephalogram (EEG) monitoring or documented high depth of consciousness index values. An interesting phenomenon was observed in one case, where adequately-dosed anesthesia was delivered without technical issue, processed EEG monitoring was employed, and the index value suggested an adequate depth of consciousness throughout the case. Conclusions Provider-reported adverse event data in the immediate post-operative period are likely insensitive for detecting cases of intraoperative awareness. Though causation cannot firmly be established from our data, themes identified in this series of cases of awareness with recall under general anesthesia provide important reminders for anesthesia providers to maintain vigilance in monitoring depth and dose of anesthesia, particularly with total intravenous anesthesia.
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Affiliation(s)
- Amanda S Deis
- Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Michael P Schnetz
- Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - James W Ibinson
- Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore, Suite 467, Pittsburgh, PA, 15213, USA.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, USA.,Department of Anesthesiology, Surgical Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, USA
| | - Keith M Vogt
- Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore, Suite 467, Pittsburgh, PA, 15213, USA. .,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, USA. .,Center for the Neural Basis of Cognition, Pittsburgh, USA.
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10
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Ungerman EA, Vogt KM, Sakai T, Metro DG, Adams PS. Wellness Principles Correlate With More Favorable Burnout Scores in Junior Anesthesiology Residents. J Educ Perioper Med 2020; 22:E636. [PMID: 32432151 PMCID: PMC7219025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Strategies to prevent or reduce burnout for anesthesiology residents remain relatively unexplored. We aimed to determine if participation in a wellness course would be associated with lower burnout. METHODS A prospective, case-control survey/questionnaire study was implemented within a single anesthesiology residency in a large academic medical center program. One class participated in an inaugural wellness course (n = 15) promoting particular wellness principles 4 months into their postgraduate year (PGY)-1, while another class with no course participation served as controls (n = 13). Both groups completed the Maslach Burnout Inventory (MBI) 6 months into their PGY-2 year. In addition, a survey measuring their perceived ability to implement wellness principles (regardless of course participation) as well as validated questionnaires measuring stress, depression, and sleep quality were administered. RESULTS Course participants had a trend toward lower MBI depersonalization scores; however, this was not statistically significant (MBI score 7 versus 12, P = .078, Cohen d 0.71). In a multivariable model, course participation yielded lower exhaustion scores (P = .011) whereas higher stress yielded higher exhaustion scores (P = .013), and higher depression scores yielded higher depersonalization scores (P = .019). A higher perceived ability to implement the wellness principles resulted in significantly better scores in all 3 burnout components (exhaustion P = .049, depersonalization P = .004 achievement P = .001). CONCLUSION Residents who felt they could implement wellness principles had lower burnout, regardless of course participation. Our brief course exposure had only marginal independent effects, suggesting that more longitudinal and repeated exposures to wellness training are likely required to produce a more effective outcome for mitigating burnout.
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Adams DR, Vogt KM, Norton CM, Metro DG. Financial Incentive, in Place of Nonclinical Time, Increases Faculty Involvement and Improves Resident Didactic Evaluation Scores in an Anesthesiology Residency Training Program. J Educ Perioper Med 2019; 21:E630. [PMID: 32123695 PMCID: PMC7039672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Providing clinical faculty to lead high-quality resident didactic sessions remains a challenge for academic departments that host graduate medical education training programs. In an effort to both reduce costs and to continue to recruit faculty to give lectures, our department began to incentivize clinicians with a $500 stipend in place of a nonclinical day to present didactics. Our hypothesis is that with financial incentive, more attendings would present didactics and the quality would improve. METHODS Residents routinely evaluate all didactic sessions using a Likert scale of 1 to 5. Residents also answer yes or no to indicate whether the presenter should return. We compared academic year (AY) 2016, in which faculty were incentivized with nonclinical time, with AY 2017 and AY 2018, in which incentive came in the form of a $500 stipend. For each, the mean Likert score and percentage of positive responses for lecturer returning were calculated. A 1-way ANOVA and post hoc t tests were performed to determine significant changes. RESULTS Comparing AY 2016 (before the incentive switch) with AY 2017 and AY 2018, there was more faculty involvement in resident didactic after implementing the financial incentive. The quality of lectures also improved after the incentive switch, according to resident evaluations. There were higher overall Likert scores in AY 2018 and a higher percentage of positive responses to the question of whether presenters should return in AY 2017 and AY 2018, compared with AY 2016. CONCLUSIONS After implementation of a financial incentive in place of nonclinical time, more faculty became involved in lectures and overall lecture quality improved as measured by resident evaluations.
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Vogt KM, Norton CM, Speer LE, Tremel JJ, Ibinson JW, Reder LM, Fiez JA. Memory for non-painful auditory items is influenced by whether they are experienced in a context involving painful electrical stimulation. Exp Brain Res 2019; 237:1615-1627. [PMID: 30941440 PMCID: PMC6586482 DOI: 10.1007/s00221-019-05534-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 03/27/2019] [Indexed: 12/11/2022]
Abstract
In this study, we sought to examine the effect of experimentally induced somatic pain on memory. Subjects heard a series of words and made categorization decisions in two different conditions. One condition included painful shocks administered just after presentation of some of the words; the other condition involved no shocks. For the condition that included painful stimulations, every other word was followed by a shock, and subjects were informed to expect this pattern. Word lists were repeated three times within each condition in randomized order, with different category judgments but consistent pain-word pairings. After a brief delay, recognition memory was assessed. Non-pain words from the pain condition were less strongly encoded than non-pain words from the completely pain-free condition. Recognition of pain-paired words was not significantly different than either subgroup of non-pain words. An important accompanying finding is that response times to repeated experimental items were slower for non-pain words from the pain condition, compared to non-pain words from the completely pain-free condition. This demonstrates that the effect of pain on memory may generalize to non-pain items experienced in the same experimental context.
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Affiliation(s)
- Keith M Vogt
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA.
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA.
| | - Caroline M Norton
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Lauren E Speer
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joshua J Tremel
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - James W Ibinson
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Lynne M Reder
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Julie A Fiez
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
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Schnetz MP, Hochheiser HS, Danks DJ, Landsittel DP, Vogt KM, Ibinson JW, Whitehurst SL, McDermott SP, Duque MG, Kaynar AM. The triple variable index combines information generated over time from common monitoring variables to identify patients expressing distinct patterns of intraoperative physiology. BMC Med Res Methodol 2019; 19:17. [PMID: 30642260 PMCID: PMC6332613 DOI: 10.1186/s12874-019-0660-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 01/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Mean arterial pressure (MAP), bispectral index (BIS), and minimum alveolar concentration (MAC) represent valuable, yet dynamic intraoperative monitoring variables. They provide information related to poor outcomes when considered together, however their collective behavior across time has not been characterized. Methods We have developed the Triple Variable Index (TVI), a composite variable representing the sum of z-scores from MAP, BIS, and MAC values that occur together during surgery. We generated a TVI expression profile, defined as the sequential TVI values expressed across time, for each surgery where concurrent MAP, BIS, and MAC monitoring occurred in an adult patient (≥18 years) at the University of Pittsburgh Medical Center between January and July 2014 (n = 5296). Patterns of TVI expression were identified using k-means clustering and compared across numerous patient, procedure, and outcome characteristics. TVI and the triple low state were compared as prediction models for 30-day postoperative mortality. Results The median frequency MAP, BIS, and MAC were recorded was one measurement every 3, 5, and 5 min. Three expression patterns were identified: elevated, mixed, and depressed. The elevated pattern displayed the highest average MAP, BIS, and MAC values (86.5 mmHg, 45.3, and 0.98, respectively), while the depressed pattern displayed the lowest values (76.6 mmHg, 38.0, 0.66). Patterns (elevated, mixed, depressed) were distinct across the following characteristics: average patient age (52, 53, 54 years), American Society of Anesthesiologists Physical Status 4 (6.7, 16.1, 27.3%) and 5 (0.1, 0.6, 1.6%) categories, cardiac (2.2, 6.5, 16.1%) and emergent (5.8, 10.5, 12.8%) surgery, cardiopulmonary bypass use (0.3, 2.6, 9.8%), intraoperative medication administration including etomidate (3.0, 7.3, 12.6%), hydromorphone (47.6, 26.3, 25.2%), ketamine (11.2, 4.6, 3.0%), dexmedetomidine (18.4, 16.6, 13.6%), phenylephrine (74.0, 74.8, 83.0), epinephrine (2.0, 6.0, 18.0%), norepinephrine (2.4, 7.5, 21.2%), vasopressin (3.4, 7.6, 21.0%), succinylcholine (74.0, 69.0, 61.9%), intraoperative hypotension (28.8, 33.0, 52.3%) and the triple low state (9.4, 30.3, 80.0%) exposure, and 30-day postoperative mortality (0.8, 2.7, 5.6%). TVI was a better predictor of patients that died or survived in the 30 days following surgery compared to cumulative triple low state exposure (AUC 0.68 versus 0.62, p < 0.05). Conclusions Surgeries that share similar patterns of TVI expression display distinct patient, procedure, and outcome characteristics. Electronic supplementary material The online version of this article (10.1186/s12874-019-0660-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael P Schnetz
- Department of Anesthesiology, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA, 15261, USA.
| | - Harry S Hochheiser
- Department of Biomedical Informatics, University of Pittsburgh, 5607 Baum Boulevard, Pittsburgh, PA, 15206, USA
| | - David J Danks
- Departments of Philosophy and Psychology, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA
| | - Douglas P Landsittel
- Department of Biomedical Informatics, University of Pittsburgh, 5607 Baum Boulevard, Pittsburgh, PA, 15206, USA
| | - Keith M Vogt
- Department of Anesthesiology, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA, 15261, USA
| | - James W Ibinson
- Department of Anesthesiology, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA, 15261, USA
| | - Steven L Whitehurst
- Department of Anesthesiology, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA, 15261, USA
| | - Sean P McDermott
- Department of Anesthesiology, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA, 15261, USA
| | - Melissa Giraldo Duque
- Department of Anesthesiology, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA, 15261, USA
| | - Ata M Kaynar
- Department of Anesthesiology, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA, 15261, USA.,Department of Critical Care Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA, 15261, USA
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Abstract
We examined the neurobiological basis of temporal resetting, an aspect of temporal order memory, using a version of the delayed-match-to-multiple-sample task. While in an fMRI scanner, participants evaluated whether an item was novel or whether it had appeared before or after a reset event that signified the start of a new block of trials. Participants responded "old" to items that were repeated within the current block and "new" to both novel items and items that had last appeared before the reset event (pseudonew items). Medial-temporal, prefrontal, and occipital regions responded to absolute novelty of the stimulus-they differentiated between novel items and previously seen items, but not between old and pseudonew items. Activation for pseudonew items in the frontopolar and parietal regions, in contrast, was intermediate between old and new items. The posterior cingulate cortex extending to precuneus was the only region that showed complete temporal resetting, and its activation reflected whether an item was new or old according to the task instructions regardless of its familiarity. There was also a significant Condition (old/pseudonew) × Familiarity (second/third presentations) interaction effect on behavioral and neural measures. For pseudonew items, greater familiarity decreased response accuracy, increased RTs, increased ACC activation, and increased functional connectivity between ACC and the left frontal pole. The reverse was observed for old items. On the basis of these results, we propose a theoretical framework in which temporal resetting relies on an episodic retrieval network that is modulated by cognitive control and conflict resolution.
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Affiliation(s)
| | - Vencislav Popov
- Carnegie Mellon University, Pittsburgh, PA
- Center for the Neural Basis of Cognition, Pittsburgh, PA
| | - Christopher Paynter
- Carnegie Mellon University, Pittsburgh, PA
- Center for the Neural Basis of Cognition, Pittsburgh, PA
| | | | | | - Keith M. Vogt
- University of Pittsburgh, Pittsburgh, PA
- Center for the Neural Basis of Cognition, Pittsburgh, PA
| | - Lynne M. Reder
- Carnegie Mellon University, Pittsburgh, PA
- Center for the Neural Basis of Cognition, Pittsburgh, PA
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15
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Vogt KM, Becker CJ, Wasan AD, Ibinson JW. Human Posterior Insula Functional Connectivity Differs Between Electrical Pain and the Resting State. Brain Connect 2016; 6:786-794. [PMID: 27527402 DOI: 10.1089/brain.2016.0436] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The objective in this study was to directly compare MRI-based functional connectivity between conditions of rest and painful electrical nerve stimulation for key regions involved in pain processing: the anterior and posterior insula and the anterior cingulate cortex. Electric nerve stimulation, rated 7/10 for pain, was delivered to the right index finger of 14 healthy pain-free adult volunteers in four 30-sec blocks and continuously for 2 min. Functional connectivity maps obtained at rest and during both pain tasks were compared using seed time courses from the left anterior and posterior insula and anterior cingulate. Significant Pain versus Rest connectivity differences were consistently shown for the posterior insula, notably to the posterior cingulate and precuneus, while minimal and inconsistent differences were observed for the anterior insula and anterior cingulate. This study reinforces the known differences that can occur with changes in seed region selection in functional connectivity analysis. It also presents preliminary evidence that functional connectivity for the left posterior insula can potentially differentiate the presence of acute right-sided electrical pain from the nonpainful resting state.
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Affiliation(s)
- Keith M Vogt
- 1 Department of Anesthesiology, School of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Christopher J Becker
- 2 Department of Anesthesiology, Center for Pain Research, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Ajay D Wasan
- 1 Department of Anesthesiology, School of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,2 Department of Anesthesiology, Center for Pain Research, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - James W Ibinson
- 1 Department of Anesthesiology, School of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,2 Department of Anesthesiology, Center for Pain Research, University of Pittsburgh , Pittsburgh, Pennsylvania
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16
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Ibinson JW, Vogt KM, Taylor KB, Dua SB, Becker CJ, Loggia M, Wasan AD. Optimizing and Interpreting Insular Functional Connectivity Maps Obtained During Acute Experimental Pain: The Effects of Global Signal and Task Paradigm Regression. Brain Connect 2015; 5:649-57. [PMID: 26061382 DOI: 10.1089/brain.2015.0354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The insula is uniquely located between the temporal and parietal cortices, making it anatomically well-positioned to act as an integrating center between the sensory and affective domains for the processing of painful stimulation. This can be studied through resting-state functional connectivity (fcMRI) imaging; however, the lack of a clear methodology for the analysis of fcMRI complicates the interpretation of these data during acute pain. Detected connectivity changes may reflect actual alterations in low-frequency synchronous neuronal activity related to pain, may be due to changes in global cerebral blood flow or the superimposed task-induced neuronal activity. The primary goal of this study was to investigate the effects of global signal regression (GSR) and task paradigm regression (TPR) on the changes in functional connectivity of the left (contralateral) insula in healthy subjects at rest and during acute painful electric nerve stimulation of the right hand. The use of GSR reduced the size and statistical significance of connectivity clusters and created negative correlation coefficients for some connectivity clusters. TPR with cyclic stimulation gave task versus rest connectivity differences similar to those with a constant task, suggesting that analysis which includes TPR is more accurately reflective of low-frequency neuronal activity. Both GSR and TPR have been inconsistently applied to fcMRI analysis. Based on these results, investigators need to consider the impact GSR and TPR have on connectivity during task performance when attempting to synthesize the literature.
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Affiliation(s)
- James W Ibinson
- 1 Department of Anesthesiology, Center for Pain Research, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Keith M Vogt
- 2 Department of Anesthesiology, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | - Kevin B Taylor
- 3 University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Shiv B Dua
- 4 George Washington University School of Medicine and Health Sciences , Washington, District of Columbia
| | | | - Marco Loggia
- 5 Department of Radiology, Massachusetts General Hospital, Brigham and Women's Hospital , and Harvard Medical School, Boston, Massachusetts
| | - Ajay D Wasan
- 1 Department of Anesthesiology, Center for Pain Research, University of Pittsburgh , Pittsburgh, Pennsylvania
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Ibinson JW, Vogt KM. Pain does not follow the boxcar model: temporal dynamics of the BOLD fMRI signal during constant current painful electric nerve stimulation. J Pain 2013; 14:1611-9. [PMID: 24135433 DOI: 10.1016/j.jpain.2013.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 07/08/2013] [Accepted: 08/04/2013] [Indexed: 11/18/2022]
Abstract
UNLABELLED The temporal dynamics of the blood oxygen level-dependent (BOLD) signal, especially for painful stimulations, is not completely understood. In this study, the BOLD signal response to a long painful electrical stimulation (a continuous painful stimulation of 2 minutes) is directly compared to that of a short painful stimulation (four 30-second periods of painful stimulation interleaved with 30-second rest) in an effort to further probe the relationship between the temporal dynamics of the BOLD signal during constant-intensity pain stimulation. Time course analysis showed that both stimulation protocols produced 3 similarly timed peaks in both data sets, suggesting an early and delayed BOLD response to painful stimulation initiation, and a response related to stimulus termination. Despite the continuous stimulation, the BOLD signal returned to baseline in the 2-minute task. Even with this signal discrepancy, however, the activation maps of the 2 pain tasks differed only slightly, suggesting that the bulk of the activation is determined by the sharp rise in BOLD signal with stimulus onset. These findings imply that the BOLD signal response time course is not directly reflective of pain perception. PERSPECTIVE This article demonstrates that the BOLD signal for a painful stimulation contains multiple peaks and does not maintain the constant level during stimulation that is assumed in typical analysis. Although these dynamics should be accounted for in future studies because of their ability to confound results, their presence did not significantly alter the overall group maps.
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Affiliation(s)
- James W Ibinson
- Center for Pain Research, Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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18
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Vogt KM, Ibinson JW, Schmalbrock P, Small RH. Comparison between end-tidal CO₂ and respiration volume per time for detecting BOLD signal fluctuations during paced hyperventilation. Magn Reson Imaging 2011; 29:1186-94. [PMID: 21908130 DOI: 10.1016/j.mri.2011.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 05/15/2011] [Accepted: 07/06/2011] [Indexed: 11/20/2022]
Abstract
Respiratory motion and capnometry monitoring were performed during blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) of the brain while a series of paced hyperventilation tasks were performed that caused significant hypocapnia. Respiration volume per time (RVT) and end-tidal carbon dioxide (ETCO(2)) were determined and compared for their ability to explain BOLD contrast changes in the data. A 35% decrease in ETCO(2) was observed along with corresponding changes in RVT. A best-fit ETCO(2) response function, with an average initial peak delay time of 12 s, was empirically determined. ETCO(2) data convolved with this response function was more strongly and prevalently correlated to BOLD signal changes than RVT data convolved with the corresponding respiration response function. The results suggest that ETCO(2) better models BOLD signal fluctuations in fMRI experiments with significant transient hypocapnia. This is due to hysteresis in the ETCO(2) response when moving from hypocapnia to normocapnia, compared to moving from normocapnia to hypocapnia.
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Affiliation(s)
- Keith M Vogt
- Department of Anesthesiology, The Ohio State University Medical Center, Columbus, OH 43210, USA
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Vogt KM, Ibinson JW, Schmalbrock P, Small RH. The impact of physiologic noise correction applied to functional MRI of pain at 1.5 and 3.0 T. Magn Reson Imaging 2011; 29:819-26. [PMID: 21571474 DOI: 10.1016/j.mri.2011.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 10/31/2010] [Accepted: 02/20/2011] [Indexed: 11/26/2022]
Abstract
This study quantified the impact of the well-known physiologic noise correction algorithm RETROICOR applied to a pain functional magnetic resonance imaging (FMRI) experiment at two field strengths: 1.5 and 3.0 T. In the 1.5-T acquisition, there was an 8.2% decrease in time course variance (σ) and a 227% improvement in average model fit (increase in mean R(2)(a)). In the 3.0-T acquisition, significantly greater improvements were seen: a 10.4% decrease in σ and a 240% increase in mean R(2)(a). End-tidal carbon dioxide data were also collected during scanning and used to account for low-frequency changes in cerebral blood flow; however, the impact of this correction was trivial compared to applying RETROICOR. Comparison between two implementations of RETROICOR demonstrated that oversampled physiologic data can be applied by either downsampling or modification of the timing in the RETROICOR algorithm, with equivalent results. Furthermore, there was no significant effect from manually aligning the physiologic data with corresponding image slices from an interleaved acquisition, indicating that RETROICOR accounts for timing differences between physiologic changes and MR signal changes. These findings suggest that RETROICOR correction, as it is commonly implemented, should be included as part of the data analysis for pain FMRI studies performed at 1.5 and 3.0 T.
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Affiliation(s)
- Keith M Vogt
- Department of Anesthesiology, The Ohio State University Medical Center, Columbus, OH 43210, USA
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Vogt KM, Kauh CY, Holder DM, DePhilip RM. Reply: Aberrant right subclavian artery and fluoroscopy in the dissection laboratory. Clin Anat 2011. [DOI: 10.1002/ca.21132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Vogt KM, Kauh CY, Holder DM, DePhilip RM. Fluoroscopic angiography in the gross anatomy dissection laboratory: visualizing the aortic arch and its branches in a cadaver. Clin Anat 2011; 24:253-7. [PMID: 21322048 DOI: 10.1002/ca.21080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 09/15/2010] [Accepted: 09/16/2010] [Indexed: 11/09/2022]
Abstract
We present fluoroscopic images of the aortic arch and its branches obtained in a first year medical gross anatomy teaching laboratory after an aberrant right subclavian artery was discovered during dissection. The aortic arch and its branches in the cadaver were filled with contrast medium in molten agar. After the agar solidified, a portable fluoroscope was used to obtain radiographic images. These post-mortem images were then compared with computed tomography images obtained while the individual was living. The embryology, prevalence, and clinical findings of this arterial variation are reviewed, and the importance of recognizing the presence of an aberrant right subclavian artery before performing various procedures is discussed. This exercise gave students the unique opportunity to compare the three-dimensional anatomy seen in the dissection laboratory with the two-dimensional presentation of that same anatomy in the radiographic images that they will see in clinical practice.
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Affiliation(s)
- Keith M Vogt
- Division of Anatomy, College of Medicine, The Ohio State University, Columbus, Ohio 43210, USA
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