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Thesis
Functional near-infrared spectroscopy for the measurement of propofol effects in conscious sedation during outpatient elective colonoscopy
Master of Science (M.S.), Drexel University
Dec 2012
DOI:
https://doi.org/10.17918/etd-4034
Abstract
Endoscopic procedures performed in the United States routinely involve the use of conscious sedation as standard of care. The use of sedation reduces patient discomfort and anxiety while improving the technical quality of the procedure, and as a result, over 98% of clinicians have adopted the practice. The tremendous benefits of sedation are offset by heightened costs, increased patient discharge time, and cardiopulmonary complication risks. The inherent liabilities of putting patients under sedation have necessitated a large number of physiological monitoring systems in order to ensure patient comfort and safety. Currently American Society of Anesthesiologist (ASA) guidelines recommend monitoring of pulse oximetry, blood pressure, heart rate, and end-tidal CO₂; although important safeguards, these physiological measurements do not allow for the reliable assessment of patient awareness. Proper monitoring of patient state ensures procedure quality and patient safety; however no "gold-standard" is available to determine the depth of sedation which is comparable to the anesthesiologist's professional judgment. Developments in functional Near-Infrared Spectroscopy (fNIR) over the past two decades have introduced cost-effective, portable, and non-invasive neuroimaging tools which measure cortical hemodynamic activity as a correlate of neural functions. Anesthetic drugs, such as propofol, operate by suppressing cerebral metabolism. fNIR imaging methods have the ability to detect these drug related effects as well as neuronal activity through the measurement of local cerebral hemodynamic changes. The current study attempts an initial evaluation into the benefits of using fNIR during gastrointestinal (GI) endoscopy, with the ultimate goal of improving patient safety and satisfaction. To achieve this objective, an observational study with 72 patients was conducted to establish the feasibility of continuous neuromonitoring using fNIR during outpatient sedation. The fNIR measures of hemodynamic changes in response to propofol and its relation to other physiologic measures were evaluated, and a prototype user interface for a sedation monitoring system was designed. The outcome of this thesis provides an exploration of fNIR within the context of sedation and paves the way for potential deployment of optical neuromonitoring devices in conscious sedation settings.
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Details
- Title
- Functional near-infrared spectroscopy for the measurement of propofol effects in conscious sedation during outpatient elective colonoscopy
- Creators
- Adrian Bernhard Curtin - DU
- Contributors
- Kurtulus Izzetoglu (Advisor) - Drexel University (1970-)James Reynolds (Advisor) - Drexel University (1970-)
- Awarding Institution
- Drexel University
- Degree Awarded
- Master of Science (M.S.)
- Publisher
- Drexel University; Philadelphia, Pennsylvania
- Resource Type
- Thesis
- Language
- English
- Academic Unit
- School of Biomedical Engineering, Science, and Health Systems (1997-2026); Drexel University
- Other Identifier
- 4034; 991014632421104721