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Related Concept Videos

Stages of General Anesthesia01:22

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Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
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Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
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Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
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Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
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Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
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Related Experiment Video

Updated: Sep 22, 2025

An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
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Measuring "pain load" during general anesthesia.

Stephen Green1, Keerthana Deepti Karunakaran1, Delany Berry1

  • 1The Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, United States.

Cerebral Cortex Communications
|May 25, 2022
PubMed
Summary

Functional near-infrared spectroscopy (fNIRS) can monitor brain activity during surgery. A new method using a ±0.3 mM threshold in oxygenated hemoglobin signals may track intraoperative pain load, correlating with post-operative pain.

Keywords:
brainfNIRSmodelingnociceptionsurgery

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Area of Science:

  • Neuroscience
  • Anesthesiology
  • Medical Technology

Background:

  • Functional near-infrared spectroscopy (fNIRS) enables continuous brain monitoring during surgery.
  • Assessing cumulative pain during general anesthesia is challenging.
  • fNIRS measures hemodynamic responses, reflecting brain activity.

Purpose of the Study:

  • To develop and validate a method for real-time monitoring of intraoperative nociception using fNIRS.
  • To establish a threshold for detecting painful events during surgery.
  • To correlate fNIRS-derived pain indicators with post-operative pain levels.

Main Methods:

  • fNIRS signals were collected from the primary somatosensory cortex (S1) and medial prefrontal cortex (mPFC) in patients undergoing knee surgery under general anesthesia.
  • A threshold of ±0.3 mM change in oxygenated hemoglobin concentration, standardized over 25 seconds, was used to identify nociceptive events.
  • Statistical correlations were analyzed between fNIRS signals, surgical incisions, and post-operative pain.

Main Results:

  • A threshold of ±0.3 mM for oxygenated hemoglobin changes was observed during surgical incisions, indicating potential nociception.
  • True positive signals were detected in S1, while true negatives were observed in mPFC, showing regional specificity.
  • The fNIRS-based threshold demonstrated a correlation with the number of surgical incisions.

Conclusions:

  • Standardized fNIRS measurements with a ±0.3 mM threshold can serve as an indicator of intraoperative pain load.
  • This approach may contribute to an intraoperative pain index that correlates with post-operative pain and the risk of pain chronification.
  • fNIRS offers a promising tool for objective pain assessment in surgical settings.