Håvard Kalvøy

Current Threshold for Nerve Stimulation Depends on Electrical Impedance of the Tissue: A Study of Ultrasound-Guided Electrical Nerve Stimulation of the Median Nerve

BACKGROUND: Understanding the mechanisms causing variation in current thresholds for electrical nerve stimulation may improve the safety and success rate of peripheral nerve blocks. Electrical impedance of the tissue surrounding a nerve may affect the response to nerve stimulation. In this volunteer study, we investigated the relationship between impedance and current threshold needed to obtain a neuromuscular response. METHODS: Electrical nerve stimulation and impedance measurements were performed for the median nerve in the axilla and at the elbow in 29 volunteers. The needletip was positioned at a distance of 5, 2.5, and 0 mm from the nerve as judged by ultrasound. Impulse widths of 0.1 and 0.3 ms were used for nerve stimulation. RESULTS: A significant inverse relationship between impedance and current threshold was found at the elbow, at nerve-to-needle distances of 5 and 2.5 mm (P = 0.001 and P = 0.036). Impedance values were significantly lower in the axilla (mean 21.1, sd 9.7 kohm) than at the elbow (mean 36.6, sd 13.4 kohm) (P < 0.001). Conversely, current thresholds for nerve stimulation were significantly higher in the axilla than at the elbow (P < 0.001, P < 0.001, P = 0.024). A mean ratio of 1.82 was found for the measurements of current thresholds with 0.1 versus 0.3 ms impulse duration. CONCLUSIONS: Our results demonstrate an inverse relationship between impedance measurements and current thresholds and suggest that current settings used for nerve stimulation may require adjustment based on the tissue type. Further studies should be performed to investigate the clinical impact of our findings.

Impedance-based tissue discrimination for needle guidance

Measurement of electrical impedance can discriminate between tissues of different electrical properties. A measurement system with adequate spatial resolution focused on a volume around the tip of a needle or other invasive clinical equipment can be used to determine in which type of tissue the tip is positioned. We have measured the sensitivity zone of a needle electrode with an active electrode area of 0.3 mm(2), and measured impedance spectra in porcine tissue in vivo. Small electrode impedance data will be influenced by electrode polarization impedance (EPI) at low frequencies. To refine existing methods for needle guidance with higher spatial resolution, we have used multivariate analysis and new interpretations of EPI, and tissue data gathered with selected needle electrodes. The focus of this study is on discrimination between muscle and fat/subdermis for drug administration, but our results also indicate that these refinements will facilitate new clinical applications for impedance-based needle guidance in general.

New method for separation of electrode polarization impedance from measured tissue impedance.

In this paper we have shown that electrode polarization impedance (EPI) can be separated from measured tissue impedance as long as the characteristic frequencies of EPI and tissue are not too close, so that the EPI is largely displayed as a separate dispersion. In 2-electrode measurements the EPI and sample are physically connected in series, and commonly modelled by equivalent components in series. We have calculated the parallel equivalent elements and converted the series connected EPI and sample to a parallel admittance model. By curve fitting on the converted model we have shown that this provides a new method for estimating the EPI with enhanced accuracy compared to similar techniques used on the impedance model.

Waveform difference between skin conductance and skin potential responses in relation to electrical and evaporative properties of skin.

The shapes of skin conductance (SC) and skin potential (SP) responses are often similar, but can also be very different due to an unexplained cause. Using a new method to measure SC and SP simultaneously at the same electrode, this difference was investigated in a new way by comparing their temporal peak differences. SC, SP, skin susceptance (SS), and transepidermal water loss (TEWL) were recorded from 40 participants during relaxation and stress. The SP response could peak anywhere between the onset of an SC response to some time after the peak of an SC response. This peak time difference was associated with the magnitude of the SCR, the hydration of the skin, and the filling of the sweat ducts. Interpretation of the results in light of existing biophysical theories suggests that this peak difference may indicate the hydraulic capacity state of the sweat ducts at the time of a response.

A finite element model of needle electrode spatial sensitivity

We used the finite element (FE) method to estimate the spatial sensitivity of a needle electrode for bioimpedance measurements. This current conducting needle with an insulated shaft was inserted in a saline solution and the current was measured at the neutral electrode. Model resistance and reactance were calculated and successfully compared with measurements on a laboratory model. The sensitivity field was described graphically based on these FE simulations.

Invasive electrical impedance tomography for blood vessel detection.

We present a novel method for localization of large blood vessels using a bioimpedance based needle positioning system on an array of ten monopolar needle electrodes. The purpose of the study is to develop a portable, low cost tool for rapid vascular access for cooling and controlled reperfusion of cardiac arrest patients. Preliminary results show that localization of blood vessels is feasible with this method, but larger studies are necessary to improve the technology.

Determination of tissue type surrounding a needle tip by electrical bioimpedance

A novel method for determining needle position based on local tissue impedance and electrode polarization data, is presented. Measurements of electrical impedance in a small volume around a needle tip can aid in determining if the needle is in the desired tissue. There are many possible applications for this technique, such as needle positioning when administrating drugs in blood vessels or muscle tissue, for epidural analgesia or needle EMG exams.

From impedance theory to needle electrode guidance in tissue

Fast access to blood vessels or other tissues/organs can be crucial in clinical or acute medical treatment. We have developed a method for needle guidance for use in different types of applications. The feasibility of an automatic application for fast access to blood vessels during acute cardiac arrest, based on this method, has been evaluated. Suited electrode setups were found by development of needle electrode models used in simulation and sensitivity analyses. In vitro measurements were done both to determine the fundamental properties of the electrodes for use in the models and to confirm the simulation results. Development of algorithms for tissue characterization and differentiation was based on in vivo impedance measurement in porcine models and confirmed in human tissue in vivo. Feasibility was proven by application prototyping and impedance data presented as invasive Electrical Impedance Tomography (iEIT). Our conclusion is that this method can be utilized in a wide range of clinical applications.

In vivo characterization of ischemic small intestine using bioimpedance measurements.

The standard clinical method for the assessment of viability in ischemic small intestine is still visual inspection and palpation. This method is non-specific and unreliable, and requires a high level of clinical experience. Consequently, viable tissue might be removed, or irreversibly damaged tissue might be left in the body, which may both slow down patient recovery. Impedance spectroscopy has been used to measure changes in electrical parameters during ischemia in various tissues. The physical changes in the tissue at the cellular and structural levels after the onset of ischemia lead to time-variant changes in the electrical properties. We aimed to investigate the use of bioimpedance measurement to assess if the tissue is ischemic, and to assess the ischemic time duration. Measurements were performed on pigs (n = 7) using a novel two-electrode setup, with a Solartron 1260/1294 impedance gain-phase analyser. After induction of anaesthesia, an ischemic model with warm, full mesenteric arterial and venous occlusion on 30 cm of the jejunum was implemented. Electrodes were placed on the serosal surface of the ischemic jejunum, applying a constant voltage, and measuring the resulting electrical admittance. As a control, measurements were done on a fully perfused part of the jejunum in the same porcine model. The changes in tan δ (dielectric parameter), measured within a 6 h period of warm, full mesenteric occlusion ischemia in seven pigs, correlates with the onset and duration of ischemia. Tan δ measured in the ischemic part of the jejunum differed significantly from the control tissue, allowing us to determine if the tissue was ischemic or not (P < 0.0001, F = (1,75.13) 188.19). We also found that we could use tan δ to predict ischemic duration. This opens up the possibility of real-time monitoring and assessment of the presence and duration of small intestinal ischemia.

Impedance properties of stainless steel needle electrodes

We here present experimental findings on the stability of impedance properties of stainless steel needle electrodes in-vitro. Impedance spectra were measured with a 0.3 mm medical grade stainless steel needle electrode in vitro before and after electrolytic treatment. These first results show large changes in impedance properties both after electrolytic treatment and long-term saline exposure. The electrode polarization impedance of our setup decreased both for anodic and cathodic currents of 1 μA. Increased impedance was seen after long-term exposure to saline. The largest impedance decrease and the lowest post-treatment drift were observed for the cathodic treatment.