Hiroki Hirano

Monitoring of peripheral vascular condition using a log-linearized arterial viscoelastic index during endoscopic thoracic sympathectomy

This paper proposes a novel technique to support the monitoring of peripheral vascular conditions using biological signals such as electrocardiograms, arterial pressure values and pulse oximetry plethysmographic waveforms. In this approach, a second-order log-linearized model (referred to here as a log-linearized peripheral arterial viscoelastic model) is used to describe the non-linear viscoelastic relationship between blood pressure waveforms and photo-plethysmographic waveforms. The proposed index enables estimation of peripheral arterial wall stiffness changes induced by sympathetic nerve activity. The validity of the method is discussed here based on the results of peripheral vascular condition monitoring conducted during endoscopic thoracic sympathectomy (ETS). The results of ETS monitoring showed significant changes in stiffness variations between the periods before and during the procedures observed (p <; 0.01) as well as during and after them (p <; 0.01), so that it was confirmed that sympathetic nerve activity is drastically decreased in the area around the monitoring site after the thoracic sympathetic nerve trunk on the monitoring side is successfully blocked. In addition, no change was observed in the values of the proposed index during the ETS procedure on the side opposite that of the monitoring site. The experimental results obtained clearly show the proposed method can be used to assess changes in sympathetic nerve activity during ETS.

Assessment of Lower-limb Vascular Endothelial Function Based on Enclosed Zone Flow-mediated Dilation

This paper proposes a novel non-invasive method for assessing the vascular endothelial function of lower-limb arteries based on the dilation rate of air-cuff plethysmograms measured using the oscillometric approach. The principle of evaluating vascular endothelial function involves flow-mediated dilation. In the study conducted, blood flow in the dorsal pedis artery was first monitored while lower-limb cuff pressure was applied using the proposed system. The results showed blood flow was interrupted when the level of pressure was at least 50 mmHg higher than the subject’s lower-limb systolic arterial pressure and that blood flow velocity increased after cuff release. Next, values of the proposed index, %ezFMDL, for assessing the vascular endothelial function of lower-limb arteries were determined from 327 adult subjects: 87 healthy subjects, 150 subjects at high risk of arteriosclerosis and 90 patients with cardiovascular disease (CAD). The mean values and standard deviations calculated using %ezFMDL were 30.5 ± 12.0% for the healthy subjects, 23.6 ± 12.7% for subjects at high risk of arteriosclerosis and 14.5 ± 15.4% for patients with CAD. The %ezFMDL values for the subjects at high risk of arteriosclerosis and the patients with CAD were significantly lower than those for the healthy subjects (p < 0.01). The proposed method may have potential for clinical application.

Quantitative Evaluation of Pain during Electrocutaneous Stimulation using a Log-Linearized Peripheral Arterial Viscoelastic Model

In clinical practice, subjective pain evaluations, e.g., the visual analogue scale and the numeric rating scale, are generally employed, but these are limited in terms of their ability to detect inaccurate reports, and are unsuitable for use in anesthetized patients or those with dementia. We focused on the peripheral sympathetic nerve activity that responds to pain, and propose a method for evaluating pain sensation, including intensity, sharpness, and dullness, using the arterial stiffness index. In the experiment, electrocardiogram, blood pressure, and photoplethysmograms were obtained, and an arterial viscoelastic model was applied to estimate arterial stiffness. The relationships among the stiffness index, self-reported pain sensation, and electrocutaneous stimuli were examined and modelled. The relationship between the stiffness index and pain sensation could be modelled using a sigmoid function with high determination coefficients, where R2 ≥ 0.88, p < 0.01 for intensity, R2 ≥ 0.89, p < 0.01 for sharpness, and R2 ≥ 0.84, p < 0.01 for dullness when the stimuli could appropriately evoke dull pain.

Abstract PR618: Response of Arterial Mechanical Impedance to Change in Remifentanil Plasma Concentration During Abdominal Laparoscopic Surgery

1Department of Anesthesiology and Critical Care, Graduate School of Biomedical and Health Sciences of Hiroshima University, Hiroshima city, Japan, 2College of Medical Engineering Technology, Xinjiang Medical University, Urumqi, China, 3College of Medical Engineering Technology, Hiroshima University, Higashi-Hiroshima, 4Department of Cardiovascular Physiology and Medicine, Graduate School of Medicine, Hiroshima University, Hiroshima city, Japan

Evaluation of Arterial Stiffness during the Flow-Mediated Dilation Test

The paper discusses the arterial stiffness during the flow-mediated dilation (FMD) test The FMD test is a method of evaluating the vascular endothelial function and has been popular as it is non-invasive and readily performed by a skillful ultrasound technician. The FMD test, however, evaluates only the maximal increase in vascular diameter mediated by the increases in blood flow after the release of the occlusive cuff and does not evaluate the arterial viscoelastic properties. This paper thus estimates the log-linearlized stiffness, to evaluate the arterial stiffness properties using the arterial diameter and blood pressure measured in a beat-to-beat manner during the FMD test. To six healthy volunteers, we performed the FMD test to measure the arterial diameter and blood pressure with ultrasound diagnostic imaging equipment and non-invasive continuous arterial blood pressure monitor, respectively. As a result, the maximal vasodilatation ratio of FMD (FMD) was obtained after cuff occlusion. In comparison with the arterial stiffness before the FMD test, the stiffness of the arterial wall is temporarily decrease and increase. It was concluded the the arterial stiffness can be estimated on a beat-to-beat basis during the FMD test.