Monitoring subcortical responsiveness of a patient

• US 7,447,541 B2
• Filed: 06/30/2004
• Issued: 11/04/2008
• Est. Priority Date: 06/30/2004
• Status: Active Grant

• Current Assignee: Instrumentarium Dental Incorporated (Envista Holdings Corporation)
• Original Assignee: Instrumentarium Dental Incorporated (Envista Holdings Corporation)
• Inventors: Korhonen, Iikka Kimmo, Huiku, Matti Veli
• Primary Examiner(s): Marmor, II; Charles A.
• Assistant Examiner(s): SAIDI, AZADEH
• Application Number:
  US10/881,019
• Publication Number:
  US 20060004296A1
• Time in Patent Office: 1,588 Days
• Field of Search: 600/544, 600/557, 600/545, 600/485, 600/500, 600/481, 600/301, 600/513, 600/407
• US Class Current: 600/544
• CPC Class Codes: A61B 5/021 Measuring pressure in heart or blood vessels A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/024 Detecting, measuring or recording pulse rate or heart rate A61B5/0205, A61B5/021 take precedence
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• CPC Class Codes: A61B 5/0531 Measuring skin impedance
• CPC Class Codes: A61B 5/145 Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissuemeasuring of blood pressure or blood flow A61B5/02; non-radiation detecting or locating of foreign bodies in blood A61B5/06
• CPC Class Codes: A61B 5/352 Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
• CPC Class Codes: A61B 5/377 using evoked responses
• CPC Class Codes: A61B 5/389 Electromyography [EMG]
• CPC Class Codes: A61B 5/4035 Evaluating the autonomic nervous system
• CPC Class Codes: A61B 5/4821 Determining level or depth of anaesthesia A61B5/1106 takes precedence

Abstract

To monitor subcortical responsiveness of a patient at least one first measurement signal is acquired from a patient and at least one second measurement signal is derived from the at least one first measurement signal. The second measurement signal is indicative of pain-related activity in the patient. A predetermined stimulus signal is then supplied to the patient and a response caused by the stimulus signal in the at least one second measurement signal is monitored in synchronization with the supplying of the stimulus signal. Based on the monitoring step, an indicator of subcortical responsiveness is determined, the indicator being indicative of the patient'"'"'s level of antinociception.

Claims

1. A method for monitoring subcortical responsiveness of a patient, the method comprising the steps of:

acquiring at least one first physiological measurement signal from a patient using at least one sensor, the physiological measurement signal being one of the signals in a group including an RRI signal, a plethysmographic signal, an EMG signal, a blood pressure signal, and a signal representing skin conductivity;

deriving at least one second measurement signal from the at least one first measurement signal, said at least one second measurement signal being indicative of pain-related activity in the patient;

supplying a predetermined stimulus signal to the patient to cause pain to the patient, wherein the predetermined stimulus signal is supplied in synchronization with a spontaneous rhythm of the patient that is regulated by the autonomous nervous system of the patient;

monitoring a response caused by the stimulus signal in the at least one second measurement signal, wherein the monitoring step is synchronized with the supplying step;

determining, based on the monitoring step, an indicator of subcortical responsiveness, said indicator being indicative of the patient'"'"'s level of antinociception; and

outputting the indicator of subcortical responsiveness to a device.

2. A method according to claim 1, further comprising a step of synchronizing the supplying step with at least one of the at least one second measurement signal.

3. A method according to claim 1, wherein the supplying step is synchronized with an external synchronization signal.

4. A method according to claim 1, wherein the supplying step includes supplying a stimulus signal comprising a sequence of stimuli to the patient.

5. A method according to claim 4, wherein

the monitoring step includes detecting changes caused by each of said stimuli in the at least one second measurement signal;

and

the determining step includes defining the indicator of subcortical responsiveness based on the changes detected.

6. A method according to claim 1, wherein the spontaneous rhythm of the patient is the respiration rhythm of the patient, wherein the synchronizing step includes synchronizing the supplying step with the respiration rhythm of the patient.

7. A method according to claim 1, wherein the acquiring step includes acquiring a single first physiological measurement signal from the patient, whereby a single second measurement signal is obtained in the deriving step.

8. A method according to claim 1, wherein the acquiring step includes a step of measuring a set of physiological signals from the patient.

9. A method according to claim 8, wherein the acquiring step further includes calculating the first physiological measurement signal based on the set of physiological signals.

10. A method according to claim 1, wherein

the acquiring steps includes a step of measuring a plurality of first physiological measurement signals from the patient;

and

the deriving step includes the steps of normalizing each of the plurality of first physiological measurement signals and calculating the at least one second measurement signal based on the plurality of normalized physiological signals.

11. A method according to claim 10, wherein the calculating step includes calculating an index signal based upon the normalized first physiological measurement signals, wherein the index signal includes an independent, defined scale indicative of pain experienced by the patient.

12. A method according to claim 1, wherein the deriving step includes filtering at least one of the at least one first measurement signal.

13. A method according to claim 1, wherein the deriving step includes deriving at least one second measurement signal being indicative of activity in the sympathetical branch of the autonomous nervous system of the patient.

14. A method according to claim 1, wherein the device is a display.

15. A method according to claim 1, wherein the device is a system for delivering drugs to the patient.

16. The method for monitoring subcortical responsiveness of a patient, the method comprising the steps of:

measuring at least two physiological signals from the patient using at least one sensor, the at least two physiological signals belonging to a group including an RRI signal, a plethysmographic signal, an EMG signal, a blood pressure signal, and a signal representing skin conductivity;

deriving at least two second measurement signals from the at least two physiological signals, the at least two second measurement signals being indicative of rain-related activity in the patient;

supplying a predetermined stimulus signal to the patient;

monitoring a response caused by the stimulus signal in the at least two second measurement signals, wherein the monitoring step is synchronized with the supply step;

determining, based upon a combination of the responses in the at least two second measurement signals monitored in the monitoring step, an indicator of subcortical responsiveness, the indicator being indicative of the patient'"'"'s level of antinociception; and

outputting the indicator of subcortical responsiveness to a device.

17. A method according to claim 16, wherein

the monitoring step includes detecting changes caused by the stimulus signal in a plurality of second measurement signals;

and

the determining step includes a step of calculating the indicator of subcortical responsiveness based on the changes detected in the plurality of second measurement signals.

18. A method according to claim 16, wherein the device is a display.

19. A method according to claim 16, wherein the device is a system for delivering drugs to the patient.

20. An apparatus for monitoring the subcortical responsiveness of a patient, the apparatus comprising:

first means for acquiring a plurality of first measurement signals from a patient, the first measurement signals being signals from a group including an RRI signal, a plethysmographic signal, an EMG signal, a blood pressure signal and a signal representing skin conductivity;

second means for deriving a plurality of second measurement signals from the first measurement signals, the second measurement signals being indicative of pain-related activity in the patient;

stimulator means for supplying a predetermined stimulus signal to the patient;

third means for monitoring a response caused by the stimulus signal in the second measurement signals, the third means being synchronized with the stimulator means; and

fourth means, responsive to the third means, for determining an indicator of subcortical responsiveness based upon the response caused in the plurality of second measurement signals, said indicator being indicative of the patient'"'"'s level of antinociception.

21. An apparatus according to claim 20, further comprising means for synchronizing the stimulator means with a predetermined signal.

22. An apparatus according to claim 21, wherein the predetermined signal is indicative of a body function regulated by the autonomous nervous system of the patient.

23. An apparatus according to claim 20, wherein the stimulator means comprise control means for controlling the characteristics of the stimulus signal.

24. An apparatus according to claim 20, wherein the second means comprise filtering means for filtering the at least one first measurement signal.