Differentiation of skin incision and laparoscopic trocar insertion via quantifying transient bradycardia measured by electrocardiogram

Background. Most surgical procedures involve structures deeper than the skin. However, the difference in surgical noxious stimulation between skin incision and laparoscopic trocar insertion is unknown. By analyzing instantaneous heart rate (IHR) calculated from the electrocardiogram, in particular the transient bradycardia in response to surgical stimuli, this study investigates surgical noxious stimuli arising from skin incision and laparoscopic trocar insertion. Methods. Thirty-five patients undergoing laparoscopic cholecystectomy were enrolled in this prospective observational study. Sequential surgical steps including umbilical skin incision (11 mm), umbilical trocar insertion (11 mm), xiphoid skin incision (5 mm), xiphoid trocar insertion (5 mm), subcostal skin incision (3 mm), and subcostal trocar insertion (3 mm) were investigated. IHR was derived from electrocardiography and calculated by the modern time-varying power spectrum. Similar to the classical heart rate variability analysis, the time-varying low frequency power (tvLF), time-varying high frequency power (tvHF), and tvLF-to-tvHF ratio (tvLHR) were calculated. Prediction probability (PK) analysis and global pointwise F-test were used to compare the performance between indices and the heart rate readings from the patient monitor. Results. Analysis of IHR showed that surgical stimulus elicits a transient bradycardia, followed by the increase of heart rate. Transient bradycardia is more significant in trocar insertion than skin incision. The IHR change quantifies differential responses to different surgical intensity. Serial PK analysis demonstrates de-sensitization in skin incision, but not in laparoscopic trocar insertion. Conclusions. Quantitative indices present the transient bradycardia introduced by noxious stimulation. The results indicate different effects between skin incision and trocar insertion.Comment: One table and 4 figure

An Efficient Forecasting Approach to Reduce Boundary Effects in Real-Time Time-Frequency Analysis

Time-frequency (TF) representations of time series are intrinsically subject to the boundary effects. As a result, the structures of signals that are highlighted by the representations are garbled when approaching the boundaries of the TF domain. In this paper, for the purpose of real-time TF information acquisition of nonstationary oscillatory time series, we propose a numerically efficient approach for the reduction of such boundary effects. The solution relies on an extension of the analyzed signal obtained by a forecasting technique. In the case of the study of a class of locally oscillating signals, we provide a theoretical guarantee of the performance of our approach. Following a numerical verification of the algorithmic performance of our approach, we validate it by implementing it on biomedical signals

Wave-shape function analysis -- when cepstrum meets time-frequency analysis

We propose to combine cepstrum and nonlinear time-frequency (TF) analysis to study mutiple component oscillatory signals with time-varying frequency and amplitude and with time-varying non-sinusoidal oscillatory pattern. The concept of cepstrum is applied to eliminate the wave-shape function influence on the TF analysis, and we propose a new algorithm, named de-shape synchrosqueezing transform (de-shape SST). The mathematical model, adaptive non-harmonic model, is introduced and the de-shape SST algorithm is theoretically analyzed. In addition to simulated signals, several different physiological, musical and biological signals are analyzed to illustrate the proposed algorithm