Biobehavioral Recovery From Surgery and Anesthesia
Biobehavioral Recovery From Surgery and Anesthesia
Reducing postoperative pain leads to increased patient comfort and facilitates speedy
 recovery and discharge from the hospital following surgery. The focus of controlling
 postoperative pain has gradually shifted from postoperative management to intraoperative
 management. The investigators believe that this study is a unique opportunity to assess the
 adequacy of intraoperative analgesia, allowing for immediate administration of the
 appropriate opioid analgesics. The purpose of this research is to bring to light the
 applicability of facial electromyography as an intraoperative solution to postoperative pain
 management.
After consenting to enter the study, the subject will be asked a series of questions
 regarding his/her medical history. He/she will be shown the test for determining
 consciousness by squeezing the experimenter's hand when asked. It will be explained to
 him/her that once unconscious, he/she will not be able to respond to the command of squeezing
 the hand. The facial monitor will be shown to the patient, as well as its location of
 placement.

 Intraoperative Period: The leads will be placed for the FACE monitor as well as for the BIS
 monitoring device. The objective of the BIS monitor which is already in use in the University
 Hospital Operating room suites is to determine consciousness. An identical and typical
 anesthetic protocol will be utilized for all the patients in order to eliminate anesthetic
 factors. The protocol is as follows:

 After administration of propofol for induction, a forearm tourniquet device will be inflated
 to a pressure greater than 200 mm Hg. A muscle relaxant will then be given once the
 tourniquet is inflated while the arm with the tourniquet will not be paralyzed. This allows
 for a check on the unconsciousness of the patient; that is, the patient will be told,
 "squeeze my hand". It is expected that no patient will respond by squeezing his or her hand
 because they are unconscious and anesthetized. The maximum length of time the cuff will be
 inflated is 20 minutes. Tourniquets applied to the entire leg or arm are normally inflated
 for up to 120 minutes and are standard practice in orthopedic surgery.

 One group of patients, determined randomly, will be administered 250 ug of fentanyl during
 induction of anesthesia, while the second group, also determined randomly, will be
 administered 50 ug of fentanyl. Both groups of patients will be administered an inhalational
 anesthetic (isoflurane, desflurane, or sevoflurane) at the level 30% above that which insures
 unconsciousness (called 1.1 MAC), but will not be given nitrous oxide during the 10 minutes
 of our study period due to this gas' effect on Hagihira's "loss of bicoherence" phenomenon.

 The study period will begin 5 minutes before surgical incision, and will end 5 minutes after
 surgical incision. Our hypothesis is that central registration of pain exists despite the
 presence of adequate unconsciousness in the patient, and FACE technology will complement the
 use of the BIS (EEG) monitor to ensure effective administration of anesthesia for patients in
 the future.
Inclusion Criteria:

 -  Subjects 18-65 years of age

 -  Subjects who are English speaking

 -  Subjects undergoing surgery in the supine position

 -  Subjects who are undergoing a procedure where the surgical incision is expected to be
 at least 4 inches

 -  Subjects who are undergoing a surgical procedure below the level of their arms.

 -  Female subjects who have a negative Sure-Vue pregnancy test.

 -  Subjects who are undergoing surgery under general anesthesia.

 Exclusion Criteria:

 -  If the scheduled surgery involves the head, neck or arms.

 -  Subjects who have a history of chronic pain

 -  Subjects who have cognitive disabilities secondary to medical, chemical and genetic
 causes.

 -  Subjects who have peripheral vascular disease of the arms.

 -  Subjects who have carpal tunnel syndrome.

 -  Subjects who have psychiatric, substance abuse and cognitive impairments

 -  Subjects who have had a stroke which has affected function of the upper extremities

 -  Subjects who have had a mastectomy or other type of surgery which may have affected
 the lymph nodes of the arms

 -  Subjects who do not have a telephone

 -  Subjects who are having surgery under nerve block or regional anesthesia

 -  Subjects who are pregnant

 -  Subjects who have an electrical source, i.e. pacemaker or defibrillator