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Apport de la stimulation du nerf médian dans la conception d'une BCI basée sur l'activité cérébrale motrice : vers l'amélioration de la détection des réveils peropératoires au cours de l'anesthésie générale

Sébastien Rimbert 1
1 NEUROSYS - Analysis and modeling of neural systems by a system neuroscience approach
Inria Nancy - Grand Est, LORIA - AIS - Department of Complex Systems, Artificial Intelligence & Robotics
Abstract : Waking up during surgery is a terrifying experience for patients, who fear it, but also for medical staff, who are worried that the situation will occur under their supervision. This type of phenomenon is called "an Accidental Awareness during a General Anesthesia” (AAGA) and is defined as an unexpected awakening of the patient under general anesthesia. This situation occurs when the general anesthesia is insufficiently deep to compensate all the surgical stimuli related to the surgery. AAGA rate in high-risk practices (e.g. obstetric, cardiac, thoracic) is considered to vary from 1-2%. The problem is that such intraoperative awakening can cause physical pain or lead to psychological sequelae called post-traumatic stress disorder (PTSD). Consecutive PTSDs can last for several years and have serious psychological effects leading to suicide. "I couldn't breathe, I couldn't move or open my eyes, or even tell the doctors I wasn't asleep.". This testimony shows that a patient's first reaction is usually to move to alert medical staff of this terrifying situation. Unfortunately, during the majority of surgical procedures, the patient is curarized, which causes neuromuscular block and prevents any movement of the patient. The innovation proposed by this thesis is to detect AAGA reliably by analysing, in real-time, motor brain activity under general anesthesia. In theory, detection of movement intention is possible by analyzing EEG signals from the motor cortex via a brain-computer interface (BCI). Indeed, both a movement execution but also a simple movement intention are characterized by power variations (i.e., Event-related (de)-synchronization called ERD/ERS) in the EEG alpha and beta bands over the motor cortex. Electrical stimulation of the median nerve also induces changes in cortical activity which are visible in the EEG signal and similar to an intention of movement. Interestingly, when an intention to move a hand occurs at the same time as a median nerve stimulation, the ERD/ERS cortical signature is amplified and can be detected better by a BCI based on specific machine learning techniques. In order to design a BCI that would allow the detection of AAGA, this thesis is based on three disciplines (i.e. anesthesia, neurophysiology, computer science) and has three major objectives: (i) to study the effect of anaesthetics on the EEG signal of the motor cortex, (ii) to detect the patient's attempted movement without temporal markers using a BCI based on median nerve stimulation and (iii) to study motor brain activity in clinical conditions that will be close to intraoperative recovery.
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Submitted on : Friday, September 25, 2020 - 2:40:24 PM
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Sébastien Rimbert. Apport de la stimulation du nerf médian dans la conception d'une BCI basée sur l'activité cérébrale motrice : vers l'amélioration de la détection des réveils peropératoires au cours de l'anesthésie générale. Informatique [cs]. Université de Lorraine, 2020. Français. ⟨NNT : 2020LORR0056⟩. ⟨tel-02949285⟩

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