A5042374104- Pediatric Pain Management Techniques
- Anesthesia and Sedative Agents
- Infant Development and Preterm Care
- Advanced MRI Techniques and Applications
- Anesthesia and Neurotoxicity Research
- Neonatal Respiratory Health Research
- Neonatal and fetal brain pathology
- Pain Management and Placebo Effect
- Infant Health and Development
- Neuroscience of respiration and sleep
- Pain Mechanisms and Treatments
- Functional Brain Connectivity Studies
- Neural dynamics and brain function
- Heart Rate Variability and Autonomic Control
- Cardiac, Anesthesia and Surgical Outcomes
- Advanced Neuroimaging Techniques and Applications
- Plant and Biological Electrophysiology Studies
- Musculoskeletal pain and rehabilitation
- Atomic and Subatomic Physics Research
- Spinal Fractures and Fixation Techniques
- Psychosomatic Disorders and Their Treatments
- Respiratory Support and Mechanisms
- EEG and Brain-Computer Interfaces
- Traumatic Brain Injury and Neurovascular Disturbances
- Epilepsy research and treatment
Wellcome Centre for Integrative Neuroimaging
2007-2024
University of Oxford
2012-2024
John Radcliffe Hospital
2011-2021
Oxford University Hospitals NHS Trust
2017-2021
Novem (Netherlands)
2016
University of Amsterdam
2013
Cardiff University
2008
Oxford Archaeology
2008
Science Oxford
2008
Rogers (United States)
2008
Limited understanding of infant pain has led to its lack recognition in clinical practice. While the network brain regions that encode affective and sensory aspects adult are well described, structures involved nociceptive processing completely unknown, meaning we cannot infer anything about nature experience. Using fMRI identified active following acute noxious stimulation newborn infants, compared activity observed adults. Significant was 18 20 but not amygdala or orbitofrontal cortex....
While ubiquitous, pharmacological manipulation of consciousness remains poorly defined and incompletely understood (Prys-Roberts, 1987). This retards anesthetic drug development, confounds interpretation animal studies conducted under anesthesia, limits the sensitivity clinical monitors cerebral function to intact perception. Animal human propose a functional "switch" at level thalamus, with inhibition thalamo-cortical transmission characterizing loss (Alkire et al., 2000; Mashour, 2006). We...
The altered state of consciousness produced by general anesthetics is associated with a variety changes in the brain's electrical activity. Under hyperpolarizing influences such as anesthetic drugs, cortical neurons oscillate at ~1 Hz, which measurable slow waves electroencephalogram (EEG). We have administered propofol anesthesia to 16 subjects and found that, after they had lost behavioral responsiveness (response standard sensory stimuli), each individual's EEG slow-wave activity (SWA)...
Variability in opioid analgesia has been attributed to many factors. For example, genetic variability of the μ-opioid receptor (MOR)-encoding gene introduces MOR function and endogenous neurotransmission. Emerging evidence suggests that personality trait related experience reward is linked We hypothesized opioid-induced behavioral would be predicted by responsiveness (RWR) response brain circuitry noxious stimuli at baseline before administration. In healthy volunteers using functional...
BackgroundInfant pain has immediate and long-term effects but is undertreated because of a paucity evidence-based analgesics. Although morphine often used to sedate ventilated infants, its analgesic efficacy unclear. We aimed establish whether oral could provide effective safe analgesia in non-ventilated premature infants for acute procedural pain.MethodsIn this single-centre masked trial, 31 at the John Radcliffe Hospital, Oxford, UK, were randomly allocated using web-based facility with...
A measure of nociceptive brain activity that can be used to assess analgesic efficacy in infants is derived and validated.
Anatomic sites within the brain, which activate in response to noxious stimuli, can be identified with use of functional magnetic resonance imaging. The aim this study was determine whether analgesic effects ketamine could imaged.Ketamine administered eight healthy volunteers a target-controlled infusion three predicted plasma concentrations: 0 (saline), 50 (subanalgesic), and 200 ng/ml (analgesic, subanesthetic). Volunteers received thermal stimuli auditory performed motor task 3-T human...
Abstract Measuring infant pain is complicated by their inability to describe the experience. While nociceptive brain activity, reflex withdrawal and facial grimacing have been characterised, relationship between these activity patterns has not examined. As cortical spinally mediated developmentally regulated, it cannot be assumed that they are predictive of one another in immature nervous system. Here, using a new experimental paradigm, we characterise nociceptive-specific spinal behavioural...
Abstract Changes in facial expression are an essential form of social communication and nonverbal infants often used to alert care providers pain-related distress. However, studies early human brain development suggest that premature aged less than 34 weeks' gestation do not display discriminative activity patterns equally salient noxious innocuous events. Here we examine the 105 infants, between 28 42 gestation. We show presence change after stimulation is age-dependent expressions emerge...
In adults, nociceptive reflexes and behavioral responses are modulated by a network of brain regions via descending projections to the spinal dorsal horn [1Bingel U. Tracey I. Imaging CNS modulation pain in humans.Physiology (Bethesda). 2008; 23: 371-380Crossref PubMed Scopus (225) Google Scholar]. Coordinated noxious inputs manifest from balance facilitation inhibition. contrast, young infants display exaggerated uncoordinated limb [2Cornelissen L. Fabrizi Patten D. Worley A. Meek J. Boyd...
Opioid binding to the cerebral blood vessels may affect vascular responsiveness and hence confound interpretation of oxygen level-dependent (BOLD) responses, which are usually interpreted as neuronal in origin. varies different brain regions. It is unclear whether opioids alter neurovascular coupling, or their effects purely neuronal. This study used BOLD functional magnetic resonance imaging (FMRI) investigate effect a μ-opioid agonist remifentanil, on cerebrovascular CO 2 reactivity (being...
It has been postulated that a small cortical region could be responsible for the loss of behavioral responsiveness (LOBR) during general anesthesia. The authors hypothesize any brain demonstrating reduced activation to multisensory external stimuli around LOBR represents key gate underlying this transition. Furthermore, localized suppression is associated with breakdown in frontoparietal communication.During both simultaneous electroencephalography and functional magnetic resonance imaging...
Medication in hospitalised infants is often prescribed using a one-size-fits-all approach due to lack of clinical biomarkers. Caffeine one the most frequently administered medicines neonatology - for management apnoea prematurity, aid extubation and increasingly conditions such as bronchopulmonary dysplasia. guidelines prematurity indicate use based on age infant, but this does not account individual variation rate. Consequently, may risk caffeine undertreatment or adverse events...
Preclinical evidence suggests that opioid withdrawal induces central sensitization (CS) is maintained by supraspinal contributions from the descending pain modulatory system (DPMS). Here, in healthy human subjects we use functional magnetic resonance imaging to study activity during period of remifentanil. We used a crossover design and thermal stimuli on uninjured skin demonstrate withdrawal-induced hyperalgesia (OIH) without CS-inducing peripheral stimulus. Saline was control arm account...
Infants in neonatal intensive care units frequently experience clinically necessary painful procedures, which elicit a range of behavioral, physiological, and neurophysiological responses. However, the measurement pain this population is challenge no gold standard exists. The aim study was to investigate how noxious-evoked changes facial expression, reflex withdrawal, brain activity, heart rate, oxygen saturation are related examine their accuracy discriminating between noxious non-noxious...
Despite the high burden of pain experienced by hospitalised neonates, there are few analgesics with proven efficacy. Testing in neonates is experimentally and ethically challenging minimising number required to demonstrate efficacy essential. EEG (electroencephalography)-derived measures noxious-evoked brain activity can be used assess analgesic efficacy; however, as variability exists neonate’s responses painful procedures, large sample sizes often required. Here, we present an experimental...
Opioid drugs disrupt signaling in the brain stem respiratory network affecting rhythm. We evaluated influence of a steady-state infusion model opioid, remifentanil, on variability during spontaneous respiration group 11 healthy human volunteers. used dynamic linear and nonlinear models to examine effects remifentanil both directions ventilatory loop, i.e., natural variations end-tidal carbon dioxide (Pet(CO(2))) variability, which was assessed by tidal volume (Vt) breath-to-breath...
Purpose Blood oxygen level dependent (BOLD) brain activity, measured using functional MRI (fMRI), is on the echo time (TE) and reversible spin–spin relaxation constant ( ) that describes decay of transverse magnetization. Use optimal TE during fMRI experiments allows maximal sensitivity to BOLD be achieved. Reports values are longer in infants (due higher water concentrations lower lipid content) have led use TEs infant experiments; however, has not been established. Methods In this study,...
Clinically required noxious cannulation performed in children receiving sevoflurane monoanaesthesia causes a change electrophysiological brain activity. More than 235,000 children/year the UK receive general anaesthesia, but it is unknown whether nociceptive stimuli alter cortical activity anaesthetised children. Time-locked electroencephalogram (EEG) responses to experimental tactile stimuli, and clinically were examined 51 (ages 1–12 years) under monoanaesthesia. Based on pilot study (n =...
Premature birth is associated with a wide range of complications in later life, including structural and functional neurological abnormalities altered pain sensitivity. We investigated whether during anaesthesia premature-born children display different patterns background EEG activity exhibit increased responses to nociceptive stimuli. examined time-locked clinical cannulation 45 (mean age (±SD) at study: 4.9 (± 3.0) years) under sevoflurane monoanaesthesia maintained steady-state end-tidal...
Understanding the neurophysiology underlying neonatal responses to noxious stimulation is central improving early life pain management. In this multimodal MRI study, we use resting-state and diffusion investigate inter-individual variability in noxious-stimulus evoked brain activity. We observe that cerebral haemodynamic experimental can be predicted from separately acquired activity (n = 18). Applying prediction model independent Developing Human Connectome Project data 215), identify...