A Prospective Study of Age-dependent Changes in Propofol-induced Electroencephalogram Oscillations in Children

Lee, Johanna M; Akeju, Oluwaseun; Terzakis, Kristina; Pavone, Kara J.; Deng, Hao; Houle, Timothy T.; Firth, Paul G.; Shank, Erik S.; Brown, Emery N.; Purdon, Patrick L.

doi:10.1097/aln.0000000000001717

Cited by 58 publications

(50 citation statements)

References 55 publications

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“…Thus, the EEG oscillations that are induced by anesthetic drugs may elicit neurophysiological biomarkers that are not readily discernable from EEG recordings obtained during the awake state. We note that healthy aging is associated with an age-dependent decrease in anesthesia-induced frontal alpha oscillation power (Akeju et al , 2015, Purdon et al , 2015, Lee et al , 2017). However, similar to the accelerated decrease in the awake-occipital alpha oscillation power that is associated with neurodegeneration in patients with mild cognitive impairment and Alzheimer’s disease (Rossini et al , 2007, Babiloni et al , 2013, Babiloni et al , 2015), significantly decreased anesthesia-induced frontal alpha and beta power may reflect sub-clinical neurodegenerative changes.…”

Section: Discussionmentioning

confidence: 78%

Electroencephalogram dynamics during general anesthesia predict the later incidence and duration of burst-suppression during cardiopulmonary bypass

Plummer

Ibala

Hahm

et al. 2019

Clinical Neurophysiology

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Objective: Electroencephalogram burst-suppression during general anesthesia is associated with post-operative delirium (POD). Whether burst-suppression causes POD or merely reflects susceptibility to POD is unclear. We hypothesized decreased intraoperative alpha (8–12 Hz) and beta (13–33 Hz) power prior to the occurrence of burst-suppression in susceptible patients. Methods: We analyzed intraoperative electroencephalogram data of cardiac surgical patients undergoing cardiopulmonary bypass (CPB). We detected the incidence and duration of CPB burst-suppression with an automated burst-suppression detection algorithm. We analyzed EEG data with multi-taper spectral estimation methods. We assessed associations between patient characteristics and burst-suppression using Binomial and Zero-inflated Poisson Regression Models. Results: We found significantly decreased alpha and beta power (7.8–22.95 Hz) in the CPB burst-suppression cohort. The odds ratio for the association between point estimates for alpha and beta power (7.8–22.95 Hz) and the incidence of burst-suppression was 0.88 (95% CI: 0.79 to 0.98). The incidence rate ratio for the association between point estimates for power between the alpha and beta range and the duration of burst-suppression was 0.89 (95% CI: 0.84 to 0.93). Conclusion: Decreased intra-operative power within the alpha and beta range was associated with susceptibility to burst-suppression during CPB. Significance: This dynamic may be used to develop principled neurophysiological-based approaches to aid the preemptive identification and targeted care of POD vulnerable patients.

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Section: Discussionmentioning

confidence: 78%

Electroencephalogram dynamics during general anesthesia predict the later incidence and duration of burst-suppression during cardiopulmonary bypass

Plummer

Ibala

Hahm

et al. 2019

Clinical Neurophysiology

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“…We used spectral analysis of the persistence spectrogram and power spectrogram to see whether the EEG signal acquired from PLEM™ reflected typical known patterns of propofol anesthesia that had been reported in previous studies [7,12,29]. The persistence spectrogram showed wide distribution in the LOC-state and ROC-state, in contrast to a dense distribution in the UC-state.…”

Section: Discussionmentioning

confidence: 89%

Monitoring of anesthetic depth and EEG band power using phase lag entropy during propofol anesthesia

et al. 2020

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Background: Phase lag entropy (PLE) is a novel anesthetic depth indicator that uses four-channel electroencephalography (EEG) to measure the temporal pattern diversity in the phase relationship of frequency signals in the brain. The purpose of the study was to evaluate the anesthetic depth monitoring using PLE and to evaluate the correlation between PLE and bispectral index (BIS) values during propofol anesthesia.Methods: In thirty-five adult patients undergoing elective surgery, anesthesia was induced with propofol using target-controlled infusion (the Schneider model). We recorded the PLE value, raw EEG, BIS value, and hemodynamic data when the target effect-site concentration (Ce) of propofol reached 2, 3, 4, 5, and 6 μg/ml before intubation and 6, 5, 4, 3, 2 μg/ml after intubation and injection of muscle relaxant. We analyzed whether PLE and raw EEG data from the PLE monitor reflected the anesthetic depth as the Ce of propofol changed, and whether PLE values were comparable to BIS values.Results: PLE values were inversely correlated to changes in propofol Ce (propofol Ce from 0 to 6.0 μg/ml, r 2 = − 0.83; propofol Ce from 6.0 to 2.0 μg/ml, r 2 = − 0.46). In the spectral analysis of EEG acquired from the PLE monitor, the persistence spectrogram revealed a wide distribution of power at loss of consciousness (LOC) and recovery of consciousness (ROC), with a narrow distribution during unconsciousness. The power spectrogram showed the typical pattern seen in propofol anesthesia with slow alpha frequency band oscillation. The PLE value demonstrated a strong correlation with the BIS value during the change in propofol Ce from 0 to 6.0 μg/ml (r 2 = 0.84). PLE and BIS values were similar at LOC (62.3 vs. 61.8) (P > 0.05), but PLE values were smaller than BIS values at ROC (64.4 vs 75.7) (P < 0.05). Conclusions: The PLE value is a useful anesthetic depth indicator, similar to the BIS value, during propofol anesthesia. Spectral analysis of EEG acquired from the PLE monitor demonstrated the typical patterns seen in propofol anesthesia. Trial registration: This clinical trial was retrospectively registered at ClinicalTrials.gov at October 2017 (NCT03299621).

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“…Among the few available data, epileptiform EEG has been described by some authors for high concentrations of sevoflurane . In addition, recent publications using spectral and coherence methods have evidenced age‐related differences in EEG profiles during surgical anesthesia . However, the potential drug‐specific, dose‐related modifications remain poorly investigated.…”

Section: Introductionmentioning

confidence: 99%

EEG profiles during general anesthesia in children: A comparative study between sevoflurane and propofol

Rigouzzo

Khoy-Ear

Laude

et al. 2019

Pediatric Anesthesia

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Background In this prospective study, we describe the electroencephalographic (EEG) profiles in children anesthetized with sevoflurane or propofol. Methods Seventy‐three subjects (11 years, range 5‐18) were included and randomly assigned to two groups according to the anesthetic agent. Anesthesia was performed by target‐controlled infusion of propofol (group P) or by sevoflurane inhalation (group S). Steady‐state periods were performed at a fixed randomized concentration between 2, 3, 4, 5, and 6 μg.ml−1 of propofol in group P and between 1, 2, 3, 4, and 5% of sevoflurane in group S. Remifentanil was continuously administered throughout the study. Clinical data, Bispectral Index (BIS), and raw EEG were continuously recorded. The relationship between BIS and anesthetic concentrations was studied using nonlinear regression. For all steady‐state periods, EEG traces were reviewed to assess the presence of epileptoid signs, and spectral analysis of raw EEG was performed. Results Under propofol, BIS decreased monotonically and EEG slowed down as concentrations increased from 2 to 6 μg.ml−1. Under sevoflurane, BIS decreased from 0% to 4% and paradoxically rose from 4% to 5% of expired concentration: this increase in BIS was associated with the occurrence of fast oscillations and epileptoid signs on the EEG trace. Propofol was associated with more delta waves and burst suppression periods compared to sevoflurane. Conclusion Under deep anesthesia, the BIS and electroencephalographic profiles differ between propofol and sevoflurane. For high concentrations of sevoflurane, an elevated BIS value may be interpreted as a sign of epileptoid patterns or EEG fast oscillations rather than an insufficient depth of hypnosis.

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A Prospective Study of Age-dependent Changes in Propofol-induced Electroencephalogram Oscillations in Children

Cited by 58 publications

References 55 publications

Electroencephalogram dynamics during general anesthesia predict the later incidence and duration of burst-suppression during cardiopulmonary bypass

Electroencephalogram dynamics during general anesthesia predict the later incidence and duration of burst-suppression during cardiopulmonary bypass

Monitoring of anesthetic depth and EEG band power using phase lag entropy during propofol anesthesia

EEG profiles during general anesthesia in children: A comparative study between sevoflurane and propofol

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