An electroencephalogram biomarker of fentanyl drug effects

Abstract

Opioid drugs influence multiple brain circuits in parallel to produce analgesia as well as side effects including respiratory depression. At present we do not have real-time clinical biomarkers of these brain effects. We describe here the results of an experiment to characterize the electroencephalographic signatures of fentanyl in humans. We find that increasing concentrations of fentanyl induce a frontal theta band (4-8 Hz) signature distinct from slow-delta oscillations related to sleep and sedation. We also report that respiratory depression, quantified by decline in an index of instantaneous minute ventilation, occurs at ≈ 1700-fold lower concentrations than those that produce sedation as measured by reaction time. The EEG biomarker we describe could facilitate real-time monitoring of opioid drug effects and enable more precise and personalized opioid administration.

Repurposing electroencephalogram monitoring of general anaesthesia for building biomarkers of brain ageing: an exploratory study

“…These patients received a higher dose of opioid (sufentanil in the case of our study) generally resulting in notable increase in EEG power in the delta and theta bands. 39 Thus, patients at risk of developing burst suppression might receive higher doses of opioid, which boosts EEG power, which could make their brains ‘look younger’. That would be in line with observed changes of direction of association between brain age and burst suppression when comparing patients with lower (1or 2) vs higher (3) ASA scores, for whom higher brain age was associated with less burst suppression.…”

Recovery From Acute Respiratory Distress Syndrome Is Associated With Increasing Alpha Power in the Frontal Electroencephalogram During Propofol Sedation: A Case Report

“…Although a hydromorphone infusion was increased from 1 mg/h on day 0 to 2 mg/h on day 3, increasing opioid concentrations is associated with increased theta rather than alpha power. 15 No other sedatives were used during the reported EEG epochs. Hypoxia and hypotension can also alter the EEG, most notably by increasing the likelihood of burst suppression.…”

The nuts and bolts of multimodal anaesthesia in the 21st century: a primer for clinicians

“…Opioids can induce changes in the perioperative EEG [ 43 ▪ , 44 ], often having a synergistic effect to increase or stabilize hypnotic effect. These changes can include the loss or retention [ 44 , 45 ] of alpha waves (8–12 Hz) or an increase in delta power (0.5–4 Hz).…”

“…It is important to note that the initial bolus of lidocaine infusion should not exceed 1.5 mg/kg, and the maintenance [81 & ] dose should not exceed 1.5 mg/kg/h to avoid the risk of fatal overdosing. Lidocaine infusion can be an alternative for patients who cannot undergo neuraxial analgesia because of contraindications[26…”