Dexmedetomidine anesthesia enhances spike generation during intra-operative electrocorticography: A promising adjunct for epilepsy surgery

Chaitanya, Ganne; Arivazhagan, A; Sinha, Sanjib; Reddy, K. R. Madhusudan; Thennarasu, K; Bharath, Rose Dawn; Rao, Malla Bhaskara; Chandramouli, B.A.; Satishchandra, Parthasarathy

doi:10.1016/j.eplepsyres.2014.10.006

Cited by 25 publications

(20 citation statements)

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“…Various studies of patients with refractory epilepsy during anesthesia have found epileptiform spiking in the electrocorticogram. [43][44][45] In this study, we analyzed spiking influence on the permutation cross mutual information, detailed in Supplemental Digital Content 2 (part 2, http://links.lww. com/ALN/C71).…”

Section: The Influence Of Studying An Epileptic Brainmentioning

confidence: 99%

Information Integration and Mesoscopic Cortical Connectivity during Propofol Anesthesia

et al. 2020

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Background The neurophysiologic mechanisms of propofol-induced loss of consciousness have been studied in detail at the macro (scalp electroencephalogram) and micro (spiking or local field potential) scales. However, the changes in information integration and cortical connectivity during propofol anesthesia at the mesoscopic level (the cortical scale) are less clear. Methods The authors analyzed electrocorticogram data recorded from surgical patients during propofol-induced unconsciousness (n = 9). A new information measure, genuine permutation cross mutual information, was used to analyze how electrocorticogram cross-electrode coupling changed with electrode-distances in different brain areas (within the frontal, parietal, and temporal regions, as well as between the temporal and parietal regions). The changes in cortical networks during anesthesia—at nodal and global levels—were investigated using clustering coefficient, path length, and nodal efficiency measures. Results In all cortical regions, and in both wakeful and unconscious states (early and late), the genuine permutation cross mutual information and the percentage of genuine connections decreased with increasing distance, especially up to about 3 cm. The nodal cortical network metrics (the nodal clustering coefficients and nodal efficiency) decreased from wakefulness to unconscious state in the cortical regions we analyzed. In contrast, the global cortical network metrics slightly increased in the early unconscious state (the time span from loss of consciousness to 200 s after loss of consciousness), as compared with wakefulness (normalized average clustering coefficient: 1.05 ± 0.01 vs. 1.06 ± 0.03, P = 0.037; normalized average path length: 1.02 ± 0.01 vs. 1.04 ± 0.01, P = 0.021). Conclusions The genuine permutation cross mutual information reflected propofol-induced coupling changes measured at a cortical scale. Loss of consciousness was associated with a redistribution of the pattern of information integration; losing efficient global information transmission capacity but increasing local functional segregation in the cortical network. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Section: The Influence Of Studying An Epileptic Brainmentioning

confidence: 99%

Information Integration and Mesoscopic Cortical Connectivity during Propofol Anesthesia

et al. 2020

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“…24 Several small studies have described its use as a sedative agent in adult patients undergoing surgeries requiring EEG, with the general consensus that it does not appear to suppress EEG activity and is, therefore, a potentially viable adjunct for procedures, such as awake craniotomy and epilepsy surgery, where accurate mapping of epileptic foci is essential. 25,26 However, to the authors' knowledge, no studies have specifically observed the effect of dexmedetomidine when attempting to locate epileptogenic lesions.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine for Postoperative Sedation Following Stereotactic Lead Placement

Bui

Vega‐Talbott³

et al. 2019

Journal of Pediatric Neurology

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Dexmedetomidine has become an increasingly popular alternative to benzodiazepines and opioids as a safe agent for sedation and pain control, especially in pediatric populations. In this study, we present a case of postoperative use of dexmedetomidine in a pediatric patient, with a known history of behavioral difficulties, who underwent stereotactic lead placement for medically refractory epilepsy.

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“…[ 13 ] Moreover, at usual doses, it does not reduce the spike activity and enables intraoperative ECoG to be carried out during resection of epileptic foci. [ 14 15 ]…”

Section: Discussionmentioning

confidence: 99%

“…assessed the effect of dexmedetomidine on ECoG spikes intraoperatively in 34 patients. [ 15 ] The authors found that dexmedetomidine infusion 1 μg/kg over 5 min increased the spike rate in 67.6% patients and thus concluded that it is useful during intraoperative ECoG recording as it enhances or does not alter spike rate in majority of the cases. Mirski et al .…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of dexmedetomidine infusion for patients undergoing awake craniotomy: An observational study

et al. 2018

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Background:The goal of awake craniotomy is to maintain adequate sedation, analgesia, respiratory, and hemodynamic stability and also to provide a cooperative patient for neurologic testing. An observational study carried out to evaluate the efficacy of dexmedetomidine sedation for awake craniotomy.Materials and Methods:Adult patients with age >18 year who underwent awake craniotomy for intracranial tumor surgery were enrolled. Those who were uncooperative and had difficult airway were excluded from the study. In the operating room, the patients received a bolus dose of dexmedetomidine 1 μg/kg followed by an infusion of 0.2–0.7 μg/kg/h (bispectral index target 60–80). Once the patients were sedated, scalp block was given with bupivacaine 0.25%. The data on hemodynamics at various stages of the procedure, intraoperative complications, total amount of fentanyl used, intravenous fluids required, blood loss and transfusion, duration of surgery, Intensive Care Unit (ICU), and hospital stay were collected. The patients were assessed for Glasgow outcome scale (GOS) score and patient satisfaction score (PSS).Results:A total of 27 patients underwent awake craniotomy during a period of 2 years. Most common intraoperative complication was seizures; observed in five patients (18.5%). None of these patients experienced any episode of desaturation. Two patients had tight brain for which propofol boluses were administered. The average fentanyl consumption was 161.5 ± 85.0 μg. The duration of surgery, ICU, and hospital stays were 231.5 ± 90.5 min, 14.5 ± 3.5 h, and 4.7 ± 1.5 days, respectively. The overall PSS was 8 and GOS was good in all the patients.Conclusion:The use of dexmedetomidine infusion with regional scalp block in patients undergoing awake craniotomy is safe and efficacious. The absence of major complications and higher PSS makes it close to an ideal agent for craniotomy in awake state.

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Dexmedetomidine anesthesia enhances spike generation during intra-operative electrocorticography: A promising adjunct for epilepsy surgery

Cited by 25 publications

References 28 publications

Information Integration and Mesoscopic Cortical Connectivity during Propofol Anesthesia

Information Integration and Mesoscopic Cortical Connectivity during Propofol Anesthesia

Dexmedetomidine for Postoperative Sedation Following Stereotactic Lead Placement

Efficacy and safety of dexmedetomidine infusion for patients undergoing awake craniotomy: An observational study

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