Electroencephalographic discontinuity during sevoflurane anesthesia in infants and children

Cornelissen, Laura; Bergin, Ann M.; Lobo, Kimberly; Donado, Carolina; Soul, Janet S.; Berde, Charles B.

doi:10.1111/pan.13061

Cited by 35 publications

(46 citation statements)

References 24 publications

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“…3D). In contrast, the relationship between activity amplitude and etAnesthetic indicated frequency-specificity in human infants of 2-4 and 4-6 months, as previously reported ( 9 ). Frontal activity has been shown to be particularly sensitive to age-varying anesthesia-related effects in human neonates ( 8 ).…”

Section: Resultssupporting

confidence: 85%

“…Anesthesia-induced theta and alpha oscillations have been reported to emerge around 3-4 months of age, albeit with less frontal predominance than in older children and adults ( 8, 10 ). Moreover, high concentrations/doses of anesthetics have been reported to depress brain activity and enhance signal discontinuity in both human and rodent neonates ( 9, 21, 22). However, to our knowledge, a comprehensive algorithmic approach identifying electroencephalographic parameters that robustly correlate with anesthetic depth during early postnatal development is still lacking.…”

Section: Introductionmentioning

confidence: 99%

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Identifying neurophysiological features associated with anesthetic state in newborn mice and humans

Chini

Gretenkord

et al. 2018

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35Monitoring the hypnotic component of anesthesia during surgeries is critical to prevent 36 intraoperative awareness and reduce adverse side effects. For this purpose, 37 electroencephalographic methods complementing measures of autonomic functions and 38 behavioral responses are in use in clinical practice. However, in human neonates and 39 infants existing methods may be unreliable and the correlation between brain activity 40 and anesthetic depth is still poorly understood. Here, we characterize the effects of 41 different anesthetics on activity of several brain areas in neonatal mice and develop 42 machine learning approaches to identify electrophysiological features predicting inspired 43 or end-tidal anesthetic concentration as a proxy for anesthetic depth. We show that 44 similar features from electroencephalographic recordings can be applied to predict 45 anesthetic concentration in neonatal mice, and human neonates and infants. These 46 results might support a novel strategy to monitor anesthetic depth in human newborns. 47 49 Reliable monitoring of anesthesia depth is critical during surgery. It allows for loss 50 of consciousness, analgesia and immobility without incurring the risk of side effects and 51 complications due to anesthetic misdosing. Typically used measures to monitor 52 anesthesia depth are inspired and end-tidal anesthetic concentrations as well as 53 physiologic parameters, including respiratory rate and depth (in the absence of 54 neuromuscular blockade or controlled ventilation), heart rate, blood pressure, and 55 responses to noxious stimuli (1). These measures all respond to spinal and brainstem 56 reflexes and are not specific for arousal or cortical responses to noxious events. 57 Anesthesia-induced changes in brain activity can be measured with 58 electroencephalographic (EEG) recordings. Specific algorithms have been developed to 59 predict anesthesia depth in adults (2-4). The most commonly used of such methods, the 60 Bispectral Index, has been shown to significantly reduce intraoperative awareness, 61 amount of anesthetic used, recovery time and post-anesthesia care unit stay in a recent 62Cochrane meta-analysis (5), but see (6, 7). However, evidence of similar benefits in 63 infants and younger children is sparse, as recently shown (8-10). EEG in anesthetized 64 infants changes dramatically depending on postnatal age (8,(11)(12)(13)(14). 65 EEG recordings mainly monitor neocortical activity. Converging evidence from 66 animal and human studies has shown that most anesthetics slow 67 electroencephalographic oscillations (15)(16)(17). While power at high frequency oscillations 68 is reduced (>40 Hz), power at slower frequencies (<15 Hz) is enhanced (15). The 69 computations underling proprietary indexes such as the Bispectral index or Narcotrend 70 are thought to take advantage of these phenomena (18). However, in preterm and term 71 neonates for the first weeks of life, EEG during sleep-wake cycles is weakly correlated 72 Anesthesia and network dynamics during deve...

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Section: Resultssupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Identifying neurophysiological features associated with anesthetic state in newborn mice and humans

Chini

Gretenkord

et al. 2018

Preprint

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“…Previous articles on EEG patterns during anaesthesia on selected patients are reported elsewhere, specifically a cohort of infants 0 to 6 months of age ( n = 40) 1 and the assessment of EEG discontinuity during deep levels of anaesthesia over 0 to 3 years of age ( n = 68). 18 The current study was a descriptive analysis and had no power calculation performed a priori .…”

Section: Methodsmentioning

confidence: 99%

Clinical signs and electroencephalographic patterns of emergence from sevoflurane anaesthesia in children

Cornelissen

Donado

Lee

et al. 2018

European Journal of Anaesthesiology

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BACKGROUNDFew studies have systematically described relationships between clinical–behavioural signs, electroencephalographic (EEG) patterns and age during emergence from anaesthesia in young children.OBJECTIVETo identify the relationships between end-tidal sevoflurane (ETsevoflurane) concentration, age and frontal EEG spectral properties in predicting recovery of clinical–behavioural signs during emergence from sevoflurane in children 0 to 3 years of age, with and without exposure to nitrous oxide. The hypothesis was that clinical signs occur sequentially during emergence, and that for infants aged more than 3 months, changes in alpha EEG power are correlated with clinical–behavioural signs.DESIGNAn observational study.SETTINGA tertiary paediatric teaching hospital from December 2012 to August 2016.PATIENTSNinety-five children aged 0 to 3 years who required surgery below the neck.OUTCOME MEASURESTime–course of, and ETsevoflurane concentrations at first gross body movement, first cough, first grimace, dysconjugate eye gaze, frontal (F7/F8) alpha EEG power (8 to 12 Hz), frontal beta EEG power (13 to 30 Hz), surgery-end.RESULTSClinical signs of emergence followed an orderly sequence of events across all ages. Clinical signs occurred over a narrow ETsevoflurane, independent of age [movement: 0.4% (95% confidence interval (CI), 0.3 to 0.4), cough 0.3% (95% CI, 0.3 to 0.4), grimace 0.2% (95% CI, 0 to 0.3); P > 0.5 for age vs. ETsevoflurane]. Dysconjugate eye gaze was observed between ETsevoflurane 1 to 0%. In children more than 3 months old, frontal alpha EEG oscillations were present at ETsevoflurane 2.0% and disappeared at 0.5%. Movement occurred within 5 min of alpha oscillation disappearance in 99% of patients. Nitrous oxide had no effect on the time course or ETsevoflurane at which children showed body movement, grimace or cough.CONCLUSIONSeveral clinical signs occur sequentially during emergence, and are independent of exposure to nitrous oxide. Eye position is poorly correlated with other clinical signs or ETsevoflurane. EEG spectral characteristics may aid prediction of clinical–behavioural signs in children more than 3 months.

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“…Previous papers describing EEG characteristics during general anaesthesia on selected subjects are reported elsewhere: specifically, on anesthesia-associated EEG spectral and coherence patterns in infants from 0-6 months (n=36) , and on EEG discontinuity (profoundly suppressed EEG activity) during deep levels of anaesthesia in children from 0 to 3 yrs (n=68) (Cornelissen et al, 2017).…”

Section: Use Of Previously Published Datasetsmentioning

confidence: 99%

Electroencephalographic markers of brain development during sevoflurane anesthesia in children aged 0 to 3 years old

Cornelissen

Kim

Lee

et al. 2017

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The general anesthetic sevoflurane acts on GABAergic-interneurons to generate stereotyped oscillations that relate fundamentally to neural circuit architecture. Each year, millions of children require general anesthesia, providing an experiment of nature that allows characterization of the developmental trajectory of GABAergic-inhibitory circuits in the human brain. We used multichannel electroencephalograph recordings in 91 children 0-40 months old. We mapped spatial power and coherence across the cortex. During sevoflurane exposure: (1) slow-delta oscillations are present in all ages; (2) theta and alpha oscillations emerge around 4 months; (3) alpha oscillations increase in power from 4 to 10 months; (4) frontal alpha oscillation predominance emerge at ~6 months; (5) frontal slow oscillations are coherent in the first 6 months of age only; and (6) frontal alpha oscillations become coherent around 10 months and persist in older ages. Our results suggest key developmental milestones are visible in the functional activity of sevoflurane-stimulated GABAergic circuits.

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Electroencephalographic discontinuity during sevoflurane anesthesia in infants and children

Abstract: Electroencephalographic monitoring may complement clinical signs in providing information about brain homeostasis during general anesthesia. The impact of discontinuity events on immediate and long-term outcomes merits further study.

Cited by 35 publications

References 24 publications

Identifying neurophysiological features associated with anesthetic state in newborn mice and humans

Identifying neurophysiological features associated with anesthetic state in newborn mice and humans

Clinical signs and electroencephalographic patterns of emergence from sevoflurane anaesthesia in children

Electroencephalographic markers of brain development during sevoflurane anesthesia in children aged 0 to 3 years old

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