Epileptiform EEG patterns during different techniques of induction of general anaesthesia with sevoflurane and propofol: a randomised trial

Stasiowski, Michał; Marciniak, Radosław; Duława-Bułdak, Anna; Krawczyk, Lech; Jałowiecki, Przemysław

doi:10.5603/ait.a2019.0003

Cited by 9 publications

(23 citation statements)

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“…There were no reports of any significant side effects related to the procedure including any sedation related adverse events. In addition, although administration of propofol may lead to clinically observed seizures as reported by Stasiowski et al [17], no epileptiform discharges were recorded, nor was there any seizure activity experienced by any of the patients. All patients left the center the same day and no hospitalization was required for any.…”

Section: Resultsmentioning

confidence: 57%

“…• Deep sedation: There was a sustained increase in global delta power (0.5-3.5 Hz). All other frequency bands were also increased but the maximum increase was in the theta (4-7.5 Hz) and beta (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) ranges. This was mainly observed frontally.…”

Section: Resultsmentioning

confidence: 98%

“…These circuits are also heavily involved during natural sleep but it is not clear whether the circuits involved during natural and sedated sleep are different. Sleep studies have suggested that consciousness can be disrupted when the electroencephalogram (EEG) changes from low-voltage fast beta (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) or gamma (> 25 Hz) activity to large delta (0.5-4 Hz) waves [7]. There is also some suggestion that conscious awareness and perception are maintained, in part, by the synchronization of gamma (> 25 Hz) and/or theta (4)(5)(6)(7)(8) waves across large areas of the cortex [8][9][10].…”

Section: Original and Clinical Articlesmentioning

confidence: 99%

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Changes in topographic electroencephalogram during deepening levels of propofol sedation based on alertness/sedation scale under bispectral index guidance

Bakry¹,

Bakry²

2019

ait

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Background: Sedation has been associated with numerous changes on electroencephalogram (EEG) but there is a need to clarify specific alterations in relation to deepening levels of sedation with different agents. We aimed to evaluate the effect of deepening levels of sedation induced by propofol and how they compare to natural sleep.Methods: Fifty consecutive neurologically normal patients who underwent upper gastrointestinal endoscopy while sedated with propofol were included. Topographic EEG spectral maps and the bispectral index (BIS) values were obtained at four time points: wakefulness, mild sedation, deep sedation and recovery. Observer's Assessment of Alertness and Sedation (OAA/S) score was used to assess sedation levels.Results: Propofol induced increased delta (0.5-3.5 Hz) and gamma (25-40 Hz) power throughout sedation. In addition, there was decreased alpha power (9-11.5 Hz) in the occipital area and increased global beta (12-25 Hz)/gamma (25-40 Hz) power during mild sedation. Deep sedation was associated with increased theta (4-7 Hz)/alpha (9-11.5 Hz)/beta (12-25 Hz) power, which was maximal frontally.Conclusion: There are distinct changes associated with deepening levels of propofol induced sedation that distinguish it from natural sleep. This suggests that different mechanisms are involved in them and warrants further investigations to clarify the nature of these changes.

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Section: Resultsmentioning

confidence: 57%

Section: Resultsmentioning

confidence: 98%

Section: Original and Clinical Articlesmentioning

confidence: 99%

See 1 more Smart Citation

Changes in topographic electroencephalogram during deepening levels of propofol sedation based on alertness/sedation scale under bispectral index guidance

Bakry¹,

Bakry²

2019

ait

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“…However, pre-operational procedures to fix electrodes on patient's scalp are time-consuming and interpretation of EEG patterns is challenging even for experienced anaesthesiologists. Raw EEG signals are being increasingly used to monitor the depth of VIGA with sevoflurane because EEG-based indices are reported to show aberrant values [4,14,[22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

“…The abovementioned results suggest that EEG-based indices do not always provide a reliable measure of anaesthetic depth; hence, anaesthesiologists should not rely exclusively on the BIS and SE readings when assessing depth of anaesthesia. We had previously conducted a comparative, prospective study to assess the influence of VIGA with sevoflurane using two different techniques and intravenous induction of general anaesthesia using propofol on the possible presence of EPs [25]. This study additionally reports on the previous study [25].…”

Section: Introductionmentioning

confidence: 99%

Variations in Values of State, Response Entropy and Haemodynamic Parameters Associated with Development of Different Epileptiform Patterns during Volatile Induction of General Anaesthesia with Two Different Anaesthetic Regimens Using Sevoflurane in Comparison with Intravenous Induct: A Comparative Study

Stasiowski

Duława-Bułdak²,

Szumera

et al. 2020

Brain Sciences

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Background and Objectives: Raw electroencephalographic (EEG) signals are rarely used to monitor the depth of volatile induction of general anaesthesia (VIGA) with sevoflurane, even though EEG-based indices may show aberrant values. We aimed to identify whether response (RE) and state entropy (SE) variations reliably reflect the actual depth of general anaesthesia in the presence of different types of epileptiform patterns (EPs) in EEGs during induction of general anaesthesia. Materials and Methods: A randomized, prospective clinical study was performed with 60 patients receiving VIGA using sevoflurane with the increasing concentrations (group VIMA) or the vital capacity (group VCRII) technique or an intravenous single dose of propofol (group PROP). Facial electromyography (fEMG), fraction of inspired sevoflurane (FiAA), fraction of expired sevoflurane (FeAA), minimal alveolar concentration (MAC) of sevoflurane, RE and SE, and standard electroencephalographic evaluations were performed in these patients. Results: In contrast to periodic epileptiform discharges, erroneous SE and RE values in the patients’ EEGs were associated with the presence of polyspikes (PS) and rhythmic polyspikes (PSR), which were more likely to indicate toxic depth rather than false emergence from anaesthesia with no changes in the FiAA, FeAA, and MAC of sevoflurane. Conclusion: Calculated RE and SE values may be misleading during VIGA when EPs are present in patients’ EEGs. During VIGA with sevoflurane, we recommend monitoring raw EEG data in scientific studies to correlate it with potentially erroneous RE and SE values and the end-tidal concentration of sevoflurane in everyday clinical practice, when monitoring raw EEG is not available, because they can mislead anaesthesiologists to reduce sevoflurane levels in the ventilation gas and result in unintentional true emergence from anaesthesia. Further studies are required to investigate the behaviour of EEG-based indices during rapid changes in sevoflurane concentrations at different stages of VIGA and the influence of polyspikes and rhythmic polyspikes on the transformation of EEG signals into a digital form.

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Sevoflurane-induced high-frequency oscillations, effective connectivity and intraoperative classification of epileptic brain areas

Firestone

Sonoda

Sakakura

et al. 2023

Clinical Neurophysiology

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Epileptiform EEG patterns during different techniques of induction of general anaesthesia with sevoflurane and propofol: a randomised trial

Cited by 9 publications

References 0 publications

Changes in topographic electroencephalogram during deepening levels of propofol sedation based on alertness/sedation scale under bispectral index guidance

Changes in topographic electroencephalogram during deepening levels of propofol sedation based on alertness/sedation scale under bispectral index guidance

Sevoflurane-induced high-frequency oscillations, effective connectivity and intraoperative classification of epileptic brain areas

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