Evaluation of Anesthetic Specific EEG Dynamics during State Transitions between Loss and Return of Responsiveness

Kreuzer, Matthias; Kiel, Tobias; Ernst, Leonie; Lipp, Marlene; Schneider, Gerhard; Pilge, Stefanie

doi:10.3390/brainsci12010037

Cited by 6 publications

(6 citation statements)

References 54 publications

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“…Also, different anesthetic drugs induce different EEG patterns [ 19 ]. Further, a substance-dependent influence during emergence on the processed EEG has been shown before [ 20 ]. Some EEG features and their dynamics during emergence from general anesthesia are associated with the incidence of postoperative neurocognitive disorders [ 1 ] or postoperative pain [ 21 ].…”

Section: Introductionmentioning

confidence: 85%

“…Our analyses detected substance-specific influences on EEG-based indices during anesthesia emergence, adding information to the already described substance-specific differences in EEG emergence behavior for a limited frequency range [ 20 ]. The EEG frequency pattern during anesthesia emergence differed significantly between volatile anesthetics isoflurane and sevoflurane compared to propofol.…”

Section: Discussionmentioning

confidence: 99%

“…For this monocentric retrospective study, we used data from a previous study [ 20 ] initiated initially to evaluate the cerebral state index (CSI) performance during the loss and return of consciousness. The Ethics Committee of the Technical University of Munich, Munich, Germany (Chairman Prof. A. Schömig) approved the study (Ethical Committee No.…”

Section: Methodsmentioning

confidence: 99%

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Substance-dependent EEG during recovery from anesthesia and optimization of monitoring

Lipp,

Schneider,

Kreuzer

et al. 2023

J Clin Monit Comput

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The electroencephalographic (EEG) activity during anesthesia emergence contains information about the risk for a patient to experience postoperative delirium, but the EEG dynamics during emergence challenge monitoring approaches. Substance-specific emergence characteristics may additionally limit the reliability of commonly used processed EEG indices during emergence. This study aims to analyze the dynamics of different EEG indices during anesthesia emergence that was maintained with different anesthetic regimens. We used the EEG of 45 patients under general anesthesia from the emergence period. Fifteen patients per group received sevoflurane, isoflurane (+ sufentanil) or propofol (+ remifentanil) anesthesia. One channel EEG and the bispectral index (BIS A-1000) were recorded during the study. We replayed the EEG back to the Conox, Entropy Module, and the BIS Vista to evaluate and compare the index behavior. The volatile anesthetics induced significantly higher EEG frequencies, causing higher indices (AUC > 0.7) over most parts of emergence compared to propofol. The median duration of “awake” indices (i.e., > 80) before the return of responsiveness (RoR) was significantly longer for the volatile anesthetics (p < 0.001). The different indices correlated well under volatile anesthesia (rs > 0.6), with SE having the weakest correlation. For propofol, the correlation was lower (rs < 0.6). SE was significantly higher than BIS and, under propofol anesthesia, qCON. Systematic differences of EEG-based indices depend on the drugs and devices used. Thus, to avoid early awareness or anesthesia overdose using an EEG-based index during emergence, the anesthetic regimen, the monitor used, and the raw EEG trace should be considered for interpretation before making clinical decisions.

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Section: Introductionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Substance-dependent EEG during recovery from anesthesia and optimization of monitoring

Lipp,

Schneider,

Kreuzer

et al. 2023

J Clin Monit Comput

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“…Hence, the contrast is stronger and STE and PE may show higher accuracy. The EEG behavior during RoR may be substance-specific [ 34 ] and hence add to the heterogeneity of emergence EEG trajectories that have been described earlier [ 35 – 38 ]. The more heterogeneous EEG during RoR seems to be the reason for the wider STE and PE spread during RoR as depicted in the wider boxes of Figs.…”

Section: Discussionmentioning

confidence: 99%

Separation of responsive and unresponsive patients under clinical conditions: comparison of symbolic transfer entropy and permutation entropy

Zanner

Berger

Schröder

et al. 2023

J Clin Monit Comput

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Electroencephalogram (EEG)-based monitoring during general anesthesia may help prevent harmful effects of high or low doses of general anesthetics. There is currently no convincing evidence in this regard for the proprietary algorithms of commercially available monitors. The purpose of this study was to investigate whether a more mechanism-based parameter of EEG analysis (symbolic transfer entropy, STE) can separate responsive from unresponsive patients better than a strictly probabilistic parameter (permutation entropy, PE) under clinical conditions. In this prospective single-center study, the EEG of 60 surgical ASA I–III patients was recorded perioperatively. During induction of and emergence from anesthesia, patients were asked to squeeze the investigators’ hand every 15s. Time of loss of responsiveness (LoR) during induction and return of responsiveness (RoR) during emergence from anesthesia were registered. PE and STE were calculated at −15s and +30s of LoR and RoR and their ability to separate responsive from unresponsive patients was evaluated using accuracy statistics. 56 patients were included in the final analysis. STE and PE values decreased during anesthesia induction and increased during emergence. Intra-individual consistency was higher during induction than during emergence. Accuracy values during LoR and RoR were 0.71 (0.62–0.79) and 0.60 (0.51–0.69), respectively for STE and 0.74 (0.66–0.82) and 0.62 (0.53–0.71), respectively for PE. For the combination of LoR and RoR, values were 0.65 (0.59–0.71) for STE and 0.68 (0.62–0.74) for PE. The ability to differentiate between the clinical status of (un)responsiveness did not significantly differ between STE and PE at any time. Mechanism-based EEG analysis did not improve differentiation of responsive from unresponsive patients compared to the probabilistic PE.Trial registration: German Clinical Trials Register ID: DRKS00030562, November 4, 2022, retrospectively registered.

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“…When alpha agonists are given as premedication, they can reduce the induction dose of propofol required [ 66 ]. Therefore, EEG monitoring should ideally start while the patient is awake to minimize burst suppression during induction, especially in older patients [ 67 ▪ ]. It is worth noting that dexmedetomidine use can be expensive.…”

Section: Pharmacological Interventions In Multimodal General Anaesthesiamentioning

confidence: 99%

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

Lersch,

Correia,

Hight

et al. 2023

Current Opinion in Anaesthesiology

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Purpose of review This review article explores the application of multimodal anaesthesia in general anaesthesia, particularly in conjunction with locoregional anaesthesia, specifically focusing on the importance of EEG monitoring. We provide an evidence-based guide for implementing multimodal anaesthesia, encompassing drug combinations, dosages, and EEG monitoring techniques, to ensure reliable intraoperative anaesthesia while minimizing adverse effects and improving patient outcomes. Recent findings Opioid-free and multimodal general anaesthesia have significantly reduced opioid addiction and chronic postoperative pain. However, the evidence supporting the effectiveness of these approaches is limited. This review attempts to integrate research from broader neuroscientific fields to generate new clinical hypotheses. It discusses the correlation between high-dose intraoperative opioids and increased postoperative opioid consumption and their impact on pain indices and readmission rates. Additionally, it explores the relationship between multimodal anaesthesia and pain processing models and investigates the potential effects of nonpharmacological interventions on preoperative anxiety and postoperative pain. Summary The integration of EEG monitoring is crucial for guiding adequate multimodal anaesthesia and preventing excessive anaesthesia dosing. Furthermore, the review investigates the impact of combining regional and opioid-sparing general anaesthesia on perioperative EEG readings and anaesthetic depth. The findings have significant implications for clinical practice in optimizing multimodal anaesthesia techniques (Supplementary Digital Content 1: Video Abstract, http://links.lww.com/COAN/A96).

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Evaluation of Anesthetic Specific EEG Dynamics during State Transitions between Loss and Return of Responsiveness

Cited by 6 publications

References 54 publications

Substance-dependent EEG during recovery from anesthesia and optimization of monitoring

Substance-dependent EEG during recovery from anesthesia and optimization of monitoring

Separation of responsive and unresponsive patients under clinical conditions: comparison of symbolic transfer entropy and permutation entropy

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

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