The absence of dominant alpha-oscillatory EEG activity during emergence from delta-dominant anesthesia predicts neurocognitive impairment- results from a prospective observational trial

Lutz, Rieke; Müller, Cláudia; Dragovic, Srdjan; Schneider, F; Ribbe, Katharina; Anders, Malte; Schmid, Sebastian; García, Paul S.; Schneider, Gerhard; Kreuzer, Matthias; Kratzer, Stephan

doi:10.1016/j.jclinane.2022.110949

Cited by 24 publications

(27 citation statements)

References 47 publications

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“…To account for multiple comparisons, instead of a common approach of an alpha level adjustment, we applied a cluster-based approach, as it has been used in the literature both for 2-dimensional (Akeju et al 2014;Kreuzer et al 2020) and 3-dimensional (Lutz et al 2022;Reiser et al 2022) EEG data. We only reported results as being significant if they occurred in clusters of at least 4 × 4 adjacent significant pixels; this translates to a frequency range of 1.5 Hz and a time range of 15 ms.…”

Section: Statisticsmentioning

confidence: 99%

EEG-based sensory testing reveals altered nociceptive processing in elite endurance athletes

et al. 2022

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Increased exercise loads, as observed in elite athletes, seem to modulate the subjective pain perception in healthy subjects. The combination of electroencephalography (EEG) and standardized noxious stimulation can contribute to an objective assessment of the somatosensory stimulus processing. We assessed the subjective pain ratings and the electroencephalogram (EEG)-based response after standardized noxious mechanical and thermal stimuli as well as during conditioned pain modulation (CPM) in 26 elite endurance athletes and compared them to 26 recreationally active controls. Elite endurance athletes had consistently stronger somatosensory responses in the EEG to both mechanical and thermal noxious stimuli than the control group. We observed no significant group differences in the subjective pain ratings, which may have been influenced by our statistics and choice of stimuli. The CPM testing revealed that our conditioning stimulus modulated the subjective pain perception only in the control group, whereas the EEG indicated a modulatory effect of the conditioning stimulus on the spectral response only in the athletes group. We conclude that a higher activation in the cortical regions that process nociceptive information may either be an indicator for central sensitization or an altered stimulus salience in the elite endurance athletes’ group. Our findings from our CPM testing were limited by our methodology. Further longitudinal studies are needed to examine if exercise-induced changes in the somatosensory system might have a critical impact on the long-term health of athletes.

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Section: Statisticsmentioning

confidence: 99%

EEG-based sensory testing reveals altered nociceptive processing in elite endurance athletes

et al. 2022

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“…27,28 Also, during anesthesia emergence, an episode of alpha-dominant activity seems beneficial for the patient. 8,17 However, during a smooth emergence, the alpha power should fade and hence decrease as indicated by the negative slope. For the desired change in EEG beta band power, also a decrease, the explanation is not as straightforward.…”

Section: Discussionmentioning

confidence: 99%

“…We derived our results from retrospective post hoc analyses of a previously published data set from our patients with the goal of identifying EEG signatures that correlate with delirium, which was conducted between April 2018 and November 2019. 8 The study was approved by the ethics committee of Klinikum rechts der Isar, Technical University of Munich (Munich, Germany; Clinical Trial NCT03287401, approved on May 24, 2017). We conducted a retrospective analysis and included all patients from the original study (n = 192).…”

Section: Methodsmentioning

confidence: 99%

“…This is in accordance with our previously published results. 8 The corresponding R² values are reported in Supplemental Digital Content 6 (https://links.lww.com/ALN/D293). For means of sensitivity analysis, Supplemental Digital Content 7 (https://links.lww.com/ALN/D294) shows the box plots similar to figure 3 with all data sets included (n = 192).…”

Section: Linear Regressionmentioning

confidence: 99%

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Predictors of Low Risk for Delirium during Anesthesia Emergence

Dragovic,

Schneider,

García

et al. 2023

Anesthesiology

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Background Processed EEG is used to monitor the level of anesthesia and it has shown the potential to predict the occurrence of delirium. While emergence trajectories of relative eeg band power identified post-hoc show promising results in predicting a risk for a delirium, they are not easily transferable into an online predictive application. In this article we describe a low-resource and easily applicable method to differentiate between patients at high risk and low risk for delirium, with patients at low risk expected to show decreasing eeg power during emergence. Methods We included data from 169 patients (median age: 61 [49, 73]), who underwent surgery with general anesthesia, maintained either with propofol, sevoflurane, or desflurane. The data were derived from a previously published study. We chose a single frontal channel and calculated the total and spectral band power from the EEG and calculated a linear regression model to observe the parameters’ change during anesthesia emergence, described as slope. The slope of total power and single band power was correlated with the occurrence of delirium. Results Of 169 patients, 32 (19%) showed delirium. We observed that patients whose total EEG power diminished the most during emergence were less likely to screen positive for delirium in the PACU. A positive slope in total power and band power evaluated by using a regression model was associated with a higher risk-ratio (total: RR 2.83 (95%CI: 1.46 to 5.51) alpha/beta band: RR 7.79 (95%CI: 2.24 to 27.09)) for delirium. Furthermore, a negative slope in multiple bands during emergence was specific for patients without delirium and allowed to define a test for patients at low risk. Conclusion In this study we developed an easily applicable exploratory method to analyze a single frontal EEG channel and to identify patterns specific for patients at low risk for delirium.

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“…Reduced intraoperative propofol-mediated frontal alpha power has been associated with postoperative cognitive disorders and is emerging as a marker for the vulnerable brain phenotype. 4,10,11 Whether this EEG marker is associated with cognitive impairment after hospitalization for ARDS, which carries an incidence of 73% to 100% at discharge and 25% to 45% at 1 year, 12 should be investigated in future studies. Our report also has mechanistic implications.…”

Section: Discussionmentioning

confidence: 99%

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

Guay,

Bean,

Kwon

et al. 2023

A&A Practice

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The effects of critical illness on electroencephalographic (EEG) signatures of sedatives have not been described, limiting the use of EEG-guided sedation in the intensive care unit (ICU). We report the case of a 36-year-old man recovering from acute respiratory distress syndrome (ARDS). Severe ARDS was characterized by slow-delta (0.1–4 Hz) and theta (4–8 Hz) oscillations but lacked the alpha (8–14 Hz) power expected during propofol sedation in a patient of this age. The alpha power emerged as ARDS resolved. This case raises the question of whether inflammatory states can alter EEG signatures during sedation.

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The absence of dominant alpha-oscillatory EEG activity during emergence from delta-dominant anesthesia predicts neurocognitive impairment- results from a prospective observational trial

Cited by 24 publications

References 47 publications

EEG-based sensory testing reveals altered nociceptive processing in elite endurance athletes

EEG-based sensory testing reveals altered nociceptive processing in elite endurance athletes

Predictors of Low Risk for Delirium during Anesthesia Emergence

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

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