Transient electroencephalographic alpha power loss during maintenance of general anaesthesia
EEG activity in the extended alpha frequency range (7–17 Hz) during maintenance of general anaesthesia is primarily determined by effect-site concentrations of the hypnotic and analgesic drugs used. Intermittent alpha loss during surgery, unexplained by changes in anaesthetic or opioid concentration...
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Veröffentlicht in: | British journal of anaesthesia : BJA 2019-05, Vol.122 (5), p.635-642 |
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creator | Hight, Darren F. Gaskell, Amy L. Kreuzer, Matthias Voss, Logan J. García, Paul S. Sleigh, Jamie W. |
description | EEG activity in the extended alpha frequency range (7–17 Hz) during maintenance of general anaesthesia is primarily determined by effect-site concentrations of the hypnotic and analgesic drugs used. Intermittent alpha loss during surgery, unexplained by changes in anaesthetic or opioid concentrations, could represent arousal of the cortex as a result of increased surgical stimulation.
A generalised linear model was fitted to alpha power recorded from patients undergoing general anaesthesia from induction until waking using three explanatory variables: age-adjusted volatile anaesthetic effect-site concentration, and estimated effect-site propofol and opioid concentrations. Model residuals were decomposed into uncorrelated white noise and a fluctuating auto-correlated trend. Deviations of this local trend were classified as ‘unexpected alpha dropout events’. To investigate whether these alpha dropouts might be explained by the effect of noxious stimulation, we related their occurrence to whether a patient was undergoing surgery involving the body cavity or not.
Alpha power dropouts occurred in 73 of the 237 patients included in the final analysis (31%, median amplitude of −3.5 dB, duration=103 s). They showed a bimodal or broadly skewed distribution, being more probable soon after initial incision (32%), dropping to around 10% at 1 h, and then again increasing to >30% in operations lasting >3 h. Multivariate analysis showed that alpha dropouts were significantly associated with body cavity surgery (P=0.003) and with longer operations (P |
doi_str_mv | 10.1016/j.bja.2018.11.029 |
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A generalised linear model was fitted to alpha power recorded from patients undergoing general anaesthesia from induction until waking using three explanatory variables: age-adjusted volatile anaesthetic effect-site concentration, and estimated effect-site propofol and opioid concentrations. Model residuals were decomposed into uncorrelated white noise and a fluctuating auto-correlated trend. Deviations of this local trend were classified as ‘unexpected alpha dropout events’. To investigate whether these alpha dropouts might be explained by the effect of noxious stimulation, we related their occurrence to whether a patient was undergoing surgery involving the body cavity or not.
Alpha power dropouts occurred in 73 of the 237 patients included in the final analysis (31%, median amplitude of −3.5 dB, duration=103 s). They showed a bimodal or broadly skewed distribution, being more probable soon after initial incision (32%), dropping to around 10% at 1 h, and then again increasing to >30% in operations lasting >3 h. Multivariate analysis showed that alpha dropouts were significantly associated with body cavity surgery (P=0.003) and with longer operations (P<0.001).
A loss of alpha power, unexplained by changes in anaesthetic or opioid concentrations, is suggestive of thalamocortical depolarisation induced by body cavity noxious stimuli, and could provide a measure of nociception during surgery.</description><identifier>ISSN: 0007-0912</identifier><identifier>EISSN: 1471-6771</identifier><identifier>DOI: 10.1016/j.bja.2018.11.029</identifier><identifier>PMID: 30915994</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>alpha rhythm ; anaesthesia ; arousal ; depth of anaesthesia monitor ; electroencephalography ; propofol, opioid</subject><ispartof>British journal of anaesthesia : BJA, 2019-05, Vol.122 (5), p.635-642</ispartof><rights>2019 British Journal of Anaesthesia</rights><rights>Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-5bea413d124ffb838d32f681f243295a1a7418686dfd66191dc26e2eabd934af3</citedby><cites>FETCH-LOGICAL-c396t-5bea413d124ffb838d32f681f243295a1a7418686dfd66191dc26e2eabd934af3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30915994$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hight, Darren F.</creatorcontrib><creatorcontrib>Gaskell, Amy L.</creatorcontrib><creatorcontrib>Kreuzer, Matthias</creatorcontrib><creatorcontrib>Voss, Logan J.</creatorcontrib><creatorcontrib>García, Paul S.</creatorcontrib><creatorcontrib>Sleigh, Jamie W.</creatorcontrib><title>Transient electroencephalographic alpha power loss during maintenance of general anaesthesia</title><title>British journal of anaesthesia : BJA</title><addtitle>Br J Anaesth</addtitle><description>EEG activity in the extended alpha frequency range (7–17 Hz) during maintenance of general anaesthesia is primarily determined by effect-site concentrations of the hypnotic and analgesic drugs used. Intermittent alpha loss during surgery, unexplained by changes in anaesthetic or opioid concentrations, could represent arousal of the cortex as a result of increased surgical stimulation.
A generalised linear model was fitted to alpha power recorded from patients undergoing general anaesthesia from induction until waking using three explanatory variables: age-adjusted volatile anaesthetic effect-site concentration, and estimated effect-site propofol and opioid concentrations. Model residuals were decomposed into uncorrelated white noise and a fluctuating auto-correlated trend. Deviations of this local trend were classified as ‘unexpected alpha dropout events’. To investigate whether these alpha dropouts might be explained by the effect of noxious stimulation, we related their occurrence to whether a patient was undergoing surgery involving the body cavity or not.
Alpha power dropouts occurred in 73 of the 237 patients included in the final analysis (31%, median amplitude of −3.5 dB, duration=103 s). They showed a bimodal or broadly skewed distribution, being more probable soon after initial incision (32%), dropping to around 10% at 1 h, and then again increasing to >30% in operations lasting >3 h. Multivariate analysis showed that alpha dropouts were significantly associated with body cavity surgery (P=0.003) and with longer operations (P<0.001).
A loss of alpha power, unexplained by changes in anaesthetic or opioid concentrations, is suggestive of thalamocortical depolarisation induced by body cavity noxious stimuli, and could provide a measure of nociception during surgery.</description><subject>alpha rhythm</subject><subject>anaesthesia</subject><subject>arousal</subject><subject>depth of anaesthesia monitor</subject><subject>electroencephalography</subject><subject>propofol, opioid</subject><issn>0007-0912</issn><issn>1471-6771</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp9kE1v2zAMhoWhxZJ2-wG7DDr2Yk-UHdnCTkPRjwEFdmlvBQTaohIFjuxJzob--ypI2mNPAoWHL8mHsW8gShCgfmzLboulFNCWAKWQ-hNbQt1AoZoGzthSCNEUQoNcsIuUtkJAI_XqM1tU-XOldb1kz48RQ_IUZk4D9XMcKfQ0bXAY1xGnje85Drnk0_ifIh_GlLjdRx_WfIc-zBQw83x0fE2BIg4cA1KaN5Q8fmHnDodEX0_vJXu6vXm8vi8e_tz9vv71UPSVVnOx6ghrqCzI2rmurVpbSadacLKu8r4I2NTQqlZZZ5UCDbaXiiRhZ3VVo6su2dUxd4rj332ebnY-9TQMGGjcJyNBtysF0DYZhSPax3xKJGem6HcYXwwIc5BqtiZLNQepBsBkqbnn-yl-3-3Ivne8WczAzyNA-ch_nqJJvT94tD5mp8aO_oP4V4COiPQ</recordid><startdate>201905</startdate><enddate>201905</enddate><creator>Hight, Darren F.</creator><creator>Gaskell, Amy L.</creator><creator>Kreuzer, Matthias</creator><creator>Voss, Logan J.</creator><creator>García, Paul S.</creator><creator>Sleigh, Jamie W.</creator><general>Elsevier Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201905</creationdate><title>Transient electroencephalographic alpha power loss during maintenance of general anaesthesia</title><author>Hight, Darren F. ; Gaskell, Amy L. ; Kreuzer, Matthias ; Voss, Logan J. ; García, Paul S. ; Sleigh, Jamie W.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c396t-5bea413d124ffb838d32f681f243295a1a7418686dfd66191dc26e2eabd934af3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>alpha rhythm</topic><topic>anaesthesia</topic><topic>arousal</topic><topic>depth of anaesthesia monitor</topic><topic>electroencephalography</topic><topic>propofol, opioid</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hight, Darren F.</creatorcontrib><creatorcontrib>Gaskell, Amy L.</creatorcontrib><creatorcontrib>Kreuzer, Matthias</creatorcontrib><creatorcontrib>Voss, Logan J.</creatorcontrib><creatorcontrib>García, Paul S.</creatorcontrib><creatorcontrib>Sleigh, Jamie W.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of anaesthesia : BJA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hight, Darren F.</au><au>Gaskell, Amy L.</au><au>Kreuzer, Matthias</au><au>Voss, Logan J.</au><au>García, Paul S.</au><au>Sleigh, Jamie W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Transient electroencephalographic alpha power loss during maintenance of general anaesthesia</atitle><jtitle>British journal of anaesthesia : BJA</jtitle><addtitle>Br J Anaesth</addtitle><date>2019-05</date><risdate>2019</risdate><volume>122</volume><issue>5</issue><spage>635</spage><epage>642</epage><pages>635-642</pages><issn>0007-0912</issn><eissn>1471-6771</eissn><abstract>EEG activity in the extended alpha frequency range (7–17 Hz) during maintenance of general anaesthesia is primarily determined by effect-site concentrations of the hypnotic and analgesic drugs used. Intermittent alpha loss during surgery, unexplained by changes in anaesthetic or opioid concentrations, could represent arousal of the cortex as a result of increased surgical stimulation.
A generalised linear model was fitted to alpha power recorded from patients undergoing general anaesthesia from induction until waking using three explanatory variables: age-adjusted volatile anaesthetic effect-site concentration, and estimated effect-site propofol and opioid concentrations. Model residuals were decomposed into uncorrelated white noise and a fluctuating auto-correlated trend. Deviations of this local trend were classified as ‘unexpected alpha dropout events’. To investigate whether these alpha dropouts might be explained by the effect of noxious stimulation, we related their occurrence to whether a patient was undergoing surgery involving the body cavity or not.
Alpha power dropouts occurred in 73 of the 237 patients included in the final analysis (31%, median amplitude of −3.5 dB, duration=103 s). They showed a bimodal or broadly skewed distribution, being more probable soon after initial incision (32%), dropping to around 10% at 1 h, and then again increasing to >30% in operations lasting >3 h. Multivariate analysis showed that alpha dropouts were significantly associated with body cavity surgery (P=0.003) and with longer operations (P<0.001).
A loss of alpha power, unexplained by changes in anaesthetic or opioid concentrations, is suggestive of thalamocortical depolarisation induced by body cavity noxious stimuli, and could provide a measure of nociception during surgery.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>30915994</pmid><doi>10.1016/j.bja.2018.11.029</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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subjects | alpha rhythm anaesthesia arousal depth of anaesthesia monitor electroencephalography propofol, opioid |
title | Transient electroencephalographic alpha power loss during maintenance of general anaesthesia |
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