Comparison of the Conox (qCON) and Sedline (PSI) depth of anaesthesia indices to predict the hypnotic effect during desflurane general anaesthesia with ketamine

Christenson, Catherine; Martinez-Vazquez, Pablo; Breidenstein, Max W.; Farhang, Borzoo; Mathews, Jackson; Melia, Umberto; Jensen, Erik Weber; Mathews, Donald M.

doi:10.1007/s10877-020-00619-3

Cited by 13 publications

(9 citation statements)

References 32 publications

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“…As expected, we were able to demonstrate a significant correlation for the GABA A receptor-active sedatives propofol and midazolam, the central α 2 -agonist clonidine, the opioid sufentanil, and the volatile substance sevoflurane. Such a significant correlation could also be shown for esketamine, which, however, partly contradicts the previously described increase in pEEG indices under esketamine application and seems to vary depending on the dose regimens [ 54 , 55 , 56 ]. Esketamine shows some peculiarities in the EEG patterns under sedation that could explain the outliers of the index values [ 57 ].…”

Section: Discussioncontrasting

confidence: 72%

Electroencephalogram-Based Evaluation of Impaired Sedation in Patients with Moderate to Severe COVID-19 ARDS

Flinspach

Zinn

Zacharowski

et al. 2022

JCM

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The sedation management of patients with severe COVID-19 is challenging. Processed electroencephalography (pEEG) has already been used for sedation management before COVID-19 in critical care, but its applicability in COVID-19 has not yet been investigated. We performed this prospective observational study to evaluate whether the patient sedation index (PSI) obtained via pEEG may adequately reflect sedation in ventilated COVID-19 patients. Statistical analysis was performed by linear regression analysis with mixed effects. We included data from 49 consecutive patients. None of the patients received neuromuscular blocking agents by the time of the measurement. The mean value of the PSI was 20 (±23). The suppression rate was determined to be 14% (±24%). A deep sedation equivalent to the Richmond Agitation and Sedation Scale of −3 to −4 (correlation expected PSI 25–50) in bedside examination was noted in 79.4% of the recordings. Linear regression analysis revealed a significant correlation between the sedative dosages of propofol, midazolam, clonidine, and sufentanil (p < 0.01) and the sedation index. Our results showed a distinct discrepancy between the RASS and the determined PSI. However, it remains unclear to what extent any discrepancy is due to the electrophysiological effects of neuroinflammation in terms of pEEG alteration, to the misinterpretation of spinal or vegetative reflexes during bedside evaluation, or to other causes.

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Section: Discussioncontrasting

confidence: 72%

Electroencephalogram-Based Evaluation of Impaired Sedation in Patients with Moderate to Severe COVID-19 ARDS

Flinspach

Zinn

Zacharowski

et al. 2022

JCM

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“…We are aware of the dependency on the data, but our focus was on the performance of index behavior, a concept similar to previous approaches using the prediction probability. 28,32,33 The AUC was also used to compare the PSD in the frequency range of interest from 0 to 30 Hz. Therefore, we calculated the AUC for the relative power for each discrete frequency, resulting in 77 AUC values.…”

Section: Methodsmentioning

confidence: 99%

The Strength of Alpha Oscillations in the Electroencephalogram Differently Affects Algorithms Used for Anesthesia Monitoring

Weyer¹,

Prötzl²,

Kinateder³

et al. 2021

Anesthesia &Amp; Analgesia

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BACKGROUND: Intraoperative patient monitoring using the electroencephalogram (EEG) can help to adequately adjust the anesthetic level. Therefore, the processed EEG (pEEG) provides the anesthesiologist with the estimated anesthesia level. The commonly used approaches track the changes from a fast- and a low-amplitude EEG during wakefulness to a slow- and a high-amplitude EEG under general anesthesia. However, besides these changes, another EEG feature, a strong oscillatory activity in the alpha band (8–12 Hz), develops in the frontal EEG. Strong alpha-band activity during general anesthesia seems to reflect an appropriate anesthetic level for certain anesthetics, but the way the common pEEG approaches react to changes in the alpha-band activity is not well explained. Hence, we investigated the impact of an artificial alpha-band modulation on pEEG approaches used in anesthesia research. METHODS: We performed our analyses based on 30 seconds of simulated sedation (n = 25) EEG, simulated anesthesia (n = 25) EEG, and EEG episodes from 20 patients extracted from a steady state that showed a clearly identifiable alpha peak in the density spectral array (DSA) and a state entropy (GE Healthcare) around 50, indicative of adequate anesthesia. From these traces, we isolated the alpha activity by band-pass filtering (8–12 Hz) and added this alpha activity to or subtracted it from the signals in a stepwise manner. For each of the original and modified signals, the following pEEG values were calculated: (1) spectral edge frequency (SEF95), (2) beta ratio, (3) spectral entropy (SpEntr), (4) approximate entropy (ApEn), and (5) permutation entropy (PeEn). RESULTS: The pEEG approaches showed different reactions to the alpha-band modification that depended on the data set and the amplification step. The beta ratio and PeEn decreased with increasing alpha activity for all data sets, indicating a deepening of anesthesia. The other pEEG approaches behaved nonuniformly. SEF95, SpEntr, and ApEn decreased with increasing alpha for the simulated anesthesia data (arousal) but decreased for simulated sedation. For the patient EEG, ApEn indicated an arousal, and SEF95 and SpEntr showed a nonuniform change. CONCLUSIONS: Changes in the alpha-band activity lead to different reactions for different pEEG approaches. Hence, the presence of strong oscillatory alpha activity that reflects an adequate level of anesthesia may be interpreted differently, by an either increasing (arousal) or decreasing (deepening) pEEG value. This could complicate anesthesia navigation and prevent the adjustment to an adequate, alpha-dominant anesthesia level, when titrating by the pEEG values.

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“…Nach Gabe eines i.v.-Bolus Ketamin während einer Allgemeinanästhesie mit Desfluran steigt der qCON-Wert im Unterschied zu anderen Monitoren nicht signifikant an und scheint somit weniger von höheren Frequenzbereichen abhängig zu sein. Dies führt v. a. bei multimodaler Anästhesieführung potenziell zu stabileren Indexwerten [ 85 ].…”

Section: Spezifische Technische Und Evidenzbasierte Unterschiede Proz...unclassified

Processed EEG for personalized dosing of anesthetics during general anesthesia

et al. 2023

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ZusammenfassungDie Elektroenzephalogramm(EEG)-gesteuerte Anästhesie ist aus modernen Operationssälen nicht mehr wegzudenken und hat sich als Standard-Monitoring etabliert. Viele Anästhesisten verlassen sich dabei auf die prozessierten EEG-Indizes und hoffen, dadurch ihren Patienten anästhesiebedingte Komplikationen wie intraoperative Awareness, postoperatives Delir oder andere kognitive Komplikationen zu ersparen. Diese Übersichtsarbeit fasst klinisch relevante Informationen und Studien über die 5 im Klinikalltag am häufigsten verwendeten Anästhesietiefe-Monitore zusammen. Messprinzipien, die den verschiedenen Monitoren zugrunde liegen, werden erläutert. Zudem wird eine praktische Anleitung im Umgang mit potenziellen Artefakten und irreführenden „Trendanzeigen“ im prozessiertem EEG angeboten.

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Comparison of the Conox (qCON) and Sedline (PSI) depth of anaesthesia indices to predict the hypnotic effect during desflurane general anaesthesia with ketamine

Cited by 13 publications

References 32 publications

Electroencephalogram-Based Evaluation of Impaired Sedation in Patients with Moderate to Severe COVID-19 ARDS

Electroencephalogram-Based Evaluation of Impaired Sedation in Patients with Moderate to Severe COVID-19 ARDS

The Strength of Alpha Oscillations in the Electroencephalogram Differently Affects Algorithms Used for Anesthesia Monitoring

Processed EEG for personalized dosing of anesthetics during general anesthesia

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