Electroencephalographic Burst-Suppression, Perioperative Neuroprotection, Postoperative Cognitive Function, and Mortality: A Focused Narrative Review of the Literature

Ma, Kan; Bebawy, John F.

doi:10.1213/ane.0000000000005806

Cited by 7 publications

(7 citation statements)

References 121 publications

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“…The occurrence of EEG suppression was rather targeted, and data collected after its supposed onset were excluded. Indeed, spectral analyses does not yield meaningful results if performed when EEG suppression is present, as the EEG signal normally becomes strongly non-stationary (high-amplitude bursts alternating with periods of low-amplitude silence) [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Spatio-temporal electroencephalographic power distribution in experimental pigs receiving propofol

Mirra,

Hight,

Spadavecchia

et al. 2024

PLoS ONE

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Introduction When assessing the spatio-temporal distribution of electroencephalographic (EEG) activity, characteristic patterns have been identified for several anesthetic drugs in humans. A shift in EEG power from the occipital to the prefrontal regions has been widely observed during anesthesia induction. This has been called “anteriorization” and has been correlated with loss of consciousness in humans. The spatio-temporal distribution of EEG spectral power in pigs and its modulation by anesthetics have not been described previously. The aim of the present study was to analyze EEG power across an anterior-posterior axis in pigs receiving increasing doses of propofol to 1) characterize the region of highest EEG power during wakefulness, 2) depict its spatio-temporal modification during propofol infusion, and 3) determine the region demonstrating the most significant modulations across different doses administered. Materials and methods Six pigs with a body weight of 33.3 ± 3.6 kg and aged 11.3 ± 0.5 weeks were included in a prospective experimental study. Electroencephalographic activity was collected at the occipital, parietal and prefrontal regions at increasing doses of propofol (starting at 10 mg kg-1 h-1 and increasing it by 10 mg kg-1 h-1 every 15 minutes). The EEG power was assessed using a generalized linear mixed model in which propofol doses and regions were treated as fixed effects, whereas pig was used as a random effect. Pairwise comparisons of marginal linear predictions were used to assess the change in power when the specific propofol dose (or region) was considered. Results During both wakefulness and propofol infusion, the highest EEG power was located in the prefrontal region (p<0.001). The EEG power, both total and for each frequency band, mostly followed the same pattern, increasing from awake until propofol 20 mg kg-1 h-1 and then decreasing at propofol 30 mg kg-1 h-1. The region showing the strongest differences in EEG power across propofol doses was the prefrontal. Conclusion In juvenile pigs receiving increasing doses of propofol, the prefrontal region showed the highest EEG power both during wakefulness and propofol administration and was the area in which the largest frequency-band specific variations were observed across different anesthetic doses. The assessment of the spectral EEG activity at this region could be favorable to distinguish DoA levels in pigs.

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Section: Discussionmentioning

confidence: 99%

Spatio-temporal electroencephalographic power distribution in experimental pigs receiving propofol

Mirra,

Hight,

Spadavecchia

et al. 2024

PLoS ONE

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“…53 Ma and Bebawy published an excellent narrative review on the physiological mechanisms that underlie the burst-suppression pattern and the evidence for its clinical use in various perioperative settings. 54 Chowdhury et al published a continuing professional development module on anesthetic considerations and management of endovascular thrombectomy for patients with AIS. 55 There have been few focused reviews on BP and hemodynamic management in patients with acute brain injuries.…”

Section: Narrative Reviews Of Interestmentioning

confidence: 99%

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2022

Nijs

Chhabra

Venkatraghavan

2023

J Neuroanaesth Crit Care

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This review is a synopsis of selected articles from neuroscience, neuroanesthesia, and neurocritical care from the year 2022 (January–November 2022). The journals reviewed include anesthesia journals, critical care medicine journals, neurosurgical journals as well as high-impact medical journals such as the Lancet, Journal of American Medical Association (JAMA), New England Journal of Medicine (NEJM), and Stroke. The summary of important articles will serve to update the knowledge of neuroanesthesiologists and other perioperative physicians who provide care to neurosurgical and neurocritical cases.

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“…It can also occur during the use of certain anesthetics, specifically GABAergic drugs that lower the cerebral metabolic rate of oxygen ( Hirsch and Taylor, 2010 ; Ching et al, 2012 ). Though burst suppression is often seen as an unwanted outcome, the literature on the prognosis of patients who experience this state is mixed ( Ma and Bebawy, 2022 ). Burst suppression has been associated with increased mortality ( Watson et al, 2008 ) and post-operative delirium ( Andresen et al, 2014 ; Fritz et al, 2016 ) but also with protection against post-operative cognitive dysfunction in the elderly ( Deiner et al, 2015 ).…”

Section: Introductionmentioning

confidence: 99%

Diversity of electroencephalographic patterns during propofol-induced burst suppression

Jones,

Lybbert,

Euler

et al. 2023

Front. Syst. Neurosci.

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Burst suppression is a brain state consisting of high-amplitude electrical activity alternating with periods of quieter suppression that can be brought about by disease or by certain anesthetics. Although burst suppression has been studied for decades, few studies have investigated the diverse manifestations of this state within and between human subjects. As part of a clinical trial examining the antidepressant effects of propofol, we gathered burst suppression electroencephalographic (EEG) data from 114 propofol infusions across 21 human subjects with treatment-resistant depression. This data was examined with the objective of describing and quantifying electrical signal diversity. We observed three types of EEG burst activity: canonical broadband bursts (as frequently described in the literature), spindles (narrow-band oscillations reminiscent of sleep spindles), and a new feature that we call low-frequency bursts (LFBs), which are brief deflections of mainly sub-3-Hz power. These three features were distinct in both the time and frequency domains and their occurrence differed significantly across subjects, with some subjects showing many LFBs or spindles and others showing very few. Spectral-power makeup of each feature was also significantly different across subjects. In a subset of nine participants with high-density EEG recordings, we noted that each feature had a unique spatial pattern of amplitude and polarity when measured across the scalp. Finally, we observed that the Bispectral Index Monitor, a commonly used clinical EEG monitor, does not account for the diversity of EEG features when processing the burst suppression state. Overall, this study describes and quantifies variation in the burst suppression EEG state across subjects and repeated infusions of propofol. These findings have implications for the understanding of brain activity under anesthesia and for individualized dosing of anesthetic drugs.

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Electroencephalographic Burst-Suppression, Perioperative Neuroprotection, Postoperative Cognitive Function, and Mortality: A Focused Narrative Review of the Literature

Cited by 7 publications

References 121 publications

Spatio-temporal electroencephalographic power distribution in experimental pigs receiving propofol

Spatio-temporal electroencephalographic power distribution in experimental pigs receiving propofol

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2022

Diversity of electroencephalographic patterns during propofol-induced burst suppression

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