Intraoperative EEG Monitoring in Pediatric Anesthesia

Yuan, Ian; Chao, Jerry Y.; Kurth, C. Dean; Missett, Richard; Cornelissen, Laura

doi:10.1007/s40140-023-00562-4

Cited by 5 publications

(6 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additional studies will be required to determine the extent of neurophysiologic differences (e.g., in brain network activity or in connectivity patterns) between preBSup and BSup, yet the results presented here suggest that preBSup may add value beyond that of BSup for identifying patients with impaired preoperative cognition and/or postoperative delirium risk. There are other areas of research in which lower EEG amplitudes [e.g., discontinuity in infants ( Yuan et al, 2023 )] have been observed, and the extent to which these patterns are related to BSup and preBSup may be another important area for future study. Additional work would be needed to understand the underlying neurophysiological mechanisms of preBsup and the changes in neural activity (e.g., periodic vs. aperiodic) that occur before the onset of BSup itself, especially in patients who later develop perioperative neurocognitive disorders such as delirium.…”

Section: Discussionmentioning

confidence: 99%

EEG pre-burst suppression: characterization and inverse association with preoperative cognitive function in older adults

Reese,

Christensen,

Anolick

et al. 2023

Front. Aging Neurosci.

View full text Add to dashboard Cite

The most common complication in older surgical patients is postoperative delirium (POD). POD is associated with preoperative cognitive impairment and longer durations of intraoperative burst suppression (BSup) – electroencephalography (EEG) with repeated periods of suppression (very low-voltage brain activity). However, BSup has modest sensitivity for predicting POD. We hypothesized that a brain state of lowered EEG power immediately precedes BSup, which we have termed “pre-burst suppression” (preBSup). Further, we hypothesized that even patients without BSup experience these preBSup transient reductions in EEG power, and that preBSup (like BSup) would be associated with preoperative cognitive function and delirium risk. Data included 83 32-channel intraoperative EEG recordings of the first hour of surgery from 2 prospective cohort studies of patients ≥age 60 scheduled for ≥2-h non-cardiac, non-neurologic surgery under general anesthesia (maintained with a potent inhaled anesthetic or a propofol infusion). Among patients with BSup, we defined preBSup as the difference in 3–35 Hz power (dB) during the 1-s preceding BSup relative to the average 3–35 Hz power of their intraoperative EEG recording. We then recorded the percentage of time that each patient spent in preBSup, including those without BSup. Next, we characterized the association between percentage of time in preBSup and (1) percentage of time in BSup, (2) preoperative cognitive function, and (3) POD incidence. The percentage of time in preBSup and BSup were correlated (Spearman’s ρ [95% CI]: 0.52 [0.34, 0.66], p < 0.001). The percentage of time in BSup, preBSup, or their combination were each inversely associated with preoperative cognitive function (β [95% CI]: −0.10 [−0.19, −0.01], p = 0.024; −0.04 [−0.06, −0.01], p = 0.009; −0.04 [−0.06, −0.01], p = 0.003, respectively). Consistent with prior literature, BSup was significantly associated with POD (odds ratio [95% CI]: 1.34 [1.01, 1.78], p = 0.043), though this association did not hold for preBSup (odds ratio [95% CI]: 1.04 [0.95, 1.14], p = 0.421). While all patients had ≥1 preBSup instance, only 20.5% of patients had ≥1 BSup instance. These exploratory findings suggest that future studies are warranted to further study the extent to which preBSup, even in the absence of BSup, can identify patients with impaired preoperative cognition and/or POD risk.

show abstract

Section: Discussionmentioning

confidence: 99%

EEG pre-burst suppression: characterization and inverse association with preoperative cognitive function in older adults

Reese,

Christensen,

Anolick

et al. 2023

Front. Aging Neurosci.

View full text Add to dashboard Cite

show abstract

“…Anesthetics alter the electrical activity of the brain and generate distinct age-and dose-dependent EEG patterns, followed by topographic distributions, suggesting that multiple neural circuits contribute to inducing loss of consciousness [2,10]. Gamma aminobutyric acid (GABAergic) anesthetics (e.g., sevoflurane and propofol) increase EEG amplitude while decreasing EEG frequency.…”

Section: Eeg Basics and Changes In The Anesthetized Brainmentioning

confidence: 99%

“…The DSA can be monitored in conjunction with raw EEG waveforms and the SEF95 to guide anesthesia management in children [7,10,25,40]. DSA monitoring allows clinicians to directly and accurately visualize the effects of various anesthetic drugs on a patient's EEG without relying on the pEEG number, enabling them to make better clinical inferences and titrate anesthesia doses more precisely to meet each patient's requirements at any given time.…”

Section: Combining Non-proprietary Eeg Parameters To Guide Anesthetic...mentioning

confidence: 99%

“…For infants and children of all ages receiving propofol anesthesia, Xu et al [41] suggested that SEF95 values of 15-20, 10-15, and 6-14 Hz should be targeted for sedation, surgical maintenance, and laryngoscopy/surgical incision, respectively. In infants aged > 3 months receiving sevoflurane anesthesia, Koch et al [42] identified SEF95 cutoff values of < 7 Hz for deep anesthesia, < 13 Hz for surgical anesthesia, and > 20 Hz for sedation/ consciousness, while Yuan et al [10] proposed targeting SEF95 at 15-20 Hz for sedation, 10-15 Hz for surgical maintenance, and 6-14 Hz for laryngoscopy/surgical incision. These suggested values should be considered in the context of the patient's raw EEG waveform, DSA, and other clinical parameters including heart rate, blood pressure, and movement to accurately assess the overall hypnotic state.…”

Section: Children Of All Agesmentioning

confidence: 99%

See 1 more Smart Citation

Intraoperative pediatric electroencephalography monitoring: an updated review

Yuan,

Bong,

Chao

2024

Korean J Anesthesiol

Self Cite

View full text Add to dashboard Cite

Intraoperative electroencephalography (EEG) monitoring under pediatric anesthesia has begun to attract increasing interest, driven by the availability of pediatric-specific EEG monitors and the realization that traditional dosing methods based on patient movement or changes in hemodynamic response often lead to imprecise dosing, especially in younger infants who may experience adverse events (e.g., hypotension) due to excess anesthesia. EEG directly measures the effects of anesthetics on the brain, which is the target end-organ responsible for inducing loss of consciousness. Over the past ten years, research on anesthesia and computational neuroscience has improved our understanding of intraoperative pediatric EEG monitoring and expanded the utility of EEG in clinical practice. We now have better insights into neurodevelopmental changes in the developing pediatric brain, functional connectivity, the use of non-proprietary EEG parameters to guide anesthetic dosing, epileptiform EEG changes during induction, EEG changes from spinal/regional anesthesia, EEG discontinuity, and the use of EEG to improve clinical outcomes. This review article summarizes the recent literature on EEG monitoring in perioperative pediatric anesthesia, highlighting several of the topics mentioned above.

show abstract

“…The phrase suggests that there are more brain components influencing the rhythm. (Note: word is used to describe change in the EEG, but it is also used interpretatively)(Yuan et al, 2023)…”

mentioning

confidence: 99%

Sleep Spindles using Electroencephalography signals

2024

IJFMR

View full text Add to dashboard Cite

EEG stands for electroencephalography. It is a non-invasive neurophysiological technique that and amplify the tiny electrical signals produced by neurons. A medical imaging method called electroencephalography measures the electrical activity in the scalp that is produced by brain regions (Teplan, 2002). Short oscillations known as sleep spindles can be seen in the human electroencephalogram (EEG) when a person is sleepy or drowsy (Lüthi, 2014). Neither the topography nor the morphology of sleep spindles remains constant throughout the lifespan (Clawson et al., 2016). Sleep spindles frequency range is between 12 Hz and 14 Hz. This frequency was extended to 11 Hz to 16 Hz after the American Academy of Sleep Medicine (AASM) published a new version of their sleep scoring guidelines in 2002 [37,16,15,43,23] One of the two primary sleep cycles that comprise a full sleep cycle is called NREM (Non-Rapid Eye Movement), the other being REM (Rapid Eye Movement) sleep. There are three stages of NREM sleep: N1, N2, and N3 (Al-Salman et al., 2019). With a sensitivity ranging from 89.1% to 100%, deep learning techniques have been developed to detect sleep spindles using 11 to 30 adult sleep EEGs

show abstract

Intraoperative EEG Monitoring in Pediatric Anesthesia

Cited by 5 publications

References 40 publications

EEG pre-burst suppression: characterization and inverse association with preoperative cognitive function in older adults

EEG pre-burst suppression: characterization and inverse association with preoperative cognitive function in older adults

Intraoperative pediatric electroencephalography monitoring: an updated review

Sleep Spindles using Electroencephalography signals

Contact Info

Product

Resources

About