The Ageing Brain: Age-dependent changes in the electroencephalogram during propofol and sevoflurane general anaesthesia

Purdon, Patrick L.; Pavone, Kara J.; Akeju, Oluwaseun; Smith, Anne C.; Sampson, Aaron L.; Lee, Joon; Zhou, David; Solt, Ken; Brown, Emery N.

doi:10.1093/bja/aev213

Cited by 302 publications

(313 citation statements)

References 63 publications

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“…Despite considerable progress in anesthesiology care and research, neural circuit mechanisms to explain MDDE-induced unconsciousness are yet to be defined. However, an emerging paradigm for probing anesthetic mechanisms is to study electroencephalogram (EEG) recordings and relate the findings to the behavioral state and putative neural circuit-level mechanisms (Ching et al, 2010, Cimenser et al, 2011, Supp et al, 2011, Purdon et al, 2013, Vijayan et al, 2013, Akeju et al, 2014a, Akeju et al, 2014b, Blain-Moraes et al, 2014, Akeju et al, 2015, Purdon et al, 2015a, Pavone et al, 2016). This approach is beginning to provide key insights into the mechanisms of anesthetic action.…”

Section: Introductionmentioning

confidence: 99%

GABAA circuit mechanisms are associated with ether anesthesia-induced unconsciousness

Akeju

Hamilos

Song

et al. 2016

Clinical Neurophysiology

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Objective An emerging paradigm for understanding how anesthetics induce altered arousal is relating receptor targeting in specific neural circuits to electroencephalogram (EEG) activity. We have previously found that enhanced gamma amino-butyric acid A (GABAA) inhibitory post-synaptic currents (IPSCs) manifest with large-amplitude slow (0.1–1 Hz) and frontally coherent alpha (8–12 Hz) oscillations. Therefore, we investigated the EEG signatures of modern day derivatives of ether (MDDE) to assess the extent to which we could obtain insights into MDDE anesthetic mechanisms Methods We retrospectively studied cases from our database in which patients received isoflurane vs. isoflurane/ketamine (n=10 each) or desflurane vs. desflurane/ketamine (n = 9 each). We analyzed the EEG recordings with spectral power and coherence methods. Results Similar to known GABAA circuit level mechanisms, we found that MDDE induced large amplitude slow and frontally coherent alpha oscillations. Additionally, MDDE also induced frontally coherent theta (4–8 Hz) oscillations. Reduction of GABAergic IPSCs with ketamine resulted in beta/gamma (13–40 Hz) oscillations, and significantly reduced MDDE-induced slow, theta and alpha oscillation power. Conclusions MDDE are associated with large amplitude slow oscillations and coherent alpha and theta oscillations. Significance These observations are consistent with the notion that GABAA circuit-level mechanisms are associated with MDDE-induced unconsciousness.

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Section: Introductionmentioning

confidence: 99%

GABAA circuit mechanisms are associated with ether anesthesia-induced unconsciousness

Akeju

Hamilos

Song

et al. 2016

Clinical Neurophysiology

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“…Several studies are dealing with intraoperative EEG dynamics and evaluation, paving the way to newer and more effective strategies. Such studies have recently shown a reduced alpha band power in elderly patients during unconsciousness as well as an elevated risk to develop burst suppression state during anesthesia [52]. This is crucial since avoidance of burst suppression states ( fig.…”

Section: Neuromonitoringmentioning

confidence: 99%

Perioperative Management of Elderly Patients with Gastrointestinal Malignancies: The Contribution of Anesthesia

et al. 2017

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Introduction: Elderly patients suffering from gastrointestinal malignancies are particularly prone to perioperative complications. Elderly patients often present with reduced physiological reserves, and comorbidities can limit treatment options and promote complications. Surgeons and anesthesiologists must be aware of strategies required to deal with this vulnerable subgroup. Methods: We provide a brief review of current and emerging perioperative strategies for the treatment of elderly patients with gastrointestinal malignancies and frequent comorbidities. Results: Especially in combination with advanced age, the effects of malignancies can be devastating, bringing new health challenges, exacerbating preexisting conditions, and exerting severe psychological strain. An interdisciplinary assessment and process planning provide an ideal setting to identify and prevent potential complications, especially in regards to frailty and cardiovascular risk. In addition, important perioperative considerations are presented, such as malnutrition, fasting, intraoperative neuromonitoring, and hemodynamic control, as well as postoperative early mobilization, pain, and delirium management. Conclusion: The decisions and interventions made in the perioperative stage can positively influence many intra- and postoperative factors, significantly improving the chances of successful treatment of elderly cancer patients. Appropriate management can help prevent or mitigate complications, secure a quick recovery, and improve short- and long-term outcomes.

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“…These indices have been designed with a one-size-fits-all approach in which the same index value is meant to represent the same state of unconsciousness, regardless of the anesthetic being administered, and without regard to significant age-dependent differences in anesthesia-induced electroencephalogram features. 24–26 Anesthesiologists have learned over the years that their use does not reduce the incidence of awareness 27 and that patients’ underlying brain states can vary substantially despite being maintained within the recommended index range. 26,28,29 Alternatively, the unprocessed electroencephalogram and its spectrogram make it possible to view directly the patient’s brain states under general anesthesia.…”

Section: In Replymentioning

confidence: 99%

In Reply

Purdon¹,

Akeju²,

Brown³

2015

Anesthesiology

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The Ageing Brain: Age-dependent changes in the electroencephalogram during propofol and sevoflurane general anaesthesia

Cited by 302 publications

References 63 publications

GABAA circuit mechanisms are associated with ether anesthesia-induced unconsciousness

GABAA circuit mechanisms are associated with ether anesthesia-induced unconsciousness

Perioperative Management of Elderly Patients with Gastrointestinal Malignancies: The Contribution of Anesthesia

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