The influence of age on EEG-based anaesthesia indices

Obert, David; Schweizer, Catrin; Zinn, Sebastian; Kratzer, Stephan; Hight, Darren; Sleigh, Jamie; Schneider, Gerhard; García, Paul S.; Kreuzer, Matthias

doi:10.1016/j.jclinane.2021.110325

Cited by 34 publications

(31 citation statements)

References 56 publications

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“…Nevertheless, only a small percentage of the measurements showed muscular activity in the sense of a derivable EMG activity. Whereas the statistical correlation of age and determined pEEG could already be shown in non-COVID patients, we failed to show such a relationship [ 45 , 59 ].…”

Section: Discussioncontrasting

confidence: 78%

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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: 78%

“…Separate representation of the two performed individual pEEG recordings for each patient. Patient State Index range of 25–50, corresponding to the expected value of sufficient sedation depth [ 23 , 45 ].…”

Section: Figurementioning

confidence: 99%

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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“…2b). This effect has been more clearly shown in a very recent study by Obert et al 42 not in place as in the Ni et al study, 24 even though results were broadly similar (2.7% decrease in MAC when BIS was absent) in that study. We note that although clinicians could see the Narcotrend index in all patients and sometimes age-adjusted MAC (displayed in around half of our patients), this is no guarantee that those values were integrated into the clinical decision-making process.…”

Section: Discussionmentioning

confidence: 55%

Age, minimum alveolar concentration and choice of depth of sedation monitor: examining the paradox of age when using the Narcotrend monitor

Hight

Schanderhazi

Huber

et al. 2021

European Journal of Anaesthesiology

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BACKGROUND With an ageing global population, it is important to individualise titration of anaesthetics according to age and by measuring their effect on the brain. A recent study reported that during general surgery, the given concentration of volatile anaesthetics, expressed as a fraction of the minimum alveolar concentration (MAC fraction), decreases by around only 3% per age-decade, which is less than the 6% expected from age-adjusted MAC. Paradoxically, despite the excessive dosing, Bispectral index (BIS) values also increased.OBJECTIVE We planned to investigate the paradox of age when using the Narcotrend depth of anaesthesia monitor.DESIGN Secondary analyses of a prospective observational study.SETTING Tertiary hospital in Switzerland, recordings took place during 2016 and 2017.PATIENTS One thousand and seventy-two patients undergoing cardiac surgery entered the study, and 909 with noisefree recordings and isoflurane anaesthesia were included in this analysis.INTERVENTION We calculated mean end-tidal MAC fraction and mean index value of the Narcotrend depth of sedation monitor used in the study during the prebypass period. Statistical associations were modelled using linear regression, local weighted regression (LOESS) and a generalised additive model (GAM).MAIN OUTCOME MEASURES Primary endpoints in this study were the change in end-tidal MAC fraction and mean Narcotrend index values, both measured per age-decade. RESULTSWe observed a linear decrease in end-tidal MAC fraction of 3.2% per age-decade [95% confidence interval (CI) À3.97% to À2.38%, P < 0.001], consistent with previous findings. In contrast to the BIS, mean Narcotrend index values decreased with age at 3.0 index points per agedecade (95% CI, À3.55 points to À2.36 points, P < 0.001), a direction of change commensurate with the increasing age-adjusted MAC fraction with patient age. These relationships were consistent regardless of whether age-adjusted MAC was displayed on the anaesthetic machine.CONCLUSIONS We caution that the 'paradox of age' may in part depend on the choice of depth of sedation monitor.

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“…ЭЭГ-мониторинг предоставляет более полную и обьективную информацию о глубине анестезии по сравнению с обработанными индексами ЭЭГ (BIS, СВП, энтропия) даже после введения миорелаксантов, гипнотиков или наркотических анальгетиков [110]. Когда пациент бодрствует, необработанная ЭЭГ обычно имеет преобладающую бета-активность (от 20 до 30 Гц), у бодрствующего пациента с закрытыми глазами регистрируют последовательные волны альфа-ритма (8-14 Гц), при переходе от начальной стадии сна к глубокой отмечается прирост медленноволновых тета-(4-8 Гц) и дельта-ритмов (0,5-3 Гц) [111].…”

Section: проблема интранаркозного пробуждения и оценки глубины анесте...unclassified

Choice of Anesthesia for Orthopedic Surgery in Elderly and Senile Patients (Review)

Lisichenko

Gusarov

2022

Obŝaâ reanimatologiâ

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Management of elderly and senile patients is a major challenge due to signiﬁcant comorbidity, especially in surgery under general anesthesia.The aim of the review was to identify the optimal method of anesthesia for knee arthroplasty in elderly patients based on the available clinical and experimental studies.We searched PubMed, Medline, and Elibrary.ru databases for relevant sources. Out of more than 300 publications initially analyzed, 113 literature sources (dating from 1951 to 2021) were included in the review, of which 80 were published within the last ﬁve years (2016–2021). The inclusion criteria were high informative value and relevance, except for sources cited as historical references. Both randomized multicenter studies and individual case reports were included in the review. Exclusion criteria were low informative value, outdated and repetitive data.We reviewed the physiology of elderly and senile patients, various variants of anesthesia, the use of neuroaxial anesthesia and peripheral regional blocks, xenon-based general anesthesia, assessed the advantages and drawbacks of each method, and discussed the monitoring of the depth of anesthesia and the issues of inraoperative awareness during knee arthroplasty in elderly and senile patients.Conclusion. The choice of anesthesia for knee arthroplasty in elderly and senile patients should be based on the risks of decompensation of cardiovascular comorbidities and cognitive impairment. No known anesthetic method is ideal in terms of safety. The use of xenon as the main anesthetic seems promising due to its cardio- and neuroprotective properties. However, its use is limited due to relatively high cost. Therefore, the search for optimal (lower than recommended) inhalation concentrations may lead to expanding use of xenon in elderly and senile patients. At the same time, the use of lower concentrations of the drug is associated with the intraoperative awakening and the need for its combination with narcotic analgesics or amnestic agents, which may not be optimal. In addition, the protective eﬀect of xenon retrograde amnesia against the stress of unintended intraoperative awakening has not been studied, and routine methods of monitoring the depth of hypnosis when using xenon often yield skewed measurement results inconsistent with the clinical manifestations of anesthesia.Therefore, there is a need for further studies concerning the retrograde amnesic eﬀect of xenon and search for optimal methods of assessing the depth of hypnosis when using this gas to safely reduce its inhalation concentration.

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The influence of age on EEG-based anaesthesia indices

Cited by 34 publications

References 56 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

Age, minimum alveolar concentration and choice of depth of sedation monitor: examining the paradox of age when using the Narcotrend monitor

Choice of Anesthesia for Orthopedic Surgery in Elderly and Senile Patients (Review)

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