The posterior dominant rhythm: an electroencephalographic biomarker for cognitive recovery after general anaesthesia

Labonte, Alyssa K.; Kafashan, MohammadMehdi; Huels, Emma R.; Blain-Moraes, Stefanie; Basner, Mathias; Kelz, Max B.; Mashour, George A.; Avidan, Michael S.; Palanca, Ben Julian A.

doi:10.1016/j.bja.2022.01.019

Cited by 12 publications

(7 citation statements)

References 35 publications

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“…In addition, there are reports that the great physical stress of surgery can affect patients’ EEG. According to a recent study by Labonte et al (2023) young volunteers exposed to inhalation anesthetics demonstrated notable EEG changes. Building on these findings, our study investigated the connection between prefrontal EEG biomarkers and postoperative delirium in the elderly.…”

Section: Discussionmentioning

confidence: 99%

Resting-state prefrontal EEG biomarker in correlation with postoperative delirium in elderly patients

Kim,

Park,

Kim

et al. 2023

Front. Aging Neurosci.

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Postoperative delirium (POD) is associated with adverse outcomes in elderly patients after surgery. Electroencephalography (EEG) can be used to develop a potential biomarker for degenerative cerebral dysfunctions, including mild cognitive impairment and dementia. This study aimed to explore the relationship between preoperative EEG and POD. We included 257 patients aged >70 years who underwent spinal surgery. We measured the median dominant frequency (MDF), which is a resting-state EEG biomarker involving intrinsic alpha oscillations that reflect an idle cortical state, from the prefrontal regions. Additionally, the mini-mental state examination and Montreal cognitive assessment (MoCA) were performed before surgery as well as 5 days after surgery. For long-term cognitive function follow up, the telephone interview for cognitive status™ (TICS) was performed 1 month and 1 year after surgery. Fifty-two (20.2%) patients were diagnosed with POD. A multivariable logistic regression analysis that included age, MoCA score, Charlson comorbidity index score, Mini Nutritional Assessment, and the MDF as variables revealed that the MDF had a significant odds ratio of 0.48 (95% confidence interval 0.27–0.85). Among the patients with POD, the postoperative neurocognitive disorders could last up to 1 year. Low MDF on preoperative EEG was associated with POD in elderly patients undergoing surgery. EEG could be a novel potential tool for identifying patients at a high risk of POD.

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Section: Discussionmentioning

confidence: 99%

Resting-state prefrontal EEG biomarker in correlation with postoperative delirium in elderly patients

Kim,

Park,

Kim

et al. 2023

Front. Aging Neurosci.

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“…While some recent evidence suggests that a shift of oscillatory peak frequency of the posterior alpha frequency activity can outlast anaesthesia and might relate to cognitive performance 37 , the importance of aperiodic activity for cognitive function in a perioperative setting has not yet been investigated. Recently, several lines of inquiry highlighted that aperiodic activity tracks task-related neural activity in a variety of cognitive domains such as attention 18 , motor execution 38 and working memory 14, 39 and is related to better task performance.…”

Section: Discussionmentioning

confidence: 99%

“…c, Association of EEG oscillatory power differences between memory sessions in frequency bands of interest (Δ Se2-Se1, n = 26) and NP z-score of CVLT total recall. d, Association of EEG oscillatory power differences between memory sessions in frequency bands of interest (Δ Se2-Se1, n = 26) and EEG spectral slope(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) difference between memory sessions in cluster channels (Δ Se2-Se1 spectral slope cluster-permutation test: p = 0.073, Fig.5). e, Association of EEG oscillatory power differences between memory sessions in frequency bands of interest (Δ Se2-Se1, n = 26) and NP z-score of CVLT learning slope (Fig.5).…”

mentioning

confidence: 99%

Changes of oscillatory and aperiodic neuronal activity in working memory following anaesthesia: a prospective observational study

Lendner

Harler

Daume

et al. 2022

Preprint

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BackgroundAnaesthesia and surgery can lead to cognitive decline, especially in the elderly. However, to date, the neurophysiological underpinnings of perioperative cognitive decline remain unknown.MethodsWe included male patients, who were 60 years or older scheduled for elective radical prostatectomy under general anaesthesia. We obtained neuropsychological (NP) tests as well as a visual match-to-sample working memory (WM) task with concomitant 62-channel scalp electroencephalography (EEG) before and after surgery.ResultsA total number of 26 patients completed neuropsychological assessments and EEG pre- and postoperatively. Behavioural performance declined in the neuropsychological assessment after anaesthesia (total recall; t-tests: t25 = -3.25, Bonferroni-corrected p = 0.015 d = -0.902), while WM performance showed a dissociation between match and mis-match accuracy (rmANOVA: match*session F1,25 = 3.866, p = 0.060). Distinct EEG signatures tracked behavioural performance: Better performance in the NP assessment was correlated with an increase of non-oscillatory (aperiodic) activity, reflecting increased cortical activity (cluster permutation tests: total recall r = 0.66, p = 0.029, learning slope r = 0.66, p = 0.015), while WM accuracy was tracked by distinct temporally-structured oscillatory theta/alpha (7 – 9 Hz), low beta (14 – 18 Hz) and high beta/gamma (34 – 38 Hz) activity (cluster permutation tests: matches: p < 0.001, mis-matches: p = 0.022).ConclusionsOscillatory and non-oscillatory (aperiodic) activity in perioperative scalp EEG recordings track distinct features of perioperative cognition. Aperiodic activity provides a novel electrophysiological biomarker to identify patients at risk for developing perioperative neurocognitive decline.

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“…5,6 During emergence, occipital alpha power returns suggesting that a sudden return of occipital alpha/beta power in raw EEG indicates arousal. [7][8][9] Beta power is known to increase in the frontal brain regions as an indicator of increasing sedation. 10 The administration of ketamine, often used as a component of multimodal general anesthesia, increases bispectral index (BIS) values to values wrongly suggesting light sedation or wakefulness due to increased cortical activity in the beta (15-30 Hz) and gamma (>30 Hz) frequency bands.…”

Section: Key Pointsmentioning

confidence: 99%

A Pilot Investigation Evaluating Relative Changes in Fronto-Occipital Alpha and Beta Spectral Power as Measurement of Anesthesia Hypnotic Depth

Fehrlin

Hight

Kaiser

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Other than clinical observation of a patient’s vegetative response to nociception, monitoring the hypnotic component of general anesthesia (GA) and unconsciousness relies on electroencephalography (EEG)-based indices. These indices exclusively based on frontal EEG activity neglect an important observation. One of the main hallmarks of transitions from wakefulness to GA is a shift in alpha oscillations (7.5–12.5 Hz activity) from occipital brain regions toward anterior brain regions (“alpha anteriorization”). Monitoring the degree of this alpha anteriorization may help to guide induction and maintenance of hypnotic depth and prevent intraoperative awareness. However, the occipital region of the brain is completely disregarded and occipital alpha as characteristic of wakefulness and its posterior-to-anterior shift during induction are missed. Here, we propose an application of Narcotrend’s reduced power alpha beta (RPAB) index, originally developed to monitor differences in hemispheric perfusion, for determining the ratio of alpha and beta activity in the anterior-posterior axis. METHODS: Perioperative EEG data of 32 patients undergoing GA in the ophthalmic surgery department of Bern University Hospital were retrospectively analyzed. EEG was recorded with the Narcotrend® monitor using a frontal (Fp1-Fp2) and a posterior (T9-Oz) bipolar derivation with reference electrode over A2. The RPAB index was computed between both bipolar signals, defining the fronto-occipital RPAB (FO-RPAB). FO-RPAB was analyzed during wakefulness, GA maintenance, and emergence, as well as before and after the intraoperative administration of a ketamine bolus. FO-RPAB was compared with a classical quantitative EEG measure—the spectral edge frequency 95% (SEF-95). RESULTS: A significant shift of the FO-RPAB was observed during both induction of and emergence from GA (P < .001). Interestingly, the additional administration of ketamine during GA did not lead to a significant change in FO-RPAB (P = 0.81). In contrast, a significant increase in the SEF-95 in the frontal channel was observed during the 10-minute period after ketamine administration (P < .001). CONCLUSIONS: FO-RPAB appears to qualify as a marker of unconsciousness, reflecting physiological fronto-occipital activity differences during GA. In contrast to frontal SEF-95, it is not disturbed by additional administration of ketamine for analgesia.

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The posterior dominant rhythm: an electroencephalographic biomarker for cognitive recovery after general anaesthesia

Cited by 12 publications

References 35 publications

Resting-state prefrontal EEG biomarker in correlation with postoperative delirium in elderly patients

Resting-state prefrontal EEG biomarker in correlation with postoperative delirium in elderly patients

Changes of oscillatory and aperiodic neuronal activity in working memory following anaesthesia: a prospective observational study

A Pilot Investigation Evaluating Relative Changes in Fronto-Occipital Alpha and Beta Spectral Power as Measurement of Anesthesia Hypnotic Depth

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