Using Electroencephalography (EEG) to Guide Propofol and Sevoflurane Dosing in Pediatric Anesthesia

Yuan, Ian; Xu, Tao; Kurth, C. Dean

doi:10.1016/j.anclin.2020.06.007

Cited by 25 publications

(55 citation statements)

References 48 publications

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“…21 Improved IONM communication and standardized emergence allowed quicker emergence while maintaining analgesia. 15 Improving scheduling accuracy has been shown to be important to OR efficiency. 4 In our study, using predictive model based scheduling increased case completions from 33% to 68%.…”

Section: Discussionmentioning

confidence: 99%

“…To enable consistent and efficient emergence from anesthesia and tracheal extubation, in November 2015, the IONM team implemented systematic communication procedures regarding depth of anesthesia and optimal titration of total intravenous anesthesia based on EEG features (waveform, density spectral array, and spectral edge frequency) monitored by the IONM team and communicated periodically to the anesthesia team. Propofol infusion was titrated to achieve spectral edge frequency 12–15 Hz with strong delta and alpha wave power during surgery and 18–20 Hz with strong beta wave power for emergence extubation 15 . Pathways for management of critical IONM changes were already in place before this project.…”

Section: Methodsmentioning

confidence: 99%

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Timely completion of spinal fusion: A multidisciplinary quality improvement initiative to improve operating room efficiency

Chidambaran

Kara

et al. 2022

Pediatric Anesthesia

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Background: Failure to complete surgery within the scheduled timeframe impairs operating room efficiency leading to patient dissatisfaction and unplanned labor costs.We sought to improve timely completion (within 30 min of scheduled time) of firstcase spine fusion surgery (for idiopathic scoliosis) from a baseline of 25%-80% over 12 months. We also targeted timely completion of perioperative stages within predetermined target completion times. Methods: The project was conducted in three overlapping phases over 16 months. A simplified process map outlining five sequential perioperative stages, preintervention baselines (N = 24) and time targets were defined. A multidisciplinary team conducted a series of tests of change addressing the aims. The key drivers included effective scheduling, team communications, family engagement, data collection veracity, standardized pathways, and situational awareness. Data collected by an independent data collector and from electronic medical records were analyzed using control charts and statistical process control methods. Results: Post-intervention, timely case completion increased from 25% to 68% (N = 49) (95% CI 15.1-62.7), (p = 0.003) and was sustained (N = 14). Implementation of prediction model for case-scheduling decreased difference between scheduled and actual case end-time (33 vs. 53 min [baseline]) and variance [lower/upper control limits ([−26, 51] vs. [−109, 216] min [baseline]). Average start time delay decreased from 6to 2 min and on-time surgical starts improved from 50% to 70% (95% CI 3.2-41.6%). Timely completion increased for anesthesia induction (60% to 85%), surgical procedure (26% to 48%) and emergence from anesthesia (44% to 80%) but not for intraoperative patient preparation (30% to 25%) perioperative stages. Families reported satisfaction with preoperative processes (N = 14), and no untoward intraoperative safety events occurred.Conclusions: Application of QI methodology reduced time variation of several tasks and improved timely completion of spine surgery. Beyond the study period, sustained team behavior, adaptive changes, and vigilant monitoring are imperative for continued success.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Timely completion of spinal fusion: A multidisciplinary quality improvement initiative to improve operating room efficiency

Chidambaran

Kara

et al. 2022

Pediatric Anesthesia

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“…conclusions: Isoelectric events were common worldwide in young children during anesthesia and associated with age, specific anesthetic practices, and and cardiorespiratory monitoring, neither of which directly reflects the patient's brain response to these drugs. 1 Electroencephalography (EEG) provides a noninvasive method to monitor changes in brain electrical activity that can reflect brain drug levels, as EEG waveforms change predictably with propofol and sevoflurane dose. 2 Increased dose leads to an initial increase in EEG amplitude and progressively decreased frequency, until isoelectric EEG occurs where amplitude and frequency are close to zero, indicating an electrically inactive neocortex.…”

Section: What This Article Tells Us That Is Newmentioning

confidence: 99%

“…2 Increased dose leads to an initial increase in EEG amplitude and progressively decreased frequency, until isoelectric EEG occurs where amplitude and frequency are close to zero, indicating an electrically inactive neocortex. 1 Isoelectric EEG has been associated with intraoperative hypotension and postoperative delirium in adults. [3][4][5] In contrast, this association with delirium has not been shown in children.…”

Section: What This Article Tells Us That Is Newmentioning

confidence: 99%

Isoelectric Electroencephalography in Infants and Toddlers during Anesthesia for Surgery: An International Observational Study

Yuan

Skowno

et al. 2022

Anesthesiology

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Background Intraoperative isoelectric electroencephalography (EEG) has been associated with hypotension and postoperative delirium in adults. This international prospective observational study sought to determine the prevalence of isoelectric EEG in young children during anesthesia. We hypothesized that the prevalence of isoelectric events would be common worldwide and associated with certain anesthetic practices and intraoperative hypotension. Methods. Fifteen hospitals enrolled patients age ≤ 36 months for surgery using sevoflurane or propofol anesthetic. Frontal 4-channel EEG was recorded for isoelectric events. Demographics, anesthetic, emergence behavior, and Pediatric Quality of Life (PedsQL) variables were analyzed for association with isoelectric events. Results. Isoelectric events occurred in 32% (206/648) of patients, varied significantly among sites (9-88%), and were most prevalent during pre-incision (117/628, 19%) and surgical maintenance (117/643, 18%). Isoelectric events were more likely with [odds ratio-OR (95% confidence interval-CI)] infants < 3 months [4.4 (2.57-7.4) p<0.001], endotracheal tube use [1.78 (1.16-2.73) p=0.008], propofol bolus for airway placement after sevoflurane induction [2.92 (1.78-4.8) p<0.001], and less likely with use of muscle relaxant for intubation [0.67 (0.46-0.99) p=0.046]. Expired sevoflurane was higher in patients with isoelectric events [mean difference (95% CI)] during pre-incision [0.2% (0.1, 0.4) p=0.005] and surgical maintenance [0.2% (0.1, 0.3) p=0.002]. Isoelectric events were associated with moderate (8/12, 67%) and severe hypotension (11/18, 61%) during pre-incision [OR: 4.6 (1.30-16.1) p=0.018; 3.54 (1.27, 9.9) p=0.015] and surgical maintenance [OR: 3.64 (1.71-7.8) p=0.001; 7.1 (1.78- 28.1) p=0.005], and lower PedsQL scores [median of differences (95% CI)] at baseline in patients 0-12 [-3.5 (-6.2, -0.7) p=0.008] and 25-36 months [-6.3 (-10.4, -2.1) p=0.003] and 30-day follow-up in 0-12 months [-2.8 (-4.9, 0) p=0.036]. Isoelectric events were not associated with emergence behavior or anesthetic (sevoflurane vs propofol). Conclusions. Isoelectric events were common worldwide in young children during anesthesia and associated with age, specific anesthetic practices, and intraoperative hypotension.

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“…Anesthesiologists analyze and interpret qEEG through BIS, which can improve the understanding of patients' brain states during general anesthesia, control the anesthesia dose, and reduce the occurrence of adverse prognosis. Recent studies have shown that discontinuous brain electrical activity can also be observed in children under general anesthesia [17][18][19] ,…”

Section: Introductionmentioning

confidence: 99%

Intraoperative BIS Monitoring Can Predict the Occurrence of EEG Suppression and Improve the Operation Quality

Zhao

et al. 2022

Preprint

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Recent years, researches on diagnosis of anesthesia status and postoperative recovery based on electroencephalogram (EEG) signals have become increasingly popular. Bispectral index (BIS) is the earliest and most effective indicator for monitoring the depth of clinical anesthesia, and the waveform of intraoperative EEG can be displayed in real time. Excessive anesthesia and other conditions will cause burst suppression (BS) of intraoperative EEG, which will prolong the operation time and ICU stay time, and increase the incidence of postoperative delirium. This study analyzes the changes of intraoperative BIS monitoring on real-time EEG waveform and spectrogram, the results showed that BIS can predict the occurrence of EEG BS and then reduce the operation time and the incidence of postoperative delirium through rational use of intraoperative drugs.

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Using Electroencephalography (EEG) to Guide Propofol and Sevoflurane Dosing in Pediatric Anesthesia

Cited by 25 publications

References 48 publications

Timely completion of spinal fusion: A multidisciplinary quality improvement initiative to improve operating room efficiency

Timely completion of spinal fusion: A multidisciplinary quality improvement initiative to improve operating room efficiency

Isoelectric Electroencephalography in Infants and Toddlers during Anesthesia for Surgery: An International Observational Study

Intraoperative BIS Monitoring Can Predict the Occurrence of EEG Suppression and Improve the Operation Quality

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