Continuing professional development module : An updated introduction to electroencephalogram-based brain monitoring during intended general anesthesia.

Hight, Darren F.; Kaiser, Heiko A.; Sleigh, Jamie W; Avidan, Michael S (2020). Continuing professional development module : An updated introduction to electroencephalogram-based brain monitoring during intended general anesthesia. Canadian journal of anesthesia / Journal canadien d'anesthesie, 67(12), pp. 1858-1878. Springer-Verlag 10.1007/s12630-020-01820-3

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The electroencephalogram (EEG) provides a reliable reflection of the brain's electrical state, so it can reassure us that the anesthetic agents are actually reaching the patient's brain, and are having the desired effect. In most patients, the EEG changes somewhat predictably in response to propofol and volatile agents, so a frontal EEG channel can guide avoidance of insufficient and excessive administration of general anesthesia. Persistent alpha-spindles (around 10 Hz) phase-amplitude coupled with slow delta waves (around 1 Hz) are commonly seen during an "appropriate hypnotic state of general anesthesia". Such patterns can be appreciated from the EEG waveform or from the spectrogram (a colour-coded display of how the power in the various EEG frequencies changes with time). Nevertheless, there are exceptions to this. For example, administration of ketamine and nitrous oxide is generally not associated with the aforementioned alpha-spindle coupled with delta wave pattern. Also, some patients, including older adults and those with neurodegenerative disorders, are less predisposed to generate a strong electroencephalographic "alpha-spindle" pattern during general anesthesia. There might also be some rare instances when the frontal EEG shows a pattern suggestive of general anesthesia, while the patient has some awareness and is able to follow simple commands, albeit this is typically without obvious distress or memory formation. Thus, the frontal EEG alone, as currently analyzed, is an imperfect but clinically useful mirror, and more scientific insights will be needed before we can claim to have a reliable readout of brain "function" during general anesthesia.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Hight, Darren and Kaiser, Heiko

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0832-610X

Publisher:

Springer-Verlag

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

29 Dec 2020 10:03

Last Modified:

29 Dec 2020 10:03

Publisher DOI:

10.1007/s12630-020-01820-3

PubMed ID:

33190217

BORIS DOI:

10.48350/148955

URI:

https://boris.unibe.ch/id/eprint/148955

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