Electroencephalographic arousal response during tracheal intubation and laryngeal mask airway insertion after induction of anaesthesia with propofol

EEG power spectrum analysis for monitoring depth of anaesthesia during experimental surgery

The first attempts to introduce computerized power spectrum analysis of the electroencephalogram (EEG) as an intraoperative anaesthesia monitoring device started approximately 30 years ago. Since that time, the effects of various anaesthetic agents, sedative and analgesic drugs on the EEG pattern have been addressed in numerous studies in human patients and different animal species. These studies revealed dose-dependent changes in the EEG power spectrum for many intravenous and volatile anaesthetics. Moreover, EEG responses evoked by surgical stimuli during relative light levels of surgical anaesthesia have been classified as 'arousal' and 'paradoxical arousal' reaction, previously referred to as 'desynchronization' and 'synchronization', respectively. Contrasting reports on the correlation between quantitative EEG (QEEG) variables derived from power spectrum analysis (i.e. spectral edge frequency, median frequency) and simultaneously recorded clinical signs such as movement and haemodynamic responses, however, limited the routine use of intraoperative EEG monitoring. In addition, the appearance of EEG burst suppression pattern and isoelectricity at clinically relevant concentrations/doses of newer general anaesthetics (i.e. isoflurane, sevoflurane, propofol) may have weakened the dose-related EEG changes previously reported. Despite these findings, the EEG power spectrum analysis may still provide valuable information during intraoperative monitoring in the individual subject. The information obtained from EEG power spectrum analysis may be further supplemented by newer EEG indices such as bispectral index and approximate entropy or other neurophysiological monitors including auditory evoked potentials or somatosensory evoked potentials.

Effects of averaging data series on the electroencephalographic response to noxious visceral stimulation in isoflurane-anaesthetized dogs

The effects of averaging epochs on electroencephalographic (EEG) responses to visceral stimulation has been determined in seven isoflurane-anaesthetized dogs. Quantitative EEG variables including 80% spectral edge frequency (SEF80), median frequency (MF), relative power in the delta, theta, alpha, beta band and power band ratios (theta/delta, alpha/delta, beta/delta) were recorded over 1min before stimulation and during a 1-minute stimulation period. During off-line analysis EEG variables were derived from either single 2-second EEG epochs or as an average from 5, 10, 15 and 30 consecutive 2-second epochs. Noxious stimulation resulted in significant increases in SEF80, MF, alpha power, beta power, alpha/delta ratio and beta/delta ratio. The number of variables that were significantly affected as well as the strength of changes as indicated by p-values, however, varied with the number of epochs subjected to averaging. The data suggest that stimulation-induced EEG changes may be more pronounced at lower rather than at higher averaging rates.

Larynxmaske

Introduction of the laryngeal mask airway (LMA) has been a revolutionary development in airway management over the last decades. It was first used clinically in 1981 by A. Brain and has been widely used in Germany since 1990. Originally intended as a substitute for conventional mask respiration for short periods of general anaesthesia, the laryngeal mask is in the meantime used in many areas as an alternative to elective endotracheal intubation as well as an option for controlling difficult airways. This contribution provides an overview of the basics as well as practical aspects of LMA use, and discusses the possibilities and limitations of the laryngeal mask in daily practice.