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Touchard C, Guessous K, Cartailler J. In Response. Anesth Analg 2023; 137:e50-e51. [PMID: 37973137 DOI: 10.1213/ane.0000000000006616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- Cyril Touchard
- AP-HP, Hôpital Lariboisière, Departement d'Anesthésie-Réanimation, Paris, France, Université Paris Cité, Boulogne-Billancourt, France
| | - Karim Guessous
- AP-HP, Hôpital Lariboisière, Département d'Anesthésie-Réanimation, Paris, France, Sorbonne Université, Paris, France, UMR-942, INSERM Délégation Régionale Paris 7, Bagnolet France,
| | - Jérôme Cartailler
- AP-HP, Hôpital Lariboisière, Département d'Anesthésie-Réanimation, Paris, France, UMR-942, INSERM Délégation Régionale Paris 7, Bagnolet, France
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Gutiérrez R, Purdon PL. Anesthesia-induced Brain Oscillations and Vulnerability to Postoperative Neurocognitive Disorders. Anesthesiology 2023; 139:557-559. [PMID: 37815470 DOI: 10.1097/aln.0000000000004704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Affiliation(s)
- Rodrigo Gutiérrez
- Department of Anesthesia and Perioperative Medicine, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Patrick L Purdon
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Medicine, Palo Alto, California
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Guessous K, Touchard C, Glezerson B, Levé C, Sabbagh D, Mebazaa A, Gayat E, Paquet C, Vallée F, Cartailler J. Intraoperative Electroencephalography Alpha-Band Power Is a Better Proxy for Preoperative Low MoCA Under Propofol Compared With Sevoflurane. Anesth Analg 2023; 137:1084-1092. [PMID: 37014984 DOI: 10.1213/ane.0000000000006422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
BACKGROUND Preoperative abnormal cognitive status is a risk factor for postoperative complications yet remains underdiagnosed. During propofol general anesthesia, intraoperative electroencephalography (EEG) variables, such as alpha band power (α-BP), correlate with cognitive status. This relationship under sevoflurane is unclear. We investigated whether EEG biomarkers of poor cognitive status found under propofol could be extended to sevoflurane. METHODS In this monocentric prospective observational study, 106 patients with intraoperative EEG monitoring were included (propofol/sevoflurane = 55/51). We administered the Montreal Cognitive Assessment (MoCA) scale to identify abnormal cognition (low MoCA) 1 day before intervention. EEG variables included delta to beta frequency band powers. Results were adjusted to age and drug dosage. We assessed depth of anesthesia (DoA) using the spectral edge frequency (SEF 95 ) and maintained it within (8-13) Hz. RESULTS The difference in α-BP between low and normal MoCA patients was significantly larger among propofol patients (propofol: 4.3 ± 4.8 dB versus sevoflurane: 1.5 ± 3.4 dB, P = .022). SEF 95 and age were not statistically different between sevoflurane and propofol groups. After adjusting to age and dose, low α-BP was significantly associated with low MoCA under propofol (odds ratio [OR] [confidence interval {CI}] = 0.39 [0.16-0.94], P = .034), but not under sevoflurane, where theta-band power was significantly associated with low MoCA (OR [CI] = 0.31 [0.13-0.73], P = .007). CONCLUSIONS We suggest that intraoperative EEG biomarkers of abnormal cognition differ between propofol and sevoflurane under general anesthesia.
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Affiliation(s)
- K Guessous
- From the AP-HP, Hôpital Lariboisière, Paris, France
- Sorbonne Université, Paris, France
- UMR-942, Inserm Délégation Régionale Paris 7, Bagnolet, France
| | - C Touchard
- From the AP-HP, Hôpital Lariboisière, Paris, France
- Université Paris Cité, Boulogne-Billancourt, France
| | - B Glezerson
- The Montréal Neurological Institute and Hospital, McGill University, Montréal, Canada
| | - C Levé
- From the AP-HP, Hôpital Lariboisière, Paris, France
- Université Paris Cité, Boulogne-Billancourt, France
| | - D Sabbagh
- Université Paris-Saclay, Inria, CEA, Palaiseau, France
| | - A Mebazaa
- From the AP-HP, Hôpital Lariboisière, Paris, France
- UMR-942, Inserm Délégation Régionale Paris 7, Bagnolet, France
- Université Paris Cité, Boulogne-Billancourt, France
| | - E Gayat
- Sorbonne Université, Paris, France
- UMR-942, Inserm Délégation Régionale Paris 7, Bagnolet, France
- Université Paris Cité, Boulogne-Billancourt, France
| | - C Paquet
- Cognitive Neurology Center, Memory department, Saint-Louis Lariboisière-Fernand Widal Hospital, APHP, Université Paris Cité INSERU1144, France
| | - F Vallée
- From the AP-HP, Hôpital Lariboisière, Paris, France
- UMR-942, Inserm Délégation Régionale Paris 7, Bagnolet, France
- Université Paris Cité, Boulogne-Billancourt, France
- Université Paris-Saclay, Inria, CEA, Palaiseau, France
| | - J Cartailler
- From the AP-HP, Hôpital Lariboisière, Paris, France
- UMR-942, Inserm Délégation Régionale Paris 7, Bagnolet, France
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Sabbagh D, Cartailler J, Touchard C, Joachim J, Mebazaa A, Vallée F, Gayat É, Gramfort A, Engemann DA. Repurposing electroencephalogram monitoring of general anaesthesia for building biomarkers of brain ageing: an exploratory study. BJA OPEN 2023; 7:100145. [PMID: 37638087 PMCID: PMC10457469 DOI: 10.1016/j.bjao.2023.100145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/16/2023] [Indexed: 08/29/2023]
Abstract
Background Electroencephalography (EEG) is increasingly used for monitoring the depth of general anaesthesia, but EEG data from general anaesthesia monitoring are rarely reused for research. Here, we explored repurposing EEG monitoring from general anaesthesia for brain-age modelling using machine learning. We hypothesised that brain age estimated from EEG during general anaesthesia is associated with perioperative risk. Methods We reanalysed four-electrode EEGs of 323 patients under stable propofol or sevoflurane anaesthesia to study four EEG signatures (95% of EEG power <8-13 Hz) for age prediction: total power, alpha-band power (8-13 Hz), power spectrum, and spatial patterns in frequency bands. We constructed age-prediction models from EEGs of a healthy reference group (ASA 1 or 2) during propofol anaesthesia. Although all signatures were informative, state-of-the-art age-prediction performance was unlocked by parsing spatial patterns across electrodes along the entire power spectrum (mean absolute error=8.2 yr; R2=0.65). Results Clinical exploration in ASA 1 or 2 patients revealed that brain age was positively correlated with intraoperative burst suppression, a risk factor for general anaesthesia complications. Surprisingly, brain age was negatively correlated with burst suppression in patients with higher ASA scores, suggesting hidden confounders. Secondary analyses revealed that age-related EEG signatures were specific to propofol anaesthesia, reflected by limited model generalisation to anaesthesia maintained with sevoflurane. Conclusions Although EEG from general anaesthesia may enable state-of-the-art age prediction, differences between anaesthetic drugs can impact the effectiveness and validity of brain-age models. To unleash the dormant potential of EEG monitoring for clinical research, larger datasets from heterogeneous populations with precisely documented drug dosage will be essential.
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Affiliation(s)
- David Sabbagh
- INSERM, Université de Paris, Paris, France
- Inria, CEA, Université Paris-Saclay, Palaiseau, France
| | - Jérôme Cartailler
- INSERM, Université de Paris, Paris, France
- Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
| | - Cyril Touchard
- Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
| | - Jona Joachim
- Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
| | - Alexandre Mebazaa
- INSERM, Université de Paris, Paris, France
- Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
| | - Fabrice Vallée
- INSERM, Université de Paris, Paris, France
- Inria, CEA, Université Paris-Saclay, Palaiseau, France
- Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
| | - Étienne Gayat
- INSERM, Université de Paris, Paris, France
- Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
| | | | - Denis A. Engemann
- Inria, CEA, Université Paris-Saclay, Palaiseau, France
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Roche Pharma Research and Early Development, Neuroscience and Rare Diseases, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
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Linassi F, Kreuzer M, Kratzer S, Olivieri S, Zanatta P, Schneider G, Carron M. Unwanted spontaneous responsiveness and burst suppression in patients undergoing entropy-guided total intravenous anesthesia with target-controlled infusion: An observational prospective trial. J Clin Anesth 2023; 86:111045. [PMID: 36680980 DOI: 10.1016/j.jclinane.2022.111045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 11/14/2022] [Accepted: 12/19/2022] [Indexed: 01/21/2023]
Abstract
STUDY OBJECTIVE To estimate the incidence of unwanted spontaneous responsiveness and burst suppression (BSupp) in patients undergoing state entropy (SE) and surgical pleth index (SPI)-guided total intravenous anesthesia (TIVA) with target-controlled infusion (TCI). DESIGN Observational, prospective, single-center study. SETTINGS Operating room. PATIENTS 107 adult (<65 years) and elderly (≥65 years) women undergoing breast surgery. INTERVENTIONS Propofol-remifentanil TIVA-TCI-guided by SE for depth of anesthesia monitoring (target value 40-60) and SPI for antinociception monitoring (target value 20-50) without neuromuscular blockade. MEASUREMENTS Age; body mass index; American Society of Anesthesiologists physical status classification; concentration at the effect site of propofol (CeP) and remifentanil (CeR) at loss of responsiveness (LoR), median during anesthesia maintenance (MdM), and at return of responsiveness (RoR); propofol infusion duration; incidence of postoperative delirium (POD) with Confusing Assessment Method for the Intensive Care Unit. MAIN RESULTS During SE-SPI-guided TIVA-TCI, 13.1% of patients showed unwanted spontaneous responsiveness, whereas 45.8% showed BSupp. Unwanted spontaneous responsiveness was observed mainly in adults (p < 0.05), and higher CeP RoR (p < 0.05) was registered. BSupp was observed mainly in patients showing a lower CeP MdM (p < 0.01) and CeP RoR (p < 0.05). Unwanted spontaneous responsiveness and BSupp were not associated with significant differences in CeRs. An age-related hysteresis effect was observed, resulting in higher CeP LoR than CeP RoR (p < 0.001). 12.2% of patients showed POD. Only preoperative serum albumin was associated with increased likelihood of POD (p = 0.046). CONCLUSIONS The SE-SPI-guided TIVA-TCI did not prevent unwanted spontaneous responsiveness and BSupp. CeP RoR may be used as a proxy for anesthetic sensitivity.
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Affiliation(s)
- Federico Linassi
- Department of Pharmaceutical and Pharmacological Sciences, Università degli Studi di Padova, via Marzolo 5, 35131, Padova, Italy; Department of Anesthesiology and Critical Care, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Piazzale Ospedale 1, Treviso 31100, Italy.
| | - Matthias Kreuzer
- Department of Anesthesiology and Intensive Care, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, München 81675, Germany
| | - Stephan Kratzer
- Department of Anesthesiology and Intensive Care, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, München 81675, Germany
| | - Sara Olivieri
- Department of Anesthesiology and Critical Care, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Piazzale Ospedale 1, Treviso 31100, Italy
| | - Paolo Zanatta
- Department of Anesthesia and Intensive Care, Integrated University Hospital of Verona, Piazzale Aristide Stefani 1, Verona 37121, Italy
| | - Gerhard Schneider
- Department of Anesthesiology and Intensive Care, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, München 81675, Germany
| | - Michele Carron
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
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Touchard C, Guimard P, Guessous K, Aubin OS, Levé C, Joachim J, Elayeb K, Mebazaa A, Gayat É, Mateo J, Vallée F, Cartailler J. Association of sleep and anaesthesia EEG biomarkers with preoperative MoCA score: A pilot study. Acta Anaesthesiol Scand 2023. [PMID: 37096645 DOI: 10.1111/aas.14251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/15/2023] [Accepted: 04/06/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Preoperative cognitive impairments increase the risk of postoperative complications. The electroencephalogram (EEG) could provide information on cognitive vulnerability. The feasibility and clinical relevance of sleep EEG (EEGsleep ) compared to intraoperative EEG (EEGintraop ) in cognitive risk stratification remains to be explored. We investigated similarities between EEGsleep and EEGintraop vis-a-vis preoperative cognitive impairments. METHODS Pilot study including 27 patients (63 year old [53.5, 70.0]) to whom Montreal cognitive assessment (MoCA) and EEGsleep were administered 1 day before a propofol-based general anaesthesia, in addition to EEGintraop acquisition from depth-of-anaesthesia monitors. Sleep spindles on EEGsleep and intraoperative alpha-band power on EEGintraop were particularly explored. RESULTS In total, 11 (41%) patients had a MoCA <25 points. These patients had a significantly lower sleep spindle power on EEGsleep (25 vs. 40 μv2 /Hz, p = .035) and had a weaker intraoperative alpha-band power on EEGintraop (85 vs. 150 μv2 /Hz, p = .001) compared to patients with normal MoCA. Correlation between sleep spindle and intraoperative alpha-band power was positive and significant (r = 0.544, p = .003). CONCLUSION Preoperative cognitive impairment appears to be detectable by both EEGsleep and EEGintraop . Preoperative sleep EEG to assess perioperative cognitive risk is feasible but more data are needed to demonstrate its benefit compared to intraoperative EEG.
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Affiliation(s)
- Cyril Touchard
- Department of Anesthesiology and Intensive Care, Lariboisière - Saint Louis Hospitals, Paris, France
- Université Paris Cité, Boulogne-Billancourt, France
| | - Pauline Guimard
- Department of Anesthesiology and Intensive Care, Lariboisière - Saint Louis Hospitals, Paris, France
- Université Paris Cité, Boulogne-Billancourt, France
| | - Karim Guessous
- Department of Anesthesiology and Intensive Care, Lariboisière - Saint Louis Hospitals, Paris, France
- Sorbonne Université, Paris, France
| | - Oriane Saint Aubin
- Department of Anesthesiology and Intensive Care, Lariboisière - Saint Louis Hospitals, Paris, France
- Université Paris Cité, Boulogne-Billancourt, France
| | - Charlotte Levé
- Department of Anesthesiology and Intensive Care, Lariboisière - Saint Louis Hospitals, Paris, France
- Université Paris Cité, Boulogne-Billancourt, France
| | - Jona Joachim
- Department of Anesthesiology and Intensive Care, Lariboisière - Saint Louis Hospitals, Paris, France
- Université Paris Cité, Boulogne-Billancourt, France
| | - Kenza Elayeb
- Department of Anesthesiology and Intensive Care, Lariboisière - Saint Louis Hospitals, Paris, France
- Université Paris Cité, Boulogne-Billancourt, France
| | - Alexandre Mebazaa
- Department of Anesthesiology and Intensive Care, Lariboisière - Saint Louis Hospitals, Paris, France
- Université Paris Cité, Boulogne-Billancourt, France
- Inserm, UMRS-942, Paris Diderot University, Paris, France
| | - Étienne Gayat
- Department of Anesthesiology and Intensive Care, Lariboisière - Saint Louis Hospitals, Paris, France
- Université Paris Cité, Boulogne-Billancourt, France
- Inserm, UMRS-942, Paris Diderot University, Paris, France
| | - Joaquim Mateo
- Department of Anesthesiology and Intensive Care, Lariboisière - Saint Louis Hospitals, Paris, France
- Université Paris Cité, Boulogne-Billancourt, France
- Inserm, UMRS-942, Paris Diderot University, Paris, France
| | - Fabrice Vallée
- Department of Anesthesiology and Intensive Care, Lariboisière - Saint Louis Hospitals, Paris, France
- Université Paris Cité, Boulogne-Billancourt, France
- Inserm, UMRS-942, Paris Diderot University, Paris, France
- Université Paris-Saclay, Palaiseau, France
| | - Jérôme Cartailler
- Department of Anesthesiology and Intensive Care, Lariboisière - Saint Louis Hospitals, Paris, France
- Inserm, UMRS-942, Paris Diderot University, Paris, France
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Tang X, Zhang X, Dong H, Zhao G. Electroencephalogram Features of Perioperative Neurocognitive Disorders in Elderly Patients: A Narrative Review of the Clinical Literature. Brain Sci 2022; 12:1073. [PMID: 36009136 PMCID: PMC9405602 DOI: 10.3390/brainsci12081073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Postoperative neurocognitive disorder (PND) is a common postoperative complication, particularly in older patients. Electroencephalogram (EEG) monitoring, a non-invasive technique with a high spatial-temporal resolution, can accurately characterize the dynamic changes in brain function during the perioperative period. Current clinical studies have confirmed that the power density of alpha oscillation during general anesthesia decreased with age, which was considered to be associated with increased susceptibility to PND in the elderly. However, evidence on whether general anesthesia under EEG guidance results in a lower morbidity of PND is still contradictory. This is one of the reasons that common indicators of the depth of anesthesia were limitedly derived from EEG signals in the frontal lobe. The variation of multi-channel EEG features during the perioperative period has the potential to highlight the occult structural and functional abnormalities of the subcortical-cortical neurocircuit. Therefore, we present a review of the application of multi-channel EEG monitoring to predict the incidence of PND in older patients. The data confirmed that the abnormal variation in EEG power and functional connectivity between distant brain regions was closely related to the incidence and long-term poor outcomes of PND in older adults.
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Affiliation(s)
- Xuemiao Tang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Xinxin Zhang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Hailong Dong
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Guangchao Zhao
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
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Jildenstål P, Bäckström A, Hedman K, Warrén-Stomberg M. Spectral edge frequency during general anaesthesia: A narrative literature review. J Int Med Res 2022; 50:3000605221118682. [PMID: 35971317 PMCID: PMC9386875 DOI: 10.1177/03000605221118682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Previous studies have attempted to determine the depth of anaesthesia with different anaesthetic agents using electroencephalogram (EEG) measurements with variable success. Measuring depth of anaesthesia is confounded by the complexity of the EEG and the fact that different agents create different pattens. A narrative review was undertaken to examine the available research evidence on the effect and reliability of spectral edge frequency (SEF) for assessing the depth of anaesthesia in adult patients under general anaesthesia. A systematic search of the PubMed®, Scopus®, CINAHL and Cochrane databases identified six randomized controlled trials and five observational studies. The findings of these studies suggest that SEF varies according to the anaesthetic drugs used. Remifentanil and age are two factors that can affect SEF, while other opioids and benzodiazepine (administered separately) seem to have no effect. No patients experienced intraoperative awareness. However, this does not indicate that SEF can provide full protection against it and the number of articles in which intraoperative awareness was studied was too small to afford any certainty. None of the studies demonstrated a reliable SEF interval associated with adequate general anaesthesia. SEF must be adapted to the anaesthetic drug used, the patient’s age and state while under general anaesthesia.
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Affiliation(s)
- Pether Jildenstål
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden.,Department of Anaesthesia and Intensive Care, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden.,Department of Anaesthesiology, Surgery and Intensive Care, Sahlgrenska University Hospital, Goteborg, Sweden.,Department of Anaesthesiology and Intensive Care, Örebro University Hospital and School of Medical Sciences, Örebro University, Örebro, Sweden.,Department of medicine & Health Sciences, Lund University, Lund, Sweden
| | - Amanda Bäckström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Klara Hedman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Margareta Warrén-Stomberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
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Manquat E, Ravaux H, Kindermans M, Joachim J, Serrano J, Touchard C, Mateo J, Mebazaa A, Gayat E, Vallée F, Cartailler J. Impact of impaired cerebral blood flow autoregulation on electroencephalogram signals in adults undergoing propofol anaesthesia: a pilot study. BJA OPEN 2022; 1:100004. [PMID: 37588691 PMCID: PMC10430849 DOI: 10.1016/j.bjao.2022.100004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/26/2022] [Indexed: 08/18/2023]
Abstract
Background Cerebral autoregulation actively maintains cerebral blood flow over a range of MAPs. During general anaesthesia, this mechanism may not compensate for reductions in MAP leading to brain hypoperfusion. Cerebral autoregulation can be assessed using the mean flow index derived from Doppler measurements of average blood velocity in the middle cerebral artery, but this is impractical for routine monitoring within the operating room. Here, we investigate the possibility of using the EEG as a proxy measure for a loss of cerebral autoregulation, determined by the mean flow index. Methods Thirty-six patients (57.5 [44.25; 66.5] yr; 38.9% women, non-emergency neuroradiology surgery) anaesthetised using propofol were prospectively studied. Continuous recordings of MAP, average blood velocity in the middle cerebral artery, EEG, and regional cerebral oxygen saturation were made. Poor cerebral autoregulation was defined as a mean flow index greater than 0.3. Results Eighteen patients had preserved cerebral autoregulation, and 18 had altered cerebral autoregulation. The two groups had similar ages, MAPs, and average blood velocities in the middle cerebral artery. Patients with altered cerebral autoregulation exhibited a significantly slower alpha peak frequency (9.4 [9.0, 9.9] Hz vs 10.5 [10.1, 10.9] Hz, P<0.001), which persisted after adjusting for age, norepinephrine infusion rate, and ASA class (odds ratio=0.038 [confidence interval, 0.004, 0.409]; P=0.007). Conclusion In this pilot study, we found that loss of cerebral autoregulation was associated with a slower alpha peak frequency, independent of age. This work suggests that impaired cerebral autoregulation could be monitored in the operating room using the existing EEG setup. Clinical trial registration NCT03769142.
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Affiliation(s)
- Elsa Manquat
- Department of Anesthesiology, Burn and Critical Care, St-Louis-Lariboisiere University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- AP-HP-Inria, Laboratoire Daniel Bernoulli, Paris, France
| | - Hugues Ravaux
- Department of Anesthesiology, Burn and Critical Care, St-Louis-Lariboisiere University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Manuel Kindermans
- Department of Anesthesiology, Burn and Critical Care, St-Louis-Lariboisiere University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jona Joachim
- Department of Anesthesiology, Burn and Critical Care, St-Louis-Lariboisiere University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - José Serrano
- Department of Anesthesiology, Burn and Critical Care, St-Louis-Lariboisiere University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Cyril Touchard
- Department of Anesthesiology, Burn and Critical Care, St-Louis-Lariboisiere University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Joaquim Mateo
- Department of Anesthesiology, Burn and Critical Care, St-Louis-Lariboisiere University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesiology, Burn and Critical Care, St-Louis-Lariboisiere University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- INSERM, UMR-942, Paris, France
| | - Etienne Gayat
- Department of Anesthesiology, Burn and Critical Care, St-Louis-Lariboisiere University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- INSERM, UMR-942, Paris, France
| | - Fabrice Vallée
- Department of Anesthesiology, Burn and Critical Care, St-Louis-Lariboisiere University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- Laboratoire de Mécanique des Solides (LMS), Ecole Polytechnique/CNRS/Institut Polytechnique de Paris, France
- INSERM, UMR-942, Paris, France
| | - Jérôme Cartailler
- Department of Anesthesiology, Burn and Critical Care, St-Louis-Lariboisiere University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- INSERM, UMR-942, Paris, France
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Cartailler J, Touchard C, Parutto P, Gayat E, Paquet C, Vallée F. Brain fragility among middle-aged and elderly patients from electroencephalogram during induction of anaesthesia. Eur J Anaesthesiol 2021; 38:1304-1306. [PMID: 34735402 PMCID: PMC8635248 DOI: 10.1097/eja.0000000000001524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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