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Lichtenfeld F, Kratzer S, Hinzmann D, García PS, Schneider G, Kreuzer M. The Influence of Electromyographic on Electroencephalogram-Based Monitoring: Putting the Forearm on the Forehead. Anesth Analg 2024; 138:1285-1294. [PMID: 37756246 DOI: 10.1213/ane.0000000000006652] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND Monitoring the electroencephalogram (EEG) during general anesthesia can help to safely navigate the patient through the procedure by avoiding too deep or light anesthetic levels. In daily clinical practice, the EEG is recorded from the forehead and available neuromonitoring systems translate the EEG information into an index inversely correlating with the anesthetic level. Electrode placement on the forehead can lead to an influence of electromyographic (EMG) activity on the recorded signal in patients without neuromuscular blockade (NMB). A separation of EEG and EMG in the clinical setting is difficult because both signals share an overlapping frequency range. Previous research showed that indices decreased when EMG was absent in awake volunteers with NMB. Here, we investigated to what extent the indices changed, when EEG recorded during surgery with NMB agents was superimposed with EMG. METHODS We recorded EMG from the flexor muscles of the forearm of 18 healthy volunteers with a CONOX monitor during different activity settings, that is, during contraction using a grip strengthener and during active diversion (relaxed arm). Both the forehead and forearm muscles are striated muscles. The recorded EMG was normalized by z -scoring and added to the EEG in different amplification steps. The EEG was recorded during anesthesia with NMB. We replayed these combined EEG and EMG signals to different neuromonitoring systems, that is, bispectral index (BIS), CONOX with qCON and qNOX, and entropy module with state entropy (SE) and response entropy (RE). We used the Friedman test and a Tukey-Kramer post hoc correction for statistical analysis. RESULTS The indices of all neuromonitoring systems significantly increased when the EEG was superimposed with the contraction EMG and with high EMG amplitudes, the monitors returned invalid values, representative of artifact contamination. When replaying the EEG being superimposed with "relaxed" EMG, the qCON and BIS showed significant increases, but not SE and RE. For SE and RE, we observed an increased number of invalid values. CONCLUSIONS With our approach, we could show that EMG activity during contraction and resting state can influence the neuromonitoring systems. This knowledge may help to improve EEG-based patient monitoring in the future and help the anesthesiologist to use the neuromonitoring systems with more knowledge regarding their function.
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Affiliation(s)
- Felicitas Lichtenfeld
- From the Department of Anesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine, Munich, Germany
| | - Stephan Kratzer
- From the Department of Anesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine, Munich, Germany
- Department of Anesthesia and Intensive Care Medicine, Hessing Foundation, Augsburg, Germany
| | - Dominik Hinzmann
- From the Department of Anesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine, Munich, Germany
| | - Paul S García
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Gerhard Schneider
- From the Department of Anesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine, Munich, Germany
| | - Matthias Kreuzer
- From the Department of Anesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine, Munich, Germany
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Kim EH, Jang YE, Ji SH, Lee JH, Cho SA, Kim JT, Yoon H, Kim HS. Changes in Plasma Glial Fibrillary Acidic Protein in Children Receiving Sevoflurane Anesthesia: A Preliminary Randomized Trial. J Clin Med 2021; 10:662. [PMID: 33572213 PMCID: PMC7915437 DOI: 10.3390/jcm10040662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/28/2021] [Accepted: 02/07/2021] [Indexed: 11/18/2022] Open
Abstract
We investigated changes in plasma glial fibrillary acidic protein concentration during sevoflurane anesthesia induction in children < 3 years old and determined the effect of co-administering dexmedetomidine. This preliminary randomized trial included 60 pediatric patients who received sevoflurane anesthesia for >3 h. Patients were assigned to dexmedetomidine or control groups at a 1:1 ratio. The primary outcome was changes in plasma glial fibrillary acidic protein concentration of dexmedetomidine and control groups over time. Fifty-five patients were included in the final analysis. The median (interquartile range (IQR)) of the plasma glial fibrillary acidic protein level was 387.7 (298.9-510.8) pg·mL-1 immediately after anesthetic induction, 302.6 (250.9-412.5) pg·mL-1 at 30 min, and 321.9 (233.8-576.2) pg·mL-1 at 180 min after the first sample. These values did not change over time (p = 0.759). However, plasma glial fibrillary acidic protein increased after 180 min of infusion of dexmedetomidine compared with values at 30 min infusion (p = 0.04, mean difference and 95% confidence interval of 221.6 and 2.2 to 441.0 pg·mL-1). In conclusion, three hours of sevoflurane anesthesia in pediatric patients < 3 years old did not provoke neuronal injury assessed by the plasma biomarker. Further studies regarding the effect of prolonged dexmedetomidine infusion on anesthetic neuronal injury are required.
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Affiliation(s)
- Eun-Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; (E.-H.K.); (Y.-E.J.); (S.-H.J.); (J.-H.L.); (S.-A.C.); (J.-T.K.)
| | - Young-Eun Jang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; (E.-H.K.); (Y.-E.J.); (S.-H.J.); (J.-H.L.); (S.-A.C.); (J.-T.K.)
| | - Sang-Hwan Ji
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; (E.-H.K.); (Y.-E.J.); (S.-H.J.); (J.-H.L.); (S.-A.C.); (J.-T.K.)
| | - Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; (E.-H.K.); (Y.-E.J.); (S.-H.J.); (J.-H.L.); (S.-A.C.); (J.-T.K.)
| | - Sung-Ae Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; (E.-H.K.); (Y.-E.J.); (S.-H.J.); (J.-H.L.); (S.-A.C.); (J.-T.K.)
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; (E.-H.K.); (Y.-E.J.); (S.-H.J.); (J.-H.L.); (S.-A.C.); (J.-T.K.)
| | - Hyunyee Yoon
- Protein Immunology Core Facility, Biomedical Research Institute, Seoul National University Hospital, Seoul 03082, Korea;
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; (E.-H.K.); (Y.-E.J.); (S.-H.J.); (J.-H.L.); (S.-A.C.); (J.-T.K.)
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Stasiowski MJ, Duława A, Król S, Marciniak R, Kaspera W, Niewiadomska E, Krawczyk L, Ładziński P, Grabarek BO, Jałowiecki P. Polyspikes and Rhythmic Polyspikes During Volatile Induction of General Anesthesia With Sevoflurane Result in Bispectral Index Variations. Clin EEG Neurosci 2020; 54:289-304. [PMID: 33241952 DOI: 10.1177/1550059420974571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although electroencephalography (EEG)-based indices may show artifactual values, raw EEG signal is seldom used to monitor the depth of volatile induction of general anesthesia (VIGA). The current analysis aimed to identify whether bispectral index (BIS) variations reliably reflect the actual depth of general anesthesia during presence of different types of epileptiform patterns (EPs) in EEGs during induction of general anesthesia. METHODS Sixty patients receiving either VIGA with sevoflurane using increasing concentrations (group VIMA) or vital capacity (group VCRII) technique or intravenous single dose of propofol (group PROP) were included. Monitoring included facial electromyography (fEMG), fraction of inspired sevoflurane (FiAA), fraction of expired sevoflurane (FeAA), minimal alveolar concentration (MAC) of sevoflurane, BIS, standard EEG, and hemodynamic parameters. RESULTS In the PROP group no EPs were observed. During different stages of VIGA with sevoflurane in the VIMA and VCRII groups, presence of polyspikes and rhythmic polyspikes in patients' EEGs resulted in artifactual BIS values indicating a false awareness/wakefulness from anesthesia, despite no concomitant change of FiAA, FeAA, and MAC of sevoflurane. Periodic epileptiform discharges did not result in aberrant BIS values. CONCLUSION Our results suggest that raw EEG correlate it with values of BIS, FiAA, FeAA, and MAC of sevoflurane during VIGA. It seems that because artifactual BIS values indicating false awareness/wakefulness as a result of presence of polyspikes and rhythmic polyspikes in patients' EEGs may be misleading to an anesthesiologist, leading to unintentional administration of toxic concentration of sevoflurane in ventilation gas.
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Affiliation(s)
- Michał J Stasiowski
- Department of Anesthesiology and Intensive Therapy, SMDZ in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Anna Duława
- Department of Anesthesiology and Intensive Care, Railway District Hospital Katowice, Medical University of Silesia, Katowice, Poland
| | - Seweryn Król
- Department of Anesthesiology and Intensive Therapy, SMDZ in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Radosław Marciniak
- Department of Anesthesiology and Intensive Therapy, SMDZ in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Wojciech Kaspera
- Department of Neurosurgery, Regional Hospital in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Ewa Niewiadomska
- Department of Epidemiology and Biostatistics, School of Public Health in Bytom, Medical University of Silesia, Katowice, Poland
| | - Lech Krawczyk
- Department of Anesthesiology and Intensive Therapy, SMDZ in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Piotr Ładziński
- Department of Neurosurgery, Regional Hospital in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Beniamin O Grabarek
- Department of Clinical Trials, Maria Sklodowska-Curie National Research Institute of Oncology Krakow Branch, Krakow, Poland.,Department of Histology, Cytophysiology and Embryology, Faculty of Medicine in Zabrze, University of Technology in Katowice, Zabrze, Poland
| | - Przemysław Jałowiecki
- Department of Anesthesiology and Intensive Therapy, SMDZ in Zabrze, Medical University of Silesia, Zabrze, Poland
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Stasiowski M, Duława A, Szumera I, Marciniak R, Niewiadomska E, Kaspera W, Krawczyk L, Ładziński P, Grabarek BO, Jałowiecki P. Variations in Values of State, Response Entropy and Haemodynamic Parameters Associated with Development of Different Epileptiform Patterns during Volatile Induction of General Anaesthesia with Two Different Anaesthetic Regimens Using Sevoflurane in Comparison with Intravenous Induct: A Comparative Study. Brain Sci 2020; 10:brainsci10060366. [PMID: 32545600 PMCID: PMC7349226 DOI: 10.3390/brainsci10060366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/27/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Raw electroencephalographic (EEG) signals are rarely used to monitor the depth of volatile induction of general anaesthesia (VIGA) with sevoflurane, even though EEG-based indices may show aberrant values. We aimed to identify whether response (RE) and state entropy (SE) variations reliably reflect the actual depth of general anaesthesia in the presence of different types of epileptiform patterns (EPs) in EEGs during induction of general anaesthesia. MATERIALS AND METHODS A randomized, prospective clinical study was performed with 60 patients receiving VIGA using sevoflurane with the increasing concentrations (group VIMA) or the vital capacity (group VCRII) technique or an intravenous single dose of propofol (group PROP). Facial electromyography (fEMG), fraction of inspired sevoflurane (FiAA), fraction of expired sevoflurane (FeAA), minimal alveolar concentration (MAC) of sevoflurane, RE and SE, and standard electroencephalographic evaluations were performed in these patients. RESULTS In contrast to periodic epileptiform discharges, erroneous SE and RE values in the patients' EEGs were associated with the presence of polyspikes (PS) and rhythmic polyspikes (PSR), which were more likely to indicate toxic depth rather than false emergence from anaesthesia with no changes in the FiAA, FeAA, and MAC of sevoflurane. CONCLUSION Calculated RE and SE values may be misleading during VIGA when EPs are present in patients' EEGs. During VIGA with sevoflurane, we recommend monitoring raw EEG data in scientific studies to correlate it with potentially erroneous RE and SE values and the end-tidal concentration of sevoflurane in everyday clinical practice, when monitoring raw EEG is not available, because they can mislead anaesthesiologists to reduce sevoflurane levels in the ventilation gas and result in unintentional true emergence from anaesthesia. Further studies are required to investigate the behaviour of EEG-based indices during rapid changes in sevoflurane concentrations at different stages of VIGA and the influence of polyspikes and rhythmic polyspikes on the transformation of EEG signals into a digital form.
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Affiliation(s)
- Michał Stasiowski
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (I.S.); (R.M.); (L.K.); (P.J.)
- Correspondence: ; Tel.: +48323682331
| | - Anna Duława
- Department of Anaesthesiology and Intensive Care, Railway District Hospital Katowice, 40-055 Katowice, Poland;
| | - Izabela Szumera
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (I.S.); (R.M.); (L.K.); (P.J.)
| | - Radosław Marciniak
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (I.S.); (R.M.); (L.K.); (P.J.)
| | - Ewa Niewiadomska
- Department of Epidemiology and Biostatistics, School of Public Health in Bytom, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Wojciech Kaspera
- Department of Neurosurgery, Regional Hospital in Sosnowiec, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (W.K.); (P.Ł.)
| | - Lech Krawczyk
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (I.S.); (R.M.); (L.K.); (P.J.)
| | - Piotr Ładziński
- Department of Neurosurgery, Regional Hospital in Sosnowiec, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (W.K.); (P.Ł.)
| | - Beniamin Oskar Grabarek
- Department of Clinical Trials, Maria Sklodowska-Curie National Research Institute of Oncology Krakow Branch, 31-115 Katowice, Poland;
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine in Zabrze, University of Technology in Katowice, 41-800 Zabrze, Poland
| | - Przemysław Jałowiecki
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (I.S.); (R.M.); (L.K.); (P.J.)
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Chung S, Hwang BY, Naveen MH, Shim YB. Detection of Rocuronium in Whole Blood Using a Lipid-bonded Conducting Polymer and Porous Carbon Composite Electrode. ELECTROANAL 2018. [DOI: 10.1002/elan.201800102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Saeromi Chung
- Department of Chemistry, Institute of BioPhysio Sensor Technology (IBST); Pusan National University; Busan 46241 Republic of Korea
| | - Boo-Young Hwang
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute; Pusan National University Hospital; Busan 49241 Republic of Korea
| | - M. H. Naveen
- Department of Chemistry, Institute of BioPhysio Sensor Technology (IBST); Pusan National University; Busan 46241 Republic of Korea
| | - Yoon-Bo Shim
- Department of Chemistry, Institute of BioPhysio Sensor Technology (IBST); Pusan National University; Busan 46241 Republic of Korea
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