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Frontal electroencephalogram reveals emergence-like brain activity occurring during transition periods in cardiac surgery

脑电图 医学 心脏外科 过渡(遗传学) 神经科学 心理学 心脏病学 生物 基因 生物化学
作者
Heiko A. Kaiser,Marie Peus,Markus M. Luedi,Friedrich Lersch,Vladimír Krejčí,David Reineke,Jamie Sleigh,Darren Hight
出处
期刊:BJA: British Journal of Anaesthesia [Elsevier BV]
卷期号:125 (3): 291-297 被引量:13
标识
DOI:10.1016/j.bja.2020.05.064
摘要

BackgroundCardiac surgery has one of the highest incidences of intraoperative awareness. The periods of initiation and discontinuation of cardiopulmonary bypass could be high-risk periods. Certain frontal EEG patterns might plausibly occur with unintended intraoperative awareness. This study sought to quantify the incidence of these pre-specified patterns during cardiac surgery.MethodsTwo-channel bihemispheric frontal EEG was recorded in 1072 patients undergoing cardiac surgery as part of a prospective observational study. Spectrograms were created, and mean theta (4–7 Hz) power and peak alpha (7–17 Hz) frequency were measured in patients under general anaesthesia with isoflurane. Emergence-like EEG activity in the spectrogram during surgery was classified as an alpha peak frequency increase by 2 Hz or more, and a theta power decrease by 5 dB or more in comparison with the median pre-bypass values.ResultsData from 1002 patients were available for analysis. Fifty-five of those patients (5.5%) showed emergence-like EEG activity at least once during surgery with a median duration of 13.2 min. These patients were younger (median age, 59 vs 67 yr; P<0.001) and the median end-tidal isoflurane concentration before cardiopulmonary bypass was higher (0.82 vs 0.75 minimum alveolar concentration [MAC]; P=0.013). There was no significant difference between those with or without emergence-like EEG activity in sex, lowest core temperature, or duration of surgery. Forty-six of these EEG changes (84%) occurred within a 1 h time window centred on separation from cardiopulmonary bypass.ConclusionThe findings of this study suggest that approximately one in 20 patients undergoing cardiac surgery with a volatile anaesthetic agent have a sustained EEG pattern while surgery is ongoing that is often seen with emergence from general anaesthesia. Monitoring the frontal EEG during cardiopulmonary bypass may identify these events and potentially reduce the incidence of unintended awareness.Clinical trial registrationNCT 02976584.
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