Top

Journal of Clinical Monitoring and Computing

Published in:

01-12-2021 | Remifentanil | Letter to the Editor

Loss of spectral alpha power during spine surgery: what could be wrong?

Authors: Francisco A Lobo, Susana Vacas, Marusa Naranjo

Published in: Journal of Clinical Monitoring and Computing | Issue 6/2021

Abstract

The electroencephalographic signatures of anesthetic drugs relate to a specific set of action mechanisms within the neural circuits. During intraoperative care, the recognition and correct interpretation of the EEG spectrogram can be used as a tool to guide anesthetic administration. For example, loss of alpha power during propofol anesthesia may be a sign of lighter level of hypnosis and/or of an increase in nociceptive inputs. We describe a case report of inadvertent interruption of propofol delivery that was first detected by changes in the electroencephalogram spectrogram.

Struys MM, De Smet T, Depoorter B, et al. Comparison of plasma compartment versus two methods for effect compartment–controlled target-controlled infusion for propofol. Anesthesiology. 2000;92(2):399–406. doi:https://doi.org/10.1097/00000542-200002000-00021.CrossRefPubMed

Hannivoort LN, Eleveld DJ, Proost JH, et al. Development of an optimized pharmacokinetic model of dexmedetomidine using target-controlled infusion in healthy volunteers. Anesthesiology. 2015;123(2):357–67. doi:https://doi.org/10.1097/aln.0000000000000740.CrossRefPubMed

Colin PJ, Hannivoort LN, Eleveld DJ, et al. Dexmedetomidine pharmacokinetic-pharmacodynamic modelling in healthy volunteers: 1. Influence of arousal on bispectral index and sedation. Br Anaesth. 2017;119(2):200–10. doi:https://doi.org/10.1093/bja/aex085.CrossRef

Minto CF, Schnider TW, Egan TD, et al. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. I. Model Development. Anesthesiology. 1997;86(1):10–23. doi:https://doi.org/10.1097/00000542-199701000-00004.CrossRefPubMed

Minto CF, Schnider TW, Shafer SL. Pharmacokinetics and pharmacodynamics of remifentanil II. model application. Anesthesiology. 1997;86(1):24–33. https://doi.org/10.1997/00000542-199701000-00005.CrossRefPubMed

Brice DD, Hetherington RR, Utting JE. A simple study of awareness and dreaming during anaesthesia. Br J Anaesth. 1970;42(6):535–42. doi:https://doi.org/10.1093/bja/42.6.535.CrossRefPubMed

Purdon PL, Sampson A, Pavone KJ, Brown EN. Clinical electroencephalography for anesthesiologists: part I: background and basic signatures. Anesthesiology. 2015;123(4):937–60. https://doi.org/10.1097/aln.0000000000000841.CrossRefPubMed

Lobo FA, Shander A. Modern Anesthetic Noninvasive Monitoring: A Deep Look into Perioperative Care. J Cardiothorac Vasc Anesth. 2019;33(Suppl 1):1-s2. doi:https://doi.org/10.1053/j.jvca.2019.03.037.CrossRef

Montupil J, Defresne A, Bonhomme V. The Raw and Processed Electroencephalogram as a Monitoring and Diagnostic Tool. J Cardiothorac Vasc Anesth. 2019;33(Suppl 1):3-s10. doi:https://doi.org/10.1053/j.jvca.2019.03.038.CrossRef

10.

Borland D, Taylor MR Rainbow color map (still) considered harmful. IEEE Comput Graph Appl. 2007;27(2):14–7. https://doi.org/10.1109/mcg.2007.323435.CrossRefPubMed

11.

Mullen KT. The contrast sensitivity of human colour vision to red-green and blue-yellow chromatic gratings. J Physiol. 1985;359:381–400. doi:https://doi.org/10.1113/jphysiol.1985.sp015591.CrossRefPubMedPubMedCentral

12.

Bombardieri AM, Wildes TS, Stevens T, et al. Practical training of anesthesia clinicians in electroencephalogram-based determination of hypnotic depth of general anesthesia. Anesth Analg. 2020;130(3):777–86. https://doi.org/10.1213/ane.0000000000004537.CrossRefPubMed

13.

Purdon PL, Pierce ET, Mukamel EA, et al. Electroencephalogram signatures of loss and recovery of consciousness from propofol. Proc Natl Acad Sci USA. 2013;110(12):E1142-51. doi:https://doi.org/10.1073/pnas.1221180110.CrossRefPubMed

14.

Gutiérrez R, Maldonado F, Egaña JI, Penna A. Electroencephalographic alpha and delta oscillation dynamics in response to increasing doses of propofol. J Neurosurg Anesthesiol. 2020. https://doi.org/10.1097/ana.0000000000000733.CrossRef

15.

Akeju O, Pavone KJ, Westover MB, et al. A comparison of propofol- and dexmedetomidine-induced electroencephalogram dynamics using spectral and coherence analysis. Anesthesiology. 2014;121(5):978–89. doi:https://doi.org/10.1097/ALN.0000000000000419.CrossRefPubMed

16.

Akeju O, Kim SE, Vasquez R, et al. Spatiotemporal dynamics of dexmedetomidine-induced electroencephalogram oscillations. PLoS One. 2016;11(10):e0163431. doi:https://doi.org/10.1371/journal.pone.0163431.CrossRefPubMedPubMedCentral

17.

Brown EN, Pavone KJ, Naranjo M. Multimodal general anesthesia: theory and practice. Anesth Analg. 2018;127(5):1246–58. https://doi.org/10.1213/ane.0000000000003668.CrossRefPubMedPubMedCentral

18.

Park HY, Kim JY, Cho SH, Lee D, Kwak HJ. The effect of low-dose dexmedetomidine on hemodynamics and anesthetic requirement during bis-spectral index-guided total intravenous anesthesia. J Clin Monit Comput Aug. 2016;30(4):429–35. doi:https://doi.org/10.1007/s10877-015-9735-2.CrossRef

19.

You HJ, Lei J, Xiao Y, et al. Pre-emptive analgesia and its supraspinal mechanisms: enhanced descending inhibition and decreased descending facilitation by dexmedetomidine. J Physiol. 2016;594(7):1875–90. doi:https://doi.org/10.1113/jp271991.CrossRefPubMedPubMedCentral

20.

Hight DF, Gaskell AL, Kreuzer M, et al. Transient electroencephalographic alpha power loss during maintenance of general anaesthesia. Br J Anaesth. 2019;122(5):635–42. doi:https://doi.org/10.1016/j.bja.2018.11.029.CrossRefPubMed

21.

García PS, Kreuzer M, Hight D, et al. Effects of noxious stimulation on the electroencephalogram during general anaesthesia: a narrative review and approach to analgesic titration. Br J Anaesth. 2021;126(2):445–57. doi:https://doi.org/10.1016/j.bja.2020.10.036.CrossRefPubMed

22.

Niu K, Guo C, Han C, Teng S. Equipment failure of intravenous syringe pump detected by increase in Narcotrend stage: A case report. Medicine (Baltimore) Nov. 2018;97(47):e13174. doi:https://doi.org/10.1097/md.0000000000013174.CrossRef

Title: Loss of spectral alpha power during spine surgery: what could be wrong?
Authors: Francisco A Lobo
Susana Vacas
Marusa Naranjo
Publication date: 01-12-2021
Publisher: Springer Netherlands
Keywords: Remifentanil
Propofol
Published in: Journal of Clinical Monitoring and Computing / Issue 6/2021
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI: https://doi.org/10.1007/s10877-021-00720-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Loss of spectral alpha power during spine surgery: what could be wrong?

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2021

Mitochondrial oxygen monitoring with COMET: verification of calibration in man and comparison with vascular occlusion tests in healthy volunteers

Laser speckle contrast imaging of forehead cutaneous blood flow during carotid endarterectomy as a potential non-invasive method for surrogate monitoring of cerebral perfusion

Non-contact thermography-based respiratory rate monitoring in a post-anesthetic care unit

Non-linear regression analysis for estimating the intraoperative motor evoked potential recovery time after bolus neuromuscular blockade

Using near-infrared spectroscopy myocardial oximetry to monitor myocardial oxygen balance in a swine model of cardiac surgery: a descriptive study

A mathematical model for predicting intracranial pressure based on noninvasively acquired PC-MRI parameters in communicating hydrocephalus