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Clin Neurophysiol. 2019 Jan;130(1):55-60. doi: 10.1016/j.clinph.2018.11.003. Epub 2018 Nov 16.

Electroencephalogram dynamics during general anesthesia predict the later incidence and duration of burst-suppression during cardiopulmonary bypass.

Author information

1
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Tufts University School of Medicine, Boston, MA, USA.
2
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
3
Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
4
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: oluwaseun.akeju@mgh.harvard.edu.

Abstract

OBJECTIVE:

Electroencephalogram burst-suppression during general anesthesia is associated with post-operative delirium (POD). Whether burst-suppression causes POD or merely reflects susceptibility to POD is unclear. We hypothesized decreased intraoperative alpha (8-12 Hz) and beta (13-33 Hz) power prior to the occurrence of burst-suppression in susceptible patients.

METHODS:

We analyzed intraoperative electroencephalogram data of cardiac surgical patients undergoing cardiopulmonary bypass (CPB). We detected the incidence and duration of CPB burst-suppression with an automated burst-suppression detection algorithm. We analyzed EEG data with multitaper spectral estimation methods. We assessed associations between patient characteristics and burst-suppression using Binomial and Zero-inflated Poisson Regression Models.

RESULTS:

We found significantly decreased alpha and beta power (7.8-22.95 Hz) in the CPB burst-suppression cohort. The odds ratio for the association between point estimates for alpha and beta power (7.8-22.95 Hz) and the incidence of burst-suppression was 0.88 (95% CI: 0.79-0.98). The incidence rate ratio for the association between point estimates for power between the alpha and beta range and the duration of burst-suppression was 0.89 (95% CI: 0.84-0.93).

CONCLUSION:

Decreased intra-operative power within the alpha and beta range was associated with susceptibility to burst-suppression during CPB.

SIGNIFICANCE:

This dynamic may be used to develop principled neurophysiological-based approaches to aid the preemptive identification and targeted care of POD vulnerable patients.

KEYWORDS:

Burst-suppression; EEG oscillations, alpha and beta oscillations; General anesthesia; Post-operative delirium

PMID:
30476711
PMCID:
PMC6377070
[Available on 2020-01-01]
DOI:
10.1016/j.clinph.2018.11.003

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