Article (Scientific journals)
Frontal alpha-delta EEG does not preclude volitional response during anaesthesia: Prospective cohort study of the isolated forearm technique
Gaskell, A. L.; Hight, D. F.; Winders, J. et al.
2017In British Journal of Anaesthesia, 119 (4), p. 664-673
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Keywords :
EEG; Article; Belgium; New Zealand; United States
Abstract :
[en] Background The isolated forearm test (IFT) is the gold standard test of connected consciousness (awareness of the environment) during anaesthesia. The frontal alpha-delta EEG pattern (seen in slow wave sleep) is widely held to indicate anaesthetic-induced unconsciousness. A priori we proposed that one responder with the frontal alpha-delta EEG pattern would falsify this concept. Methods Frontal EEG was recorded in a subset of patients from three centres participating in an international multicentre study of IFT responsiveness following tracheal intubation. Raw EEG waveforms were analysed for power-frequency spectra, depth-of-anaesthesia indices, permutation entropy, slow wave activity saturation and alpha-delta amplitude-phase coupling. Results Volitional responses to verbal command occurred in six out of 90 patients. Three responses occurred immediately following intubation in patients (from Sites 1 and 2) exhibiting an alpha-delta dominant (delta power >20 dB, alpha power >10 dB) EEG pattern. The power-frequency spectra obtained during these responses were similar to those of non-responders (P>0.05) at those sites. A further three responses occurred in (Site 3) patients not exhibiting the classic alpha-delta EEG pattern; these responses occurred later relative to intubation, and in patients had been co-administered ketamine and less volatile anaesthetic compared with Site 1 and 2 patients. None of the derived depth-of-anaesthesia indices could robustly discrimate IFT responders and non-responders. Conclusions Connected consciousness can occur in the presence of the frontal alpha-delta EEG pattern during anaesthesia. Frontal EEG parameters do not readily discriminate volitional responsiveness (a marker of connected consciousness) and unresponsiveness during anaesthesia. Clinical trial registration NCT02248623 © The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Gaskell, A. L.;  Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand, Department of Anaesthesiology, Waikato Clinical School, Waikato Clinical Campus, University of Auckland, New Zealand
Hight, D. F.;  Department of Anaesthesiology, Waikato Clinical School, Waikato Clinical Campus, University of Auckland, New Zealand
Winders, J.;  Department of Anaesthesiology, Waikato Clinical School, Waikato Clinical Campus, University of Auckland, New Zealand
TRAN, Gabriel ;  Centre Hospitalier Universitaire de Liège - CHU > Service d'anesthésie - réanimation
DEFRESNE, Aline  ;  Centre Hospitalier Universitaire de Liège - CHU > Service d'anesthésie - réanimation
BONHOMME, Vincent  ;  Centre Hospitalier Universitaire de Liège - CHU > Département d'Anesthésie et réanimation > Service d'anesthésie - réanimation
Raz, A.;  Department of Anesthesiology, University of Wisconsin School of Medicine, Public Health University of Wisconsin, Madison, WI, United States, Department of Anesthesiology, Rambam Health Care Campus, Haifa, Israel
Sleigh, J. W.;  Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand, Department of Anaesthesiology, Waikato Clinical School, Waikato Clinical Campus, University of Auckland, New Zealand
Sanders, R. D.;  Department of Anesthesiology, University of Wisconsin School of Medicine, Public Health University of Wisconsin, Madison, WI, United States
Language :
English
Title :
Frontal alpha-delta EEG does not preclude volitional response during anaesthesia: Prospective cohort study of the isolated forearm technique
Publication date :
2017
Journal title :
British Journal of Anaesthesia
ISSN :
0007-0912
eISSN :
1471-6771
Publisher :
Oxford University Press
Volume :
119
Issue :
4
Pages :
664-673
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 25 June 2018

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