A comparison of median frequency, spectral edge frequency, a frequency band power ratio, total power, and dominance shift in the determination of depth of anesthesia.
Five numerical descriptors were derived from the electroencephalogram (EEG), recorded, and processed (Tracor Nomad) during emergence from isoflurane-nitrous oxide anesthesia. The five descriptors (median frequency, spectral edge frequency-90%, total power, a frequency band power ratio, and the ratio of frontal to occipital power) were compared for their ability to predict imminent arousal. Arousal was defined as spontaneous movement, coughing or eye opening. All of the descriptors except the frontal-occipital power ratio underwent significant (P less than 0.05) changes between the initial recordings made intraoperatively during surgical stimulus under anesthesia and later recordings in the 40 s preceding arousal. A post hoc analysis was performed to identify the threshold value for each parameter that best served to predict imminent arousal. For median frequency, spectral edge frequency-90%, total power, and the frequency band power ratio, thresholds that predicted imminent arousal with sensitivities of 90% and specificities of 82-90% could be identified. The data indicate that, even in the favorable circumstances of the present study (uniform anesthetic technique, post hoC identification of thresholds), none of several previously popularized EEG descriptors (median frequency, spectral edge frequency-90%, total power, a frequency band power ratio) can serve as a completely reliable sole predictor of imminent arousal. As presently derived, these EEG descriptors at best provide trend information to be used in concert with other clinical signs of depth of anesthesia.
Drummond
J C
JC
Department of Anesthesia, Veterans Administration Medical Center, San Diego, California.
Brann
C A
CA
Perkins
D E
DE
Wolfe
D E
DE
D000328:Adult; D000368:Aged; D000513:Alpha Rhythm; D000768:Anesthesia, General; D001143:Arousal / Q000502:physiology*; D001611:Beta Rhythm; D003243:Consciousness / Q000502:physiology; D003700:Delta Rhythm; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D005283:Fentanyl; D005625:Frontal Lobe / Q000502:physiology; D006801:Humans; D007530:Isoflurane; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009020:Morphine; D009609:Nitrous Oxide; D009778:Occipital Lobe / Q000502:physiology; D012680:Sensitivity and Specificity
D009020:Morphine; D007530:Isoflurane; D009609:Nitrous Oxide; D005283:Fentanyl