title: EEG Predicts movement response to surgical stimuli during general anesthesia with combinations of isoflurane, 70% N2O, and fentanyl.
abstract: OBJECTIVE
  Our objective was to evaluate the performance of the EEG as an indicator of anesthetic depth by measuring EEG prediction of movement response to surgical stimuli.
  
  
  METHODS
  While using 5 different combinations of isoflurane, 70% N2O, and fentanyl, we measured the EEG of 246 patients during pelvic laparoscopy and observed their movement responses to opening stimuli (defined as skin incision, CO2 needle insertion, or trocar insertion) and also to closing stimuli (defined as sutures during incision closure). The EEG was expressed as F95, the frequency in hertz below which resides 95% of the power in the EEG frequency spectrum. The relations between F95 and movement response were expressed as logistic regression curves. F95-response logistic regression curves, which are analogous to dose-response curves, were calculated for each of the 2 stimuli administered during each of the 5 anesthetic techniques. The prediction of patient responsiveness by F95 was tested using beta (beta), a measure of the slope of an F95-response logistic curve. The presence of shifts among the F95-response logistic curves was tested using the differences in F95 values between curves. Hypothesis tests used a level of significance of P = 0.05.
  
  
  RESULTS
  The slopes of the F95-response logistic regression curves showed a statistically significant ability to predict movement response to stimuli for 9 of the 10 combinations of stimuli and anesthetic techniques. We did not calculate an F95-response logistic curve for the tenth combination because it contained burst suppression, which our EEG analysis method was not designed to process. The F95-response logistic curves were shifted relative to each other, and the shifts were affected by the type of stimulus and the combination of anesthetic agents. Referenced to opening curves, the mean shift of the closing curves was +4.2 +/- 0.3 Hz (mean +/- SD). With increasing doses of fentanyl, the use of 70% N2O, or both, the curves shifted to higher values of F95; the range in shifts was 0.2 to 8.1 Hz. The slope beta values of the F95-response logistic curves and the shifts among the curves were similar to the beta values and shifts that might be expected from changes in anesthetic agent doses.
  
  
  CONCLUSIONS
  The EEG, expressed as F95, predicted movement response to surgical stimuli during combinations of isoflurane, 70% N2O, and fentanyl. The F95-response curves shifted upward on the frequency scale for the less intense stimuli and for anesthetic techniques using 70% N2O, fentanyl, or both. F95 prediction of movement response appeared to be related to anesthetic agent doses. Our F95-response curves may provide helpful guidelines for using F95 to titrate the administration of anesthetic agents and for assessing the depth of general anesthesia.
authors.affiliation: Department of Anesthesia, Kaiser Permanente Medical Center, Hayward, CA 94545, USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Dutton
authors.forename: W D
authors.initials: WD
authors.lastname: Smith
authors.forename: N T
authors.initials: NT
authors.lastname: Smith
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000379:methods; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D004569:Electroencephalography; D005260:Female; D005283:Fentanyl; D006801:Humans; D007530:Isoflurane; D010535:Laparoscopy; D016015:Logistic Models; D016343:Monitoring, Intraoperative; D009609:Nitrous Oxide; D010812:Physical Stimulation; D011237:Predictive Value of Tests
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D007530:Isoflurane; D009609:Nitrous Oxide; D005283:Fentanyl