Slow EEG-power spectra correlate with haemodynamic changes during laryngoscopy and intubation following induction with fentanyl or sufentanil.
We studied nociception-associated arousal following laryngoscopy and intubation in patients scheduled for elective open heart surgery, using EEG power spectra and hemodynamics. Either fentanyl (7 micrograms/kg; n = 30) or sufentanil (1 microgram/kg; n = 30) were given in a randomized fashion to induce anesthesia in heavily premedicated patients, followed by pancuronium bromide (100 micrograms/kg). EEG-power spectra (delta, theta, alpha, beta) as well as mean arterial blood pressure (MAP) and heart rate (HF) were measured at the following end-points: before the induction of anesthesia (control), 1 and 10 minutes after laryngoscopy and intubation (L & I). Linear regression analysis was computed to determine which of the EEG power spectra was most sensitive to detect insufficient blockade of nociceptive-related arousal when correlated with haemodynamics. In the fentanyl group the change in HF closely correlated with the decrease of power in the slow delta- and theta-domain (r2 = 0.98 and r2 = 0.89 respectively) of the EEG. The change in MAP also closely correlated with a decrease in the slow delta- and theta-domain (r2 = 0.97 and r2 = 0.99 respectively). There was little correlation in regard to spectral edge frequency (SEF) and HF and MAP changes (r2 = 0.36 and r2 = 0.12 respectively). In the sufentanil group the change in HF correlated closely with an increase of power in the fast alpha and a decrease in the slow theta-domain (r2 = 0.91 and r2 = 0.98 respectively) of the EEG. The changes in MAP closely correlated with an increase in the fast alpha-band a decrease in the slow theta-domain (r2 = 0.98 and r2 = 0.73 respectively). Also there was little correlation of SEF with HF and MAP changes (r2 = 0.09 and r2 = 0.02 respectively). Among the EEG-spectra, reduction of power in the slow delta- and theta-bands are the most sensitive parameters to determine insufficient antinociception of opioids commonly used for the induction in cardiac anesthesia. Increase of power in the alpha-band seems to be closely correlated with cortical reactivation and reduction of hypnosis, while a reduction of power especially in the deltabut more so in the theta-band of the EEG reflects nociception related arousal.
Department of Vascular Surgery and Kidney Transplantation, Heinrich-Heine-University Clinics of Düsseldorf, Germany.
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Freye
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Dehnen-Seipel
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Latasch
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Behler
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Wilder-Smith
D000513:Alpha Rhythm / Q000187:drug effects; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001143:Arousal / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects*; D001026:Coronary Artery Bypass; D003700:Delta Rhythm / Q000187:drug effects; D004569:Electroencephalography / Q000187:drug effects*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006339:Heart Rate / Q000187:drug effects*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D009619:Nociceptors / Q000187:drug effects; D010197:Pancuronium / Q000008:administration & dosage; D011229:Preanesthetic Medication; D011446:Prospective Studies; D017409:Sufentanil / Q000008:administration & dosage*; D013826:Theta Rhythm / Q000187:drug effects
D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D017409:Sufentanil; D010197:Pancuronium; D005283:Fentanyl