Comparison of changes in electroencephalographic measures during induction of general anaesthesia: influence of the gamma frequency band and electromyogram signal.
Recent research has shown that high-frequency, gamma-band electroencephalographic (EEG) oscillations (40-60 Hz) may be an important marker of the conscious state. We compared the ability of the bispectral index (BIS) to distinguish the awake and anaesthetized states during the induction of general anaesthesia with: (i) components of the BIS (BetaRatio, SynchFastSlow); (ii) a new EEG variable--the median frequency of the first time derivative of the EEG signal (SE50d); and (iii) the SE50d derived from an EEG signal that has had the frequencies above 30 Hz removed (SE50d(30Hz)). Two groups of subjects were studied: (i) nine volunteers undergoing a short propofol infusion until loss of response to verbal command, and (ii) 84 patients undergoing routine anaesthesia for a variety of surgical procedures. In the volunteer group, the changes in the BetaRatio and SE50d were comparable with changes in the BIS. The changes in the SE50d(30Hz) were less consistent. In the patient group, the BIS components were equivalent to the BIS in separating the awake from the surgically anaesthetized states (area under receiver operating curve: BIS 0.95, SE50d 0.95, BetaRatio 0.96). Using the submental electromyogram (EMG) signal to estimate the frontalis EMG (30-47 Hz) signal, the changes in EMG signal were, on average, about one-tenth the magnitude of the EEG. We conclude that: (i) there exist simpler derived EEG variables that are similar in accuracy to the BIS; (ii) it is important to avoid filtering out the EEG frequencies above 30 Hz; and (iii) in most patients the confounding effects of the frontalis EMG on the EEG are minimal.
Sleigh
J W
JW
Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand.
Steyn-Ross
D A
DA
Steyn-Ross
M L
ML
Williams
M L
ML
Smith
P
P
D000328:Adult; D000368:Aged; D018681:Anesthetics, General / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000494:pharmacology; D003243:Consciousness / Q000187:drug effects; D004569:Electroencephalography / Q000187:drug effects* / Q000379:methods; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011237:Predictive Value of Tests; D015742:Propofol / Q000494:pharmacology; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted
D018681:Anesthetics, General; D018686:Anesthetics, Intravenous; D015742:Propofol