Age-dependent electroencephalogram (EEG) patterns during sevoflurane general anesthesia in infants.
Age-dependent electroencephalogram (EEG) patterns during sevoflurane general anesthesia in infants.
复制标题
婴儿七氟硫素全身麻醉期间年龄依赖性的脑电图（EEG）模式。
DOI：
10.7554/elife.06513
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发表时间：
2015-06-23
期刊：
影响因子：
7.7
通讯作者：
Berde CB
中科院分区：
文献类型：
--
作者：
Cornelissen L;Kim SE;Purdon PL;Brown EN;Berde CB
脑电图（EEG）方法可能为全身麻醉期间脑状态动力学的发育变化提供重要信息。我们使用多电极脑电图，通过多 taper频谱方法分析，并结合身体运动的视频记录，对36名0 - 6个月的婴儿在清醒时以及七氟烷全身麻醉维持和苏醒期间的大脑活动时空动力学进行了表征。在麻醉维持期间：（1）所有年龄段都存在慢δ波振荡；（2）θ波和α波振荡在约4个月时出现；（3）与成年人不同，所有婴儿都缺乏额叶α波优势和相干性。与4 - 6个月婴儿清醒和苏醒时相比，α波功率在麻醉维持期间最大。在苏醒期间，4 - 6个月婴儿的θ波和α波功率随着七氟烷浓度降低而降低。这些脑电图动态差异可能是由于发育因素，包括整个大脑皮层突触发生、葡萄糖代谢和髓鞘形成的区域差异。我们证明了需要应用年龄调整的分析方法来制定基于神经生理学的儿科麻醉状态监测策略。
DOI: http://dx.doi.org/10.7554/eLife.06513.001
美国每年约有20万婴儿在出生后的第一年接受全身麻醉。虽然麻醉对于控制婴儿手术和其他医疗程序中的疼痛至关重要，但它也存在一些风险。有一些有争议的研究表明，生命早期反复接受麻醉可能会影响大脑发育，但其他研究则令人放心，未发现此类影响。为了降低风险，医生在婴儿接受麻醉时会仔细监测其血压、心率、体温和血氧水平。
脑电图已被证明是监测接受麻醉的成年人脑活动的有用工具，但研究发现基于脑电图的监测在接受麻醉的婴儿中不可靠。需要一种更可靠的方法来监测麻醉期间婴儿的大脑。然而，麻醉师需要更好地了解婴儿大脑在全身麻醉下的工作方式，新的脑电图技术有望用于监测不同年龄婴儿的大脑健康状况并调整麻醉剂量。
婴儿大脑对麻醉反应方式的差异可能解释了为什么目前为成年人开发的基于脑电图的监测方法在婴儿身上不如在成年人身上有效。现在，科内利森、金等人使用了一种新的基于脑电图的方法来证明随着婴儿大脑发育，其对麻醉的反应会发生变化。实验涉及36名年龄不超过6个月的婴儿，他们正在接受常规手术。通过放置在婴儿头皮上的电极，在婴儿清醒时、麻醉期间以及之后恢复时记录其大脑活动。同时对婴儿进行视频拍摄。将视频与脑电图记录进行比较，可以将婴儿的大脑活动与其意识状态相匹配。
科内利森、金等人在6个月以下接受麻醉的婴儿整个头皮上检测到脑活动的慢波。年龄大于约4个月的婴儿也显示出一些较快的脑波，随着婴儿从麻醉中苏醒，这些脑波的功率降低。然而，没有一个婴儿具有在成年人中看到的相同模式——即较快的脑波出现在大脑前部附近。这些发现可能有助于科学家开发更可靠的方法来监测麻醉期间婴儿的大脑。
DOI: http://dx.doi.org/10.7554/eLife.06513.002
Electroencephalogram (EEG) approaches may provide important information about developmental changes in brain-state dynamics during general anesthesia. We used multi-electrode EEG, analyzed with multitaper spectral methods and video recording of body movement to characterize the spatio-temporal dynamics of brain activity in 36 infants 0–6 months old when awake, and during maintenance of and emergence from sevoflurane general anesthesia. During maintenance: (1) slow-delta oscillations were present in all ages; (2) theta and alpha oscillations emerged around 4 months; (3) unlike adults, all infants lacked frontal alpha predominance and coherence. Alpha power was greatest during maintenance, compared to awake and emergence in infants at 4–6 months. During emergence, theta and alpha power decreased with decreasing sevoflurane concentration in infants at 4–6 months. These EEG dynamic differences are likely due to developmental factors including regional differences in synaptogenesis, glucose metabolism, and myelination across the cortex. We demonstrate the need to apply age-adjusted analytic approaches to develop neurophysiologic-based strategies for pediatric anesthetic state monitoring. DOI: http://dx.doi.org/10.7554/eLife.06513.001 Every year about 200,000 infants in the United States are given general anesthesia during their first year of life. Though anesthesia is essential to control pain during surgery and other medical procedures on infants, it involves some risks. There are some controversial studies suggesting that repeated anesthetics early in life may impact how the brain develops, but other studies have been reassuring and found no such effects. To reduce the risks, doctors carefully monitor infants' blood pressure, heart rate, body temperature, and oxygen levels while they are receiving anesthesia. Electroencephalograms (EEGs) have proven to be a useful tool for monitoring the brain activity of adults undergoing anesthesia, but studies have found EEG-based monitoring to be unreliable in infants under anesthesia. A more reliable method of monitoring the brains of infants during anesthesia is needed. Anesthesiologists nevertheless need to better understand how the infant's brain works under general anesthesia, and novel EEG techniques hold promise for monitoring brain well-being and for adjusting anesthetic dosing in infants of different ages. Differences in the way infants' brains respond to anesthesia may explain why current EEG-based monitoring methods developed for adults don't work as well in infants as in adults. Now, Cornelissen, Kim et al. have used a new EEG-based approach to demonstrate that as infants' brains develop, their responses to anesthesia change. The experiments involved 36 infants aged up to six months old who were going through routine surgical procedures. The brain activity of the infants was recorded using EEG—via electrodes placed on their scalps—when they were awake, during anesthesia, and as they recovered afterwards. The infants were videoed at the same time. Comparing the video with the EEG recordings allowed the brain activity of the infants to be matched up with their state of consciousness. Cornelissen, Kim et al. detected slow waves of brain activity across the entire scalp of infants who are under six months old and under anesthesia. Infants who are older than about four months old also display some faster brain waves, which decreased in power as the infants emerged from anesthesia. However, none of the infants has the same pattern seen in adults—where faster waves appear near the front of the brain. These findings may help scientists develop more reliable ways to monitor infants' brains during anesthesia. DOI: http://dx.doi.org/10.7554/eLife.06513.002