Do Complexity Measures of Frontal EEG Distinguish Loss of Consciousness in Geriatric Patients Under Anesthesia?
Do Complexity Measures of Frontal EEG Distinguish Loss of Consciousness in Geriatric Patients Under Anesthesia?
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DOI：
10.3389/fnins.2018.00645
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发表时间：
2018
影响因子：
4.3
通讯作者：
MacIver MB
中科院分区：
文献类型：
--
作者：
Eagleman SL;Vaughn DA;Drover DR;Drover CM;Cohen MS;Ouellette NT;MacIver MB
虽然老年患者需要麻醉的可能性很高，但他们因使用麻醉而产生不良认知结果的风险增加。先前的研究表明，可以通过使用几种处理脑电图（EEG）测量定义的指标进行更好的术中监测来减轻这种情况。不幸的是，在目前的分析技术中，患者和麻醉剂之间的不一致性限制了脑电图作为标准护理的采用。在尝试确定区分临床相关麻醉时间点的新分析时，我们测试了1/f频率缩放以及非线性动力学的复杂性度量。具体来说，我们测试了表征延迟嵌入、相关维数（CD）、相空间几何分析和多尺度熵（MSE）的分析是否能捕捉到脑电图活动中意识丧失的变化。我们对从传统上难以监测的患者人群收集的脑电图活动进行了这些分析：使用芬太尼和异丙酚联合麻醉的β -肾上腺素能阻滞剂的老年患者。我们将这些分析与传统的频率衍生测量方法进行比较，以测试它们在对言语刺激失去反应之前和之后区分脑电图状态的能力。我们发现频谱变化与先前报道的在反应丧失期间相似。我们还发现了1/f频率缩放的显著变化。此外，我们发现延迟嵌入的相空间几何特征在响应丢失之前和之后显示出显着差异，MSE的测量也是如此。我们的研究结果表明，我们的新频谱和复杂性测量能够捕捉麻醉给药时脑电图活动的细微差异，这些差异可能会在未来的工作中揭示出来，以改善老年患者的监测。
While geriatric patients have a high likelihood of requiring anesthesia, they carry an increased risk for adverse cognitive outcomes from its use. Previous work suggests this could be mitigated by better intraoperative monitoring using indexes defined by several processed electroencephalogram (EEG) measures. Unfortunately, inconsistencies between patients and anesthetic agents in current analysis techniques have limited the adoption of EEG as standard of care. In attempts to identify new analyses that discriminate clinically-relevant anesthesia timepoints, we tested 1/f frequency scaling as well as measures of complexity from nonlinear dynamics. Specifically, we tested whether analyses that characterize time-delayed embeddings, correlation dimension (CD), phase-space geometric analysis, and multiscale entropy (MSE) capture loss-of-consciousness changes in EEG activity. We performed these analyses on EEG activity collected from a traditionally hard-to-monitor patient population: geriatric patients on beta-adrenergic blockade who were anesthetized using a combination of fentanyl and propofol. We compared these analyses to traditional frequency-derived measures to test how well they discriminated EEG states before and after loss of response to verbal stimuli. We found spectral changes similar to those reported previously during loss of response. We also found significant changes in 1/f frequency scaling. Additionally, we found that our phase-space geometric characterization of time-delayed embeddings showed significant differences before and after loss of response, as did measures of MSE. Our results suggest that our new spectral and complexity measures are capable of capturing subtle differences in EEG activity with anesthesia administration—differences which future work may reveal to improve geriatric patient monitoring.
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