Remifentanil and Nitrous Oxide Anesthesia Produces a Unique Pattern of EEG Activity During Loss and Recovery of Response
Remifentanil and Nitrous Oxide Anesthesia Produces a Unique Pattern of EEG Activity During Loss and Recovery of Response
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DOI：
10.3389/fnhum.2018.00173
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发表时间：
2018-05-07
影响因子：
2.9
通讯作者：
MacIver, M. Bruce
中科院分区：
文献类型：
--
作者：
Eagleman, Sarah L.;Drover, Caitlin M.;MacIver, M. Bruce
氧化亚氮（N2O）和瑞芬太尼（remi）与其他麻醉剂和辅助剂一起沿着用于常规外科麻醉，但是由这种组合产生的脑电图（EEG）变化描述得很少。N2O单独给药产生的EEG频谱特征与大多数催眠药不同。此外，临床相关时间点之前和之后的EEG频率衍生趋势取决于N2O浓度。瑞芬太尼通常会增加EEG中的低频活动并减少高频活动，但它如何影响N2O的EEG效应尚不清楚。以前的尝试，以表征与N2O使用频率衍生的措施麻醉患者的EEG信号已显示出冲突和不一致。因此，除了确定这种独特的组合的频谱特性，我们还测试了是否一个新提出的表征的时间延迟嵌入的EEG信号跟踪意识的丧失和恢复显着在临床相关的时间点。我们回顾性研究了remi和N2O对32例接受择期腹部手术麻醉的手术患者记录的EEG信号的影响。瑞芬太尼和N2O（66%）在手术过程中同时给药。分别在诱导后和麻醉停止后测试患者对言语刺激的反应丧失和恢复（ROR）。我们发现，在N2O麻醉中加入瑞芬太尼可以提高传统的频率衍生测量方法（包括脑电双频指数（BIS））区分损失和ROR的能力。最后，我们发现，一种新的分析EEG使用非线性动力学状态之间的差异比大多数频谱措施更显着。
Nitrous oxide (N2O) and remifentanil (remi) are used along with other anesthetic and adjuvant agents for routine surgical anesthesia, yet the electroencephalogram (EEG) changes produced by this combination are poorly described. N2O administered alone produces EEG spectral characteristics that are distinct from most hypnotics. Furthermore, EEG frequency-derived trends before and after clinically relevant time points vary depending on N2O concentration. Remifentanil typically increases low frequency and decreases high frequency activity in the EEG, but how it influences N2O's EEG effect is not known. Previous attempts to characterize EEG signals of patients anesthetized with N2O using frequency-derived measures have shown conflicts and inconsistencies. Thus, in addition to determining the spectral characteristics of this unique combination, we also test whether a newly proposed characterization of time-delayed embeddings of the EEG signal tracks loss and recovery of consciousness significantly at clinically relevant time points. We retrospectively investigated the effects of remi and N2O on EEG signals recorded from 32 surgical patients receiving anesthesia for elective abdominal surgeries. Remifentanil and N2O (66%) were co-administered during the procedures. Patients were tested for loss and recovery of response (ROR) to verbal stimuli after induction and upon cessation of anesthesia, respectively. We found that the addition of remifentanil to N2O anesthesia improves the ability of traditional frequency-derived measures, including the Bispectral Index (BIS), to discriminate between loss and ROR. Finally, we found that a novel analysis of EEG using nonlinear dynamics showed more significant differences between states than most spectral measures.