The Effects of Anesthetic Induced Loss of Consciousness on Quantitative Electroen Cephalogram, and Bispectral and Spectral Entropy Indices. Studies on Healthy Male

Changes in the electroencephalography (EEG) signal have been used to study the effects of anesthetic agents on the brain function. Several commercial EEG based anesthesia depth monitors have been developed to measure the level of the hypnotic component of anesthesia. Specific anesthetic related changes can be seen in the EEG, but still it remains difficult to determine whether the subject is consciousness or not during anesthesia. EEG reactivity to external stimuli may be seen in unconsciousness subjects, in anesthesia or even in coma. Changes in regional cerebral blood flow, which can be measured with positron emission tomography (PET), can be used as a surrogate for changes in neuronal activity. The aim of this study was to investigate the effects of dexmedetomidine, propofol, sevoflurane and xenon on the EEG and the behavior of two commercial anesthesia depth monitors, Bispectral Index (BIS) and Entropy. Slowly escalating drug concentrations were used with dexmedetomidine, propofol and sevoflurane. EEG reactivity at clinically determined similar level of consciousness was studied and the performance of BIS and Entropy in differentiating consciousness form unconsciousness was evaluated. Changes in brain activity during emergence from dexmedetomidine and propofol induced unconsciousness were studied using PET imaging. Additionally, the effects of normobaric hyperoxia, induced during denitrogenation prior to xenon anesthesia induction, on the EEG were studied. Dexmedetomidine and propofol caused increases in the low frequency, high amplitude (delta 0.5-4 Hz and theta 4.1-8 Hz) EEG activity during stepwise increased drug concentrations from the awake state to unconsciousness. With sevoflurane, an increase in delta activity was also seen, and an increase in alpha- slow beta (8.1-15 Hz) band power was seen in both propofol and sevoflurane. EEG reactivity to a verbal command in the unconsciousness state was best retained with propofol, and almost disappeared with sevoflurane. The ability of BIS and Entropy to differentiate consciousness from unconsciousness was poor. At the emergence from dexmedetomidine and propofol induced unconsciousness, activation was detected in deep brain structures, but not within the cortex. In xenon anesthesia, EEG band powers increased in delta, theta and alpha (8-12Hz) frequencies. In steady state xenon anesthesia, BIS and Entropy indices were low and these monitors seemed to work well in xenon anesthesia. Normobaric hyperoxia alone did not cause changes in the EEG. All of these results are based on studies in healthy volunteers and their application to clinical practice should be considered carefully.Siirretty Doriast

Depth of anaesthesia assessment based on time and frequency features of simplified electroencephalogram (EEG)

Anaesthesiology is a medical subject focusing on the use of drugs and other methods to deprive patients’ sensation for discomfort in painful medical diagnosis or treatment. It is important to assess the depth of anaesthesia (DoA) accurately since a precise as- sessment is helpful for avoiding various adverse reactions such as intraoperative awareness with recall (underdosage), prolonged recovery and an increased risk of post- operative complications for a patient (overdosage). Evidence shows that the depth of anaesthesia monitoring using electroencephalograph (EEG) improves patient treat- ment outcomes by reducing the incidences of intra-operative awareness, minimizing anaesthetic drug consumption and resulting in faster wake-up and recovery. For an accurate DoA assessment, intensive research has been conducted in finding 'an ulti- mate index', and various monitors and DoA algorithms were developed. Generally, the limitations of the existing DoA monitors or latest DoA algorithms include unsatis- factory data filtering techniques, time delay and inflexible. The focus of this dissertation is to develop reliable DoA algorithms for accurate DoA assessment. Some novel time-frequency domain signal processing techniques, which are better suited for non-stationary EEG signals than currently established methods, have been proposed and applied to monitor the DoA based on simplified EEG signals based on plenty of programming work (including C and other programming language). The fast Fourier transform (FFT) and the discrete wavelet transforms are applied to pre-process EEG data in the frequency domain. The nonlocal mean, mobility, permu- tation entropy, Lempel-Ziv complexity, second order difference plot and interval feature extraction methods are modified and applied to investigate the scaling behaviour of the EEG in the time domain. We proposed and developed three new indexes for identifying, classifying and monitoring the DoA. The new indexes are evaluated by comparing with the most popular BIS index. Simulation results demonstrate that our new methods monitor the DoA in all anaesthesia states accurately. The results also demonstrate the advantages of proposed indexes in the cases of poor signal quality and the consistency with the anaesthetists’ records. These new indexes show a 3.1-59.7 seconds earlier time response than BIS during the change from awake to light anaesthesia and a 33-264 seconds earlier time response than BIS during the change from deep anaesthesia to moderate anaesthesia

EEG signals analysis using multiscale entropy for depth of anesthesia monitoring during surgery through artificial neural networks

In order to build a reliable index to monitor the depth of anesthesia (DOA), many algorithms have been proposed in recent years, one of which is sample entropy (SampEn), a commonly used and important tool to measure the regularity of data series. However, SampEn only estimates the complexity of signals on one time scale. In this study, a new approach is introduced using multiscale entropy (MSE) considering the structure information over different time scales. The entropy values over different time scales calculated through MSE are applied as the input data to train an artificial neural network (ANN) model using bispectral index (BIS) or expert assessment of conscious level (EACL) as the target. To test the performance of the new index's sensitivity to artifacts, we compared the results before and after filtration by multivariate empirical mode decomposition (MEMD). The new approach via ANN is utilized in real EEG signals collected from 26 patients before and after filtering by MEMD, respectively; the results show that is a higher correlation between index from the proposed approach and the gold standard compared with SampEn. Moreover, the proposed approach is more structurally robust to noise and artifacts which indicates that it can be used for monitoring the DOA more accurately.This research was financially supported by the Center for Dynamical Biomarkers and Translational Medicine, National Central University, Taiwan, which is sponsored by Ministry of Science and Technology (Grant no. MOST103-2911-I-008-001). Also, it was supported by National Chung-Shan Institute of Science & Technology in Taiwan (Grant nos. CSIST-095-V301 and CSIST-095-V302) and National Natural Science Foundation of China (Grant no. 51475342)

EEG-Based Automatic Classification of ‘Awake’ versus ‘Anesthetized’ State in General Anesthesia Using Granger Causality

BACKGROUND: General anesthesia is a reversible state of unconsciousness and depression of reflexes to afferent stimuli induced by administration of a "cocktail" of chemical agents. The multi-component nature of general anesthesia complicates the identification of the precise mechanisms by which anesthetics disrupt consciousness. Devices that monitor the depth of anesthesia are an important aide for the anesthetist. This paper investigates the use of effective connectivity measures from human electrical brain activity as a means of discriminating between 'awake' and 'anesthetized' state during induction and recovery of consciousness under general anesthesia. METHODOLOGY/PRINCIPAL FINDINGS: Granger Causality (GC), a linear measure of effective connectivity, is utilized in automated classification of 'awake' versus 'anesthetized' state using Linear Discriminant Analysis and Support Vector Machines (with linear and non-linear kernel). Based on our investigations, the most characteristic change of GC observed between the two states is the sharp increase of GC from frontal to posterior regions when the subject was anesthetized, and reversal at recovery of consciousness. Features derived from the GC estimates resulted in classification of 'awake' and 'anesthetized' states in 21 patients with maximum average accuracies of 0.98 and 0.95, during loss and recovery of consciousness respectively. The differences in linear and non-linear classification are not statistically significant, implying that GC features are linearly separable, eliminating the need for a complex and computationally expensive non-linear classifier. In addition, the observed GC patterns are particularly interesting in terms of a physiological interpretation of the disruption of consciousness by anesthetics. Bidirectional interaction or strong unidirectional interaction in the presence of a common input as captured by GC are most likely related to mechanisms of information flow in cortical circuits. CONCLUSIONS/SIGNIFICANCE: GC-based features could be utilized effectively in a device for monitoring depth of anesthesia during surgery

Quasi-Periodicities Detection Using Phase-Rectified Signal Averaging in EEG Signals as a Depth of Anesthesia Monitor

Phase-rectified signal averaging (PRSA) has been known to be a useful method to detect periodicities in non-stationary biological signals. Determination of quasi-periodicities in electroencephalogram (EEG) is a candidate for quantifying the changes of depth of anesthesia (DOA). In this paper, DOA monitoring capacity of periodicities detected using PRSA were quantified by assessing EEG signals collected from 56 patients during surgery. The method is compared to sample entropy (SampEn), detrended fluctuation analysis (DFA) and permutation entropy (PE). The performance of quasi-periodicities defined by acceleration capacity (AC) and deceleration capacity (DC) was tested using the area under the receiver operating characteristic curve (AUC) and Pearson correlation coefficient. During the surgery, a significant difference (p < 0.05) in the quasi-periodicities was observed among three different stages under general anesthesia. There is a larger mean AUC and correlation coefficient of quasi-periodicities compared to SampEn, DFA and PE using expert assessment of conscious level (EACL) and bispectral index (BIS) as the gold standard, respectively. Quasi-periodicities detected using PRSA in EEG signals are powerful monitor of DOA and perform more accurate and robust results compared to SampEn, DFA and PE. The results do provide a valuable reference to researchers in the filed of clinical applications.10.13039/501100003711-Center for Dynamical Biomarkers and Translational Medicine, National Central University, Taiwan, which is sponsored by the Ministry of Science and Technology; 10.13039/501100001809-National Natural Science Foundation of China

Prediction of Nociceptive Responses during Sedation by Linear and Non-Linear Measures of EEG Signals in High Frequencies

The level of sedation in patients undergoing medical procedures evolves continuously, affected by the interaction between the effect of the anesthetic and analgesic agents and the pain stimuli. The monitors of depth of anesthesia, based on the analysis of the electroencephalogram (EEG), have been progressively introduced into the daily practice to provide additional information about the state of the patient. However, the quantification of analgesia still remains an open problem. The purpose of this work is to improve the prediction of nociceptive responses with linear and non-linear measures calculated from EEG signal filtered in frequency bands higher than the traditional bands. Power spectral density and auto-mutual information function was applied in order to predict the presence or absence of the nociceptive responses to different stimuli during sedation in endoscopy procedure. The proposed measures exhibit better performances than the bispectral index (BIS). Values of prediction probability of Pk above 0.75 and percentages of sensitivity and specificity above 70% were achieved combining EEG measures from the traditional frequency bands and higher frequency bands

Effects of acute bleeding followed by hydroxyethyl starch 130/0.4 or a crystalloid on propofol concentrations, cerebral oxygenation, and electroencephalographic and haemodynamic variables in pigs

Bleeding changes the haemodynamics, compromising organ perfusion. In this study, the effects of bleeding followed by replacement with hydroxyethyl starch 130/0.4 (HES) or lactated Ringer's (LR) on cerebral oxygenation and electroencephalogram-derived parameters were investigated. Twelve young pigs under propofol-remifentanil anaesthesia were bled 30 mL/kg and, after a 20-minute waiting period, volume replacement was performed with HES (GHES; N = 6) or LR (GRL; N = 6). Bleeding caused a decrease of more than 50% in mean arterial pressure (P < 0.01) and a decrease in cerebral oximetry (P = 0.039), bispectral index, and electroencephalogram total power (P = 0.04 and P < 0.01, resp.), while propofol plasma concentrations increased (P < 0.01). Both solutions restored the haemodynamics and cerebral oxygenation similarly and were accompanied by an increase in electroencephalogram total power. No differences between groups were found. However, one hour after the end of the volume replacement, the cardiac output (P = 0.03) and the cerebral oxygenation (P = 0.008) decreased in the GLR and were significantly lower than in GHES (P = 0.02). Volume replacement with HES 130/0.4 was capable of maintaining the cardiac output and cerebral oxygenation during a longer period than LR and caused a decrease in the propofol plasma concentrations.This investigation was supported by FEDER funds through the COMPETE program and by national funds from Portuguese Foundation for Science and Technology, under the Projects SFRH/BPD/75697/2011, COMPETE: FCOMP-01-0124-FEDER-009525 (PTDC/CVT/101999/2008), and Pest C/EQB/LA0006/2011

Complexity of Brain Dynamics as a Correlate of Consciousness in Anaesthetized Monkeys

The use of anaesthesia is a fundamental tool in the investigation of consciousness. Anesthesia procedures allow to investigate different states of consciousness from sedation to deep anesthesia within controlled scenarios. In this study we use information quantifiers to measure the complexity of electrocorticogram recordings in monkeys. We apply these metrics to compare different stages of general anesthesia for evaluating consciousness in several anesthesia protocols. We find that the complexity of brain activity can be used as a correlate of consciousness. For two of the anaesthetics used, propofol and medetomidine, we find that the anaesthetised state is accompanied by a reduction in the complexity of brain activity. On the other hand we observe that use of ketamine produces an increase in complexity measurements. We relate this observation with increase activity within certain brain regions associated with the ketamine used doses. Our measurements indicate that complexity of brain activity is a good indicator for a general evaluation of different levels of consciousness awareness, both in anesthetized and non anesthetizes states.Fil: Fuentes, Nicolás. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales; ArgentinaFil: Garcia, Alexis. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales; ArgentinaFil: Guevara, Ramón. Università di Padova; ItaliaFil: Orofino, Roberto. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentina. Hospital Español de Buenos Aires;Fil: Mateos, Diego Martín. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Matemática Aplicada del Litoral. Universidad Nacional del Litoral. Instituto de Matemática Aplicada del Litoral; Argentina. Universidad Nacional de Entre Rios. Facultad de Ingeniería. Departamento de Bioingeniería; Argentin

Real time depth of anaesthesia monitoring through electroencephalogram (EEG) signal analysis based on Bayesian method and analytical technique

The electroencephalogram (EEG) signal from the brain is used for analysing brain abnormality, diseases, and monitoring patient conditions during surgery. One of the applications of the EEG signals analysis is real-time anaesthesia monitoring, as the anaesthetic drugs normally targeted the central nervous system. Depth of anaesthesia has been clinically assessed through breathing pattern, heart rate, arterial blood pressure, pupil dilation, sweating and the presence of movement. Those assessments are useful but are an indirect-measurement of anaesthetic drug effects. A direct method of assessment is through EEG signals because most anaesthetic drugs affect neuronal activity and cause a changed pattern in EEG signals. The aim of this research is to improve real-time anaesthesia assessment through EEG signal analysis which includes the filtering process, EEG features extraction and signal analysis for depth of anaesthesia assessment. The first phase of the research is EEG signal acquisition. When EEG signal is recorded, noises are also recorded along with the brain waves. Therefore, the filtering is necessary for EEG signal analysis. The filtering method introduced in this dissertation is Bayesian adaptive least mean square (LMS) filter which applies the Bayesian based method to find the best filter weight step for filter adaptation. The results show that the filtering technique is able to remove the unwanted signals from the EEG signals. This dissertation proposed three methods for EEG signal features extraction and analysing. The first is the strong analytical signal analysis which is based on the Hilbert transform for EEG signal features' extraction and analysis. The second is to extract EEG signal features using the Bayesian spike accumulation technique. The third is to apply the robust Bayesian Student-t distribution for real-time anaesthesia assessment. Computational results from the three methods are analysed and compared with the recorded BIS index which is the most popular and widely accepted depth of anaesthesia monitor. The outcomes show that computation times from the three methods are leading the BIS index approximately 18-120 seconds. Furthermore, the responses to anaesthetic drugs are verified with the anaesthetist's documentation and then compared with the BIS index to evaluate the performance. The results indicate that the three methods are able to extract EEG signal features efficiently, improve computation time, and respond faster to anaesthetic drugs compared to the existing BIS index