Tu Bin, Assassi Nadege J, Bazil Carl W, Hamberger Marla J, Hirsch Lawrence J
*Department of Neurology, Columbia University Comprehensive Epilepsy Center, New York, New York, U.S.A.; †New York University Pre-Medicine Neural Science Program, New York, New York, U.S.A.; and ‡Yale University Comprehensive Epilepsy Center, New Haven, Connecticut, U.S.A.
J Clin Neurophysiol. 2015 Apr;32(2):152-8. doi: 10.1097/WNP.0000000000000154.
The intracarotid amobarbital or Wada procedure is a component of the presurgical evaluation for refractory epilepsy, during which monitoring the onset and offset of transient anesthetic effects is critical. In this study, the authors characterized changes of 8 quantitative measures during 26 Wada tests, which included alpha, beta, theta, and delta powers, alpha/delta power ratio, beta/delta power ratio, median amplitude-integrated EEG, and 90% spectral edge frequency (SEF90), and correlated them with contralateral hemiplegia. The authors found that on the side of injection, delta and theta powers, alpha/delta power ratio, beta/delta power ratio, and SEF90 peaked within 1 minute after injection of 70 to 150 mg amobarbital or 4 to 7 mg methohexital. When contralateral arm strength returned to 3/5, delta power and amplitude-integrated EEG decayed on average 24% and 19%, respectively, for amobarbital, similar to that of methohexital (27% and 18%). Because delta power resolution most closely mirrored that of the hemiplegia and amplitude-integrated EEG had the highest signal/noise ratio, these quantitative values appear to be the best measures for decay of anesthetic effects. Increase in alpha power persisted longest, and therefore may be the best measure of late residual anesthetic effects.
颈动脉内注射异戊巴比妥或瓦达试验是难治性癫痫术前评估的一部分，在此期间监测短暂麻醉效果的开始和结束至关重要。在本研究中，作者对26次瓦达试验期间8项定量指标的变化进行了特征描述，这些指标包括α、β、θ和δ波功率、α/δ波功率比、β/δ波功率比、中位振幅整合脑电图以及90%频谱边缘频率（SEF90），并将它们与对侧偏瘫相关联。作者发现，在注射侧，注射70至150毫克异戊巴比妥或4至7毫克美索比妥后1分钟内，δ波和θ波功率、α/δ波功率比、β/δ波功率比以及SEF90达到峰值。当对侧手臂力量恢复到3/5时，异戊巴比妥组的δ波功率和振幅整合脑电图平均衰减分别为24%和19%，与美索比妥组（27%和18%）相似。由于δ波功率分辨率与偏瘫最为密切相关，且振幅整合脑电图的信噪比最高，因此这些定量值似乎是麻醉效果衰减的最佳指标。α波功率增加持续时间最长，因此可能是晚期残余麻醉效果的最佳指标。
