Stolwijk Lisanne J, Weeke Lauren C, de Vries Linda S, van Herwaarden Maud Y A, van der Zee David C, van der Werff Desiree B M, Benders Manon J N L, Toet Mona, Lemmers Petra M A
Department of Neonatology, University Medical Center Utrecht, the Netherlands.
Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands.
PLoS One. 2017 Aug 31;12(8):e0183581. doi: 10.1371/journal.pone.0183581. eCollection 2017.
The aim of the current study was to determine the effect of general anesthesia on neonatal brain activity using amplitude-integrated EEG (aEEG).
A prospective cohort study of neonates (January 2013-December 2015), who underwent major neonatal surgery for non-cardiac congenital anomalies. Anesthesia was administered at the discretion of the anesthetist. aEEG monitoring was started six hours preoperatively until 24 hours after surgery. Analysis of classes of aEEG background patterns, ranging from continuous normal voltage to flat trace in six classes, and quantitative EEG-measures, using spontaneous activity transients (SATs) and interSATintervals (ISI), was performed.
In total, 111 neonates were included (36 preterm/75 full-term), age at time of surgery was (median (range) 2 (0-32) days. During anesthesia depression of brain activity was seen, with background patterns ranging from flat trace to discontinuous normal voltage. In most patients brain activity was two background pattern classes lower during anesthesia. After cessation of anesthesia, recovery to preoperative brain activity occurred within 24 hours in 86% of the preterm and 96% of the term infants. Gestational age and the dose of sevoflurane were significantly associated with SAT-rate (F(2,68) = 9.288, p < 0.001) and ISI- durations during surgery (F(3,71) = 12.96, p < 0.001). Background pattern and quantitative EEG-values were not associated with brain lesions (χ2(4) = 2.086, ns).
aEEG shows a variable reduction of brain activity in response to anesthesia in neonates with noncardiac congenital anomalies, with fast recovery after cessation of anesthesia. This reduction is related to gestational age and the dose of sevoflurane. The aEEG offers the opportunity to monitor the depth of anesthesia in the neonate.
本研究的目的是使用振幅整合脑电图（aEEG）来确定全身麻醉对新生儿脑活动的影响。
对2013年1月至2015年12月因非心脏先天性异常接受重大新生儿手术的新生儿进行一项前瞻性队列研究。麻醉由麻醉师酌情给予。术前6小时开始进行aEEG监测，直至术后24小时。对aEEG背景模式类别进行分析，范围从连续正常电压到六种类别的平线，并使用自发活动瞬变（SATs）和SAT间期（ISI）进行定量脑电图测量。
总共纳入了111名新生儿（36名早产儿/75名足月儿），手术时年龄为（中位数（范围）2（0 - 32）天）。在麻醉期间可见脑活动抑制，背景模式范围从平线到不连续正常电压。在大多数患者中，麻醉期间脑活动降低两个背景模式类别。麻醉停止后，86%的早产儿和96%的足月儿在24小时内恢复到术前脑活动。胎龄和七氟醚剂量与手术期间的SAT率（F(2,68) = 9.288，p < 0.001）和ISI持续时间显著相关（F(3,71) = 12.96，p < 0.001）。背景模式和定量脑电图值与脑损伤无关（χ2(4) = 2.086，无显著性差异）。
aEEG显示非心脏先天性异常新生儿在麻醉时脑活动有不同程度的降低，麻醉停止后恢复迅速。这种降低与胎龄和七氟醚剂量有关。aEEG为监测新生儿麻醉深度提供了机会。
