Department of Anaesthesia, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Department of Paediatric Anaesthesia, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Anaesthesia. 2019 Jan;74(1):45-50. doi: 10.1111/anae.14458. Epub 2018 Oct 27.
Electroencephalographic density spectral array monitoring has been developed to facilitate the interpretation of unprocessed electroencephalogram signals. The primary aim of this prospective observational study, performed in a tertiary children's hospital, was to identify the clinical applicability and validity of density spectral array monitoring in infants and children during sevoflurane anaesthesia. We included 104 children, aged < 6 years, undergoing elective surgery during sevoflurane anaesthesia. We investigated the correlation between non-steady state end-tidal sevoflurane and the expression of the four electroencephalogram frequency bands β, α, θ and δ, representing density spectral array. Patients were divided into three age groups (< 6 months, 6-12 months, > 12 months). There was a significant correlation between end-tidal sevoflurane and density spectral array in the age groups 6-12 months (p < 0.05) and 1-6 years (p < 0.0001). In infants < 6 months of age, the relative percentages of density spectral array did not correlate with end-tidal sevoflurane. The main finding was that different end-tidal concentrations of sevoflurane produce age-dependent changes in the density spectral array power spectrum. In infants younger than 6 months-old, α and β coherence are absent, whereas θ and δ oscillations have already emerged. In cases where anaesthesia was too deep, this presented as burst suppression on the electroencephalogram, θ disappeared, leaving the electroencephalographic activity in the δ range. Future research should address this issue, aiming to clarify whether the emergence of θ oscillations in infants helps to prevent sevoflurane overdosing.
脑电密度谱数组监测技术旨在帮助解读未经处理的脑电图信号。本前瞻性观察研究在一家三级儿童医院进行，旨在确定在七氟醚麻醉期间，密度谱数组监测在婴儿和儿童中的临床适用性和有效性。我们纳入了 104 名年龄<6 岁的择期手术患儿，在七氟醚麻醉下进行。我们研究了非稳态呼气末七氟醚浓度与代表密度谱数组的四个脑电图频带β、α、θ和δ的表达之间的相关性。患者分为三个年龄组（<6 个月、6-12 个月、>12 个月）。6-12 个月组（p<0.05）和 1-6 岁组（p<0.0001）的呼气末七氟醚浓度与密度谱数组之间存在显著相关性。在<6 个月的婴儿中，密度谱数组的相对百分比与呼气末七氟醚浓度无相关性。主要发现是不同的呼气末七氟醚浓度会导致婴儿年龄依赖性的密度谱数组功率谱变化。在 6 个月以下的婴儿中，α和β相干性缺失，而θ和δ振荡已经出现。在麻醉过深的情况下，脑电图表现为爆发抑制，θ波消失，脑电图活动仅在δ频段出现。未来的研究应解决这个问题，旨在阐明婴儿中θ振荡的出现是否有助于防止七氟醚过量。
