氯胺酮诱导的脑电图振荡可能有助于麻醉状态监测，但无助于分离监测。
Ketamine induces EEG oscillations that may aid anesthetic state but not dissociation monitoring.
机构信息
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
出版信息
Clin Neurophysiol. 2021 Dec;132(12):3010-3018. doi: 10.1016/j.clinph.2021.08.021. Epub 2021 Oct 8.
OBJECTIVE
Ketamine is an anesthetic drug associated with dissociation. Decreased electroencephalogram alpha (8-13 Hz) and low-beta (13-20 Hz) oscillation power have been associated with ketamine-induced dissociation. We aimed to characterize surface electroencephalogram signatures that may serve as biomarkers for dissociation.
METHODS
We analyzed data from a single-site, open-label, high-density surface electroencephalogram study of ketamine anesthesia (2 mg/kg, n = 15). We assessed dissociation longitudinally using the Clinician Administered Dissociation States Scale (CADSS) and administered midazolam to attenuate dissociation and enable causal inference. We analyzed electroencephalogram power and global coherence with multitaper spectral methods. Mixed effects models were used to assess whether power and global coherence signatures of ketamine could be developed into dissociation-specific biomarkers.
RESULTS
Compared to baseline, ketamine unresponsiveness was associated with increased frontal power between 0.5 to 9.3 Hz, 12.2 to 16.6 Hz, and 24.4 to 50 Hz. As subjects transitioned into a responsive but dissociated state (mean CADSS ± SD, 22.1 ± 17), there was a decrease in power between 0.5 to 10.3 Hz and 11.7 to 50 Hz. Midazolam reduced dissociation scores (14.3 ± 11.6), decreased power between 4.4 to 11.7 Hz and increased power between 14.2 to 50 Hz. Our mixed-effects model demonstrated a quadratic relationship between time and CADSS scores. When models (frontal power, occipital power, global coherence) were reanalyzed with midazolam and electroencephalogram features as covariates, only midazolam was retained.
CONCLUSIONS
Ketamine is associated with structured electroencephalogram power and global coherence signatures that may enable principled anesthetic state but not dissociation monitoring.
SIGNIFICANCE
A neurophysiological biomarker for dissociation may lead to a better understanding of neuropsychiatric disorders.
目的
氯胺酮是一种与分离有关的麻醉药物。脑电图阿尔法（8-13 Hz）和低β（13-20 Hz）振荡功率降低与氯胺酮引起的分离有关。我们旨在描述可能作为分离生物标志物的表面脑电图特征。
方法
我们分析了一项单站点、开放标签、高密度表面脑电图氯胺酮麻醉研究的数据（2 mg/kg，n=15）。我们使用临床医生管理的分离状态量表（CADSS）纵向评估分离，并给予咪达唑仑以减轻分离并进行因果推断。我们使用多音谱方法分析脑电图功率和全局相干性。混合效应模型用于评估氯胺酮的功率和全局相干性特征是否可以开发为分离特异性生物标志物。
结果
与基线相比，氯胺酮无反应与 0.5 至 9.3 Hz、12.2 至 16.6 Hz 和 24.4 至 50 Hz 之间的额部功率增加有关。当受试者过渡到反应但分离的状态（平均 CADSS±SD，22.1±17）时，0.5 至 10.3 Hz 和 11.7 至 50 Hz 之间的功率下降。咪达唑仑降低了分离评分（14.3±11.6），降低了 4.4 至 11.7 Hz 之间的功率，增加了 14.2 至 50 Hz 之间的功率。我们的混合效应模型显示了时间和 CADSS 评分之间的二次关系。当将模型（额部功率、枕部功率、全局相干性）与咪达唑仑和脑电图特征作为协变量重新分析时，仅保留了咪达唑仑。
结论
氯胺酮与可能实现原则性麻醉状态但不能监测分离的结构脑电图功率和全局相干性特征有关。
意义
分离的神经生理学生物标志物可能导致对神经精神障碍的更好理解。
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