Baron Shahaf Dana, Weissman Avi, Priven Leonid, Shahaf Goded
Department of Anesthesia, Rambam Health Care Campus, Haifa, Israel.
The Applied Neurophysiology Lab, Rambam Health Care Campus, Haifa, Israel.
Front Med (Lausanne). 2022 Apr 14;9:880384. doi: 10.3389/fmed.2022.880384. eCollection 2022.
Recall is an accepted consequence of sedation. But due to the very low prevalence of the more devastating awareness under anesthesia (AUA), it might be of value to assess first the efficacy of new markers for AUA by their efficacy in discovering the more prevalent recall under sedation (RUS). In this pilot study we assessed whether a novel index for attentional effort, the cognitive effort index (CEI), derived in real-time from one forehead EEG channel, could differentiate between patients with or without RUS.
EEG was sampled from 2 groups: (1) Patients who underwent deep sedation ( = 25) (using drugs according to the anesthesiologist preference, but generally combining either Midazolam or Propofol together with either Fentanyl or Remifentanil). (2) Patients who underwent general anesthesia (GA, = 13, a negative control for recall). In recovery, recall was assessed using the BRICE questionnaire.
Of the 25 sedated patients, 11 experienced recall. The CEI marker was high during significantly longer periods in patients with recall, compared to sedated patients, or patients under GA, without recall. Moreover, the increase in CEI was evident mainly toward the end of the procedure.
RUS seems to associate with higher level of attention, which is identified in real-time by the easy-to-extract CEI marker.
记忆恢复是镇静的一个公认后果。但由于麻醉下知晓（AUA）这种更具破坏性情况的发生率极低，首先通过新标记物在发现更常见的镇静下记忆恢复（RUS）方面的功效来评估其对AUA的有效性可能具有重要意义。在这项初步研究中，我们评估了一种从一个前额脑电图通道实时得出的注意力努力新指标——认知努力指数（CEI），能否区分有或没有RUS的患者。
从两组患者采集脑电图：（1）接受深度镇静的患者（n = 25）（根据麻醉医生的偏好使用药物，但通常将咪达唑仑或丙泊酚与芬太尼或瑞芬太尼联合使用）。（2）接受全身麻醉（GA，n = 13，作为记忆恢复的阴性对照）的患者。在恢复过程中，使用BRICE问卷评估记忆恢复情况。
在25例接受镇静的患者中，11例出现了记忆恢复。与未出现记忆恢复的镇静患者或接受GA麻醉的患者相比，出现记忆恢复的患者中CEI标记物处于高水平的时间显著更长。此外，CEI的升高主要在手术接近尾声时明显。
RUS似乎与更高水平的注意力相关，这可通过易于提取的CEI标记物实时识别。
