Boncompte Gonzalo, Cortínez Luis I, Toso Alberto, Giordano Ady, Cruzat Francisco, Fuentes Ricardo, Pedemonte Juan C, Contreras Victor, Biggs Daniela, Chiu Esteban, Ibacache Mauricio
From the División de Anestesiología (GB, LIC, FC, RF, JCP, VC, DB, EC, MI), Programa de Farmacología y Toxicología (JCP, MI), Departamento de Neonatología (AT), Escuela de Medicina. Departamento de Química Inorgánica, Escuela de Química y Farmacia (AG). Departamento del Adulto, Escuela de Enfermería (VC) and Escuela de Odontología (EC). Pontificia Universidad Católica de Chile.
Eur J Anaesthesiol. 2025 Oct 1;42(10):889-898. doi: 10.1097/EJA.0000000000002208. Epub 2025 May 23.
The developing neonatal brain displays different electroencephalographic (EEG) responses to GABAergic anaesthetics than adults. Evidence suggests the importance of isoelectric-like activity patterns. However, markers of hypnotic depth are currently lacking for this population.
To explore potential EEG markers of propofol-induced hypnosis in sedated critically ill term neonates.
Observational exploratory cohort study.
Twenty critically ill term neonates (postmenstrual age 37 to 44 weeks) undergoing intensive care and requiring anaesthesia for noncardiac surgery. Patients with perinatal asphyxia, neurological pathology, brain malformations and metabolic or haemodynamic instability were excluded.
Frontal EEG (Sedline) was recorded before induction and during a 20-min continuous rate propofol infusion.
Depending on peak amplitude, segmented EEG signals (1 s epochs) were classified as either isoelectric (<10 μV), low-voltage 10 to 25 μV), or high-voltage (>25 μV). Propofol effects were evaluated in terms of time occupancy and spectral properties within these EEG states. Correlations between clinical variables and EEG states were explored.
The EEGs of 17 neonates were analysed. Most showed periods of low-voltage (16/17, 94%) and isoelectric states (2/17, 70.5%) before anaesthesia. The time spent in these EEG states increased significantly during propofol infusion; 17/17 (100%), P < 0.001 and 16/17 (94.1%), P = 0.016, respectively. Propofol increased the mean [95% confidence interval (CI)] time spent in the isoelectric state per patient: 12.4 (3.3 to 21.5)% versus 28.6 (14.4 to 42.8)%, P < 0.002. A reduced spectral power was observed across all frequency bands during low-voltage states (all P < 0.026). Gestational age was negatively correlated with time in the isoelectric state; rho, 95% CI, -0.539 (-0.11 to -0.87), P = 0.031.
Our results show that isoelectric periods are common before anaesthesia in our studied population and more frequent in patients born at earlier gestational ages. The data suggest that propofol anaesthesia increases isoelectric EEG states while also reducing the spectral power, specifically during low-voltage EEG states. Potentially, both of these EEG changes could be biomarkers of neonatal hypnosis depth in this particular critically ill subpopulation.
ClinicalTrials.gov identifier: NCT04904965.
发育中的新生儿大脑对γ-氨基丁酸能麻醉剂的脑电图（EEG）反应与成人不同。有证据表明等电位样活动模式很重要。然而，目前该人群缺乏催眠深度的标志物。
探索在接受镇静的危重新生儿中丙泊酚诱导催眠的潜在脑电图标志物。
观察性探索性队列研究。
20名危重新生儿（孕龄37至44周），接受重症监护，因非心脏手术需要麻醉。排除围产期窒息、神经病理学、脑畸形以及代谢或血流动力学不稳定的患者。
在诱导前和丙泊酚持续输注20分钟期间记录额叶脑电图（Sedline）。
根据峰值幅度，将分段脑电图信号（1秒时间段）分为等电位（<10μV）、低电压（10至25μV）或高电压（>25μV）。从这些脑电图状态下的时间占用和频谱特性方面评估丙泊酚的作用。探索临床变量与脑电图状态之间的相关性。
分析了17名新生儿的脑电图。大多数在麻醉前显示出低电压期（16/17，94%）和等电位状态期（2/17，70.5%）。在丙泊酚输注期间，这些脑电图状态下所花费的时间显著增加；分别为17/17（100%），P<0.001和16/17（94.1%），P = 0.016。丙泊酚增加了每位患者在等电位状态下花费的平均[95%置信区间（CI）]时间：12.4（3.3至21.5）%对28.6（14.4至42.8）%，P<0.002。在低电压状态下，所有频段的频谱功率均降低（所有P<0.026）。孕龄与等电位状态下的时间呈负相关；相关系数，95%CI，-0.539（-0.11至-0.87），P = 0.031。
我们的结果表明，在我们的研究人群中，等电位期在麻醉前很常见，且在孕龄较小的患者中更频繁。数据表明，丙泊酚麻醉增加了脑电图的等电位状态，同时也降低了频谱功率，特别是在低电压脑电图状态期间。潜在地，这两种脑电图变化都可能是这个特定危重症亚群中新生儿催眠深度的生物标志物。
ClinicalTrials.gov标识符：NCT04904965。
