丙泊酚诱导意识丧失期间与皮质-皮质下解耦相关的脑电图变化：一项前瞻性观察性研究的二次分析

Electroencephalographic changes related to cortico-subcortical decoupling during propofol-induced loss of consciousness: A secondary analysis of a prospective observational study.

作者信息

Fernández-Candil Juan L, Nuttall Rachel, Gallart Lluís, Schneider Gerhard, Blanco-Hinojo Laura, Martínez-Vilavella Gerard, Pujol Jesus, Adalid Irina, Berger Sebastian, Bujosa Daniel, Deus Joan, Gambús Pedro Luis, Jaramillo Sebastian, Moltó Luis, Ortega Juan Felipe, Pacreu Susana, Pérez-Sola Víctor, Vilà Esther

机构信息

Department of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Passeig Maritim 25, 08003 Barcelona, Spain; Hospital del Mar Research Institute, Dr Aiguader 80, 08003 Barcelona, Spain.

Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675 München, Germany.

出版信息

J Clin Anesth. 2025 Sep;106:111926. doi: 10.1016/j.jclinane.2025.111926. Epub 2025 Jul 17.

DOI:10.1016/j.jclinane.2025.111926

PMID:40682867

Abstract

BACKGROUND

Cortico-subcortical decoupling has been observed in functional magnetic resonance imaging (fMRI) during slow propofol-induced loss of consciousness (LOC). However, corresponding electroencephalography (EEG) free of the cardioballistic and fMRI artifacts is essential for translating decoupling observations to clinical monitoring.

OBJECTIVE

To describe artifact-corrected EEG changes corresponding to cortico-subcortical decoupling at LOC.

DESIGN

Secondary analysis of a prospective observational study.

SETTING

Tertiary-care hospital, data collection from June 2017 to January 2019.

PARTICIPANTS

Nineteen healthy volunteers receiving a targeted propofol infusion.

INTERVENTIONS

Frontal EEG was recorded synchronously with clinical signs and fMRI. Gradient artifact correction was based on iterative peak detection. Cardioballistic artifact correction was accomplished with a recently described algorithmic method based on peak detection combined with temporal constraints.

MAIN OUTCOME MEASURES

The qCON index and frontal EEG before and after decoupling at LOC.

RESULTS

Algorithm-filtered EEG tracings were suitable for analysis in 16 subjects. Propofol-induced LOC was achieved at a median (IQR) target plasma concentration of 4.5 (3.91 to 4.61) μg/mL and an effect-site concentration of 4.0 (2.94 to 4.31) μg/mL. The qCON index remained over 80 before decoupling and gradually decreased to values below 60 afterwards. Frontal alpha band power increased significantly from a median of 0.07 (0.03 to 0.15) 30 s before decoupling to 0.48 (0.08 to 0.58) 30 s after decoupling (p < 0.001).

CONCLUSIONS

Cortico-subcortical decoupling related to propofol-induced LOC coincides with a gradual decrease in the qCON index and an increase in frontal alpha power. These results help translate fMRI findings to bedside settings. Registered at EudraCT (reference 2016-004833-25). Principal Investigator: Juan L. Fernández-Candil. Date of registration: January 4, 2017. Start Date: June 13, 2017.

摘要

背景

在丙泊酚诱导的缓慢意识丧失（LOC）期间，功能磁共振成像（fMRI）中观察到皮质-皮质下解耦。然而，对于将解耦观察结果转化为临床监测而言，不受心冲击和fMRI伪影影响的相应脑电图（EEG）至关重要。

目的

描述与LOC时皮质-皮质下解耦相对应的经伪影校正的EEG变化。

设计

一项前瞻性观察性研究的二次分析。

地点

三级护理医院，2017年6月至2019年1月收集数据。

参与者

19名接受靶向丙泊酚输注的健康志愿者。

干预措施

同步记录额叶EEG与临床体征和fMRI。梯度伪影校正是基于迭代峰值检测。心冲击伪影校正是通过一种最近描述的基于峰值检测并结合时间约束的算法方法完成的。

主要观察指标

LOC时解耦前后的qCON指数和额叶EEG。

结果

算法滤波后的EEG记录适用于16名受试者的分析。丙泊酚诱导的LOC在中位（IQR）目标血浆浓度为4.5（3.91至4.61）μg/mL和效应室浓度为4.0（2.94至4.31）μg/mL时实现。解耦前qCON指数保持在80以上，之后逐渐降至60以下。额叶α波功率从解耦前30秒的中位值0.07（0.03至0.15）显著增加至解耦后30秒的0.48（0.08至0.58）（p < 0.001）。

结论

与丙泊酚诱导的LOC相关的皮质-皮质下解耦与qCON指数逐渐降低和额叶α波功率增加同时出现。这些结果有助于将fMRI研究结果转化为床边应用。在欧洲临床试验数据库（EudraCT）注册（编号2016-004833-25）。主要研究者：胡安·L·费尔南德斯-坎迪尔。注册日期：2017年1月4日。开始日期：2017年6月13日。