Practical use of the raw electroencephalogram waveform during general anesthesia: the art and science.

Abstract:

:Quantitative electroencephalogram (qEEG) monitors are often used to estimate depth of anesthesia and intraoperative recall during general anesthesia. As with any monitor, the processed numerical output is often misleading and has to be interpreted within a clinical context. For the safe clinical use of these monitors, a clear mental picture of the expected raw electroencephalogram (EEG) patterns, as well as a knowledge of the common EEG artifacts, is absolutely necessary. This has provided the motivation to write this tutorial. We describe, and give examples of, the typical EEG features of adequate general anesthesia, effects of noxious stimulation, and adjunctive drugs. Artifacts are commonly encountered and may be classified as arising from outside the head, from the head but outside the brain (commonly frontal electromyogram), or from within the brain (atypical or pathologic). We include real examples of clinical problem-solving processes. In particular, it is important to realize that an artifactually high qEEG index is relatively common and may result in dangerous anesthetic drug overdose. The anesthesiologist must be certain that the qEEG number is consistent with the apparent state of the patient, the doses of various anesthetic drugs, and the degree of surgical stimulation, and that the qEEG number is consistent with the appearance of the raw EEG signal. Any discrepancy must be a stimulus for the immediate critical examination of the patient's state using all the available information rather than reactive therapy to "treat" a number.

journal_name

Anesth Analg

journal_title

Anesthesia and analgesia

authors

Bennett C,Voss LJ,Barnard JP,Sleigh JW

doi

10.1213/ane.0b013e3181a9fc38

subject

Has Abstract

pub_date

2009-08-01 00:00:00

pages

539-50

issue

2

eissn

0003-2999

issn

1526-7598

pii

109/2/539

journal_volume

109

pub_type

杂志文章,评审
  • Small-dose ketamine reduces the pain of propofol injection.

    abstract:BACKGROUND:I.v. injection of propofol during anesthetic induction induces pain. Ketamine has been shown to reduce injection pain. In this study, we established the optimal dose of ketamine to prevent the pain of injection with propofol. METHODS:Two hundred forty patients presenting for elective surgery were randomly a...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,随机对照试验

    doi:10.1213/01.ane.0000243334.83816.53

    authors: Koo SW,Cho SJ,Kim YK,Ham KD,Hwang JH

    更新日期:2006-12-01 00:00:00

  • Effects of augmenting cardiac contractility, preload, and heart rate on cardiac output during enflurane anesthesia.

    abstract::Changes in cardiac output in response to augmenting cardiac contractility, preload, and heart rate during enflurane anesthesia were examined in 12 open-chested dogs. Cardiac contractility was assessed by the slope of the end-systolic pressure-volume relation (Emax). Dobutamine (3, 6, and 9 micrograms.kg-1.min-1) was a...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/00000539-199111000-00014

    authors: Sato M,Hoka S,Arimura H,Ono K,Yoshitake J

    更新日期:1991-11-01 00:00:00

  • The effect of short-term epidural local anesthetic blockade on urinary levels of substance P in interstitial cystitis.

    abstract:UNLABELLED:We investigated the effect of epidural local anesthetic blockade on urinary substance P levels in five patients suffering from painful flare-ups of interstitial cystitis. Urine was collected in 24-h intervals commencing at the onset of an epidural bolus of 0.25% bupivacaine followed by maintenance epidural i...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章

    doi:10.1213/01.ane.0000099362.01312.3a

    authors: Sukiennik A,Carr DB,Bonney I,Marchand JE,Wurm H,Sant GR

    更新日期:2004-03-01 00:00:00

  • The efficacy of a novel approach to transversus abdominis plane block for postoperative analgesia after colorectal surgery.

    abstract:BACKGROUND:The analgesic efficacy of transversus abdominis plane (TAP) block has been established for patients undergoing abdominal surgery. We evaluated the efficacy of a novel approach to TAP block for postoperative analgesia after colorectal surgery. METHODS:Forty adult ASA physical status I to III patients undergo...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,随机对照试验

    doi:10.1213/ANE.0b013e3182159bf8

    authors: Bharti N,Kumar P,Bala I,Gupta V

    更新日期:2011-06-01 00:00:00

  • Adverse cardiac outcomes after noncardiac surgery in patients with prior percutaneous transluminal coronary angioplasty.

    abstract:UNLABELLED:In this retrospective cohort study, we compared adverse cardiac outcomes after noncardiac surgery among patients with prior percutaneous transluminal coronary angioplasty (PTCA), patients with nonrevascularized coronary artery disease (CAD), and normal controls. Inpatient hospital discharge abstracts from al...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1097/00000539-199909000-00003

    authors: Posner KL,Van Norman GA,Chan V

    更新日期:1999-09-01 00:00:00

  • The effect of intravenous administration of dexamethasone on postoperative pain, nausea, and vomiting after intrathecal injection of meperidine.

    abstract:BACKGROUND:Different drugs have been used to enhance postoperative neuraxial opioid analgesia and reduce adverse effects. METHODS:We randomized 60 patients into 2 groups to receive either 2 mL saline or 0.1 mg/kg dexamethasone IV before the administration of intrathecal anesthesia (15 mg and meperidine 15 mg). After s...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,随机对照试验

    doi:10.1213/01.ane.0000257926.07491.55

    authors: Movafegh A,Soroush AR,Navi A,Sadeghi M,Esfehani F,Akbarian-Tefaghi N

    更新日期:2007-04-01 00:00:00

  • A Novel Approach for the Control of Inflammatory Pain: Prostaglandin E2 Complexation by Randomly Methylated β-Cyclodextrins.

    abstract:BACKGROUND:Inhibitors of cyclooxygenase, which block the formation of prostaglandin (PG) E2, are the standard treatment of inflammatory pain. These drugs, however, have serious gastrointestinal, renal, and cardiovascular side effects that limit their clinical use. Cyclodextrins are neutral glucose oligomers that form a...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/ANE.0000000000001674

    authors: Sauer RS,Rittner HL,Roewer N,Sohajda T,Shityakov S,Brack A,Broscheit JA

    更新日期:2017-02-01 00:00:00

  • Science Without Conscience Is but the Ruin of the Soul: The Ethics of Big Data and Artificial Intelligence in Perioperative Medicine.

    abstract::Artificial intelligence-driven anesthesiology and perioperative care may just be around the corner. However, its promises of improved safety and patient outcomes can only become a reality if we take the time to examine its technical, ethical, and moral implications. The aim of perioperative medicine is to diagnose, tr...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,评审

    doi:10.1213/ANE.0000000000004728

    authors: Canales C,Lee C,Cannesson M

    更新日期:2020-05-01 00:00:00

  • Prothrombin Complex Concentrates for Bleeding in the Perioperative Setting.

    abstract::Prothrombin complex concentrates (PCCs) contain vitamin K-dependent clotting factors (II, VII, IX, and X) and are marketed as 3 or 4 factor-PCC formulations depending on the concentrations of factor VII. PCCs rapidly restore deficient coagulation factor concentrations to achieve hemostasis, but like with all procoagul...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,评审

    doi:10.1213/ANE.0000000000001188

    authors: Ghadimi K,Levy JH,Welsby IJ

    更新日期:2016-05-01 00:00:00

  • Anesthetic management of patients with severe peripheral ischemia due to calciphylaxis.

    abstract::Calciphylaxis is a small-vessel disease associated with renal failure. Here, we report the management of a 43-yr-old man with calciphylaxis who received left lower leg amputation with prostaglandin E(1) (PGE(1)) under monitoring by laser Doppler blood flowmetry in the left second and third fingers. Anesthesia was indu...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/01.ANE.0000121960.22554.D7

    authors: Horishita T,Minami K,Ogata J,Sata T

    更新日期:2004-08-01 00:00:00

  • The application of tetanic stimulation of the unilateral tibial nerve before transcranial stimulation can augment the amplitudes of myogenic motor-evoked potentials from the muscles in the bilateral upper and lower limbs.

    abstract:BACKGROUND:Recently, we reported a new technique to augment motor-evoked potentials (MEPs) under general anesthesia, posttetanic MEP (p-MEP), in which tetanic stimulation of the peripheral nerve before transcranial stimulation enlarged amplitudes of MEPs from the muscle innervated by the nerve subjected to tetanic stim...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/ane.0b013e318177082e

    authors: Hayashi H,Kawaguchi M,Yamamoto Y,Inoue S,Koizumi M,Ueda Y,Takakura Y,Furuya H

    更新日期:2008-07-01 00:00:00

  • Comparison of desflurane with propofol in outpatients undergoing peripheral orthopedic surgery.

    abstract::This study was undertaken to compare desflurane with propofol anesthesia in outpatients undergoing peripheral orthopedic surgery. Data were combined from two institutions participating in a multicenter study. Ninety-one patients, ASA physical status I or II, were each randomly assigned to one of four groups. After adm...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1213/00000539-199210000-00019

    authors: Rapp SE,Conahan TJ,Pavlin DJ,Levy WJ,Hautman B,Lecky J,Luke J,Nessly ML

    更新日期:1992-10-01 00:00:00

  • Modification of suction-induced hemolysis during cell salvage.

    abstract:BACKGROUND:The efficiency of red blood cell collection during cell salvage is dictated by multiple variables, including suction pressure. In this study, we attempted to determine the influence of suction pressure on the efficiency of cell salvage and to identify methods for minimizing the impact of suction on salvaged ...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/01.ane.0000255208.96685.2e

    authors: Waters JH,Williams B,Yazer MH,Kameneva MV

    更新日期:2007-03-01 00:00:00

  • A comparison of clinical and psychological effects of fentanyl and nalbuphine in ambulatory gynecologic patients.

    abstract::Drug dosages, length of stay (LOS), and incidence of psychological side effects of fentanyl and nalbuphine were compared in a randomized, double-blind study using unpremedicated female day-surgery patients undergoing diagnostic laparoscopy. Patients received either fentanyl 1.5 micrograms/kg (F group; n = 142), low-do...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

    authors: Garfield JM,Garfield FB,Philip BK,Earls F,Roaf E

    更新日期:1987-12-01 00:00:00

  • Association of preoperative risk factors with postoperative acute renal failure.

    abstract::We performed a systematic review of 28 studies that examined preoperative risk factors for postoperative renal failure. Included in the studies were 10,865 patients who underwent either vascular, cardiac, general, or biliary surgery. No two studies used the same criteria for acute renal failure. Variability in definit...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,评审

    doi:10.1213/00000539-199401000-00023

    authors: Novis BK,Roizen MF,Aronson S,Thisted RA

    更新日期:1994-01-01 00:00:00

  • A method for testing for epinephrine-induced arrhythmias in rats.

    abstract::Evaluation of a new inhaled anesthetic requires determination of the anesthetic's potential to predispose to ventricular (and other) arrhythmias in an animal model. This need poses logistic and economic burdens if the effects of large numbers of new anesthetics are to be surveyed. We have devised a technique for deter...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/00000539-199006000-00013

    authors: Laster MJ,Johnson BH,Eger EI 2nd,Taheri S

    更新日期:1990-06-01 00:00:00

  • In vitro anesthetic washin and washout via bubble oxygenators: influence of anesthetic solubility and rates of carrier gas inflow and pump blood flow.

    abstract::The uptake and elimination of volatile anesthetic agents administered to patients under conditions of hemodilution and hypothermia during cardiopulmonary bypass have not been determined. To define the limitations imposed by oxygenators, we defined washin and washout curves for volatile anesthetic agents administered t...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:

    authors: Nussmeier NA,Moskowitz GJ,Weiskopf RB,Cohen NH,Fisher DM,Eger EI 2nd

    更新日期:1988-10-01 00:00:00

  • The effects of general anesthesia and surgery on basal and interferon stimulated natural killer cell activity of humans.

    abstract:UNLABELLED:Natural killer (NK) cells can lyse certain tumor cells as well as virally infected cells without prior sensitization. Animal studies have shown that general anesthesia (GA) alone or GA followed by surgery decreases both basal NK cytotoxicity and enhancement of NK activity by interferon (IFN). The purpose of ...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1097/00000539-199710000-00037

    authors: Kutza J,Gratz I,Afshar M,Murasko DM

    更新日期:1997-10-01 00:00:00

  • Electro-acupuncture at the Zusanli, Yanglingquan, and Kunlun points does not reduce anesthetic requirement.

    abstract:UNLABELLED:We tested the hypothesis that electro-acupuncture at the Zusanli, Yanglingquan, and Kunlun acupuncture points on the legs decreases anesthetic requirement. Fourteen young, healthy volunteers were anesthetized with desflurane on two separate days. Needle electrodes were positioned at the three acupuncture poi...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章

    doi:10.1097/00000539-200207000-00017

    authors: Morioka N,Akça O,Doufas AG,Chernyak G,Sessler DI

    更新日期:2002-07-01 00:00:00

  • Effects of halothane on intraocular pressure in anesthetized children.

    abstract::Intraocular pressure (IOP) measurements in children are usually performed under nitrous oxide and halothane anesthesia. We studied the effects of both time and end-tidal halothane concentration on IOP in 80 children (mean age +/- SD = 4.5 +/- 2.9 yr), to determine the most optimal time to make such measurements in ane...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/00000539-199008000-00011

    authors: Watcha MF,Chu FC,Stevens JL,Forestner JE

    更新日期:1990-08-01 00:00:00

  • Estimation of optimal modeling weights for a Bayesian-based closed-loop system for propofol administration using the bispectral index as a controlled variable: a simulation study.

    abstract:BACKGROUND:Implementing Bayesian methods in a model-based closed-loop system requires the integration of a standard response model with a patient-specific response model. This process makes use of specific modeling weights, called Bayesian variances, which determine how the specific model can deviate from the standard ...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/01.ane.0000287269.06170.0f

    authors: De Smet T,Struys MM,Greenwald S,Mortier EP,Shafer SL

    更新日期:2007-12-01 00:00:00

  • Tertiary Pediatric Academic Institution's Experience With Intraoperative Neuromonitoring for Nonspinal Surgery in Children With Mucopolysaccharidosis, Based on a Novel Evidence-Based Care Algorithm.

    abstract:BACKGROUND:Musculoskeletal deformities in mucopolysaccharidoses (MPSs) patients pose unique challenges when patients present for surgery, especially nonspinal surgery. MPS patients have developed postsurgical neurological deficits after nonspinal surgery. While the incidence of neurological deficits after nonspinal sur...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/ANE.0000000000004215

    authors: Kandil AI,Pettit CS,Berry LN,Busso VO,Careskey M,Chesnut E,Buck DW,Leslie ND,Tamai J,McAuliffe JJ,Chidambaran V

    更新日期:2020-06-01 00:00:00

  • Prevalence and characteristics of pain induced by percutaneous liver biopsy.

    abstract:UNLABELLED:Percutaneous needle liver biopsy is an important procedure for the diagnosis and evaluation of liver disease and is frequently associated with pain. In this prospective study, we investigated the prevalence and characteristics of this pain syndrome. Fifty-four subjects, who underwent liver biopsy under ultra...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章

    doi:10.1213/01.ane.0000060453.74744.17

    authors: Eisenberg E,Konopniki M,Veitsman E,Kramskay R,Gaitini D,Baruch Y

    更新日期:2003-05-01 00:00:00

  • Possible air embolism during eye surgery.

    abstract::We report a case of possible air embolism during a three-port pars plana vitrectomy and air-fluid exchange of the vitreous cavity of the eye. After the start of intraocular air flushing, sudden tachycardia, a decrease in oxygen saturation and end-tidal carbon dioxide tension, and a distinct "mill-wheel" murmur were ob...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/01.ANE.0000154304.63828.C0

    authors: Ledowski T,Kiese F,Jeglin S,Scholz J

    更新日期:2005-06-01 00:00:00

  • Tactical decision making for selective expansion of operating room resources incorporating financial criteria and uncertainty in subspecialties' future workloads.

    abstract::We considered the allocation of operating room (OR) time at facilities where the strategic decision had been made to increase the number of ORs. Allocation occurs in two stages: a long-term tactical stage followed by short-term operational stage. Tactical decisions, approximately 1 yr in advance, determine what specia...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/01.ANE.0000149898.45044.3D

    authors: Dexter F,Ledolter J,Wachtel RE

    更新日期:2005-05-01 00:00:00

  • Effect of Interscalene Brachial Plexus Block on the Pulmonary Function of Obese Patients: A Prospective, Observational Cohort Study.

    abstract:BACKGROUND:The effect of interscalene block (ISB) on pulmonary function of obese participants has not been investigated. The goal of this study is to assess the association of obesity (body mass index [BMI] >29 kg/m vs BMI <25 kg/m) and change in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/ANE.0000000000002180

    authors: Melton MS,Monroe HE,Qi W,Lewis SL,Nielsen KC,Klein SM

    更新日期:2017-07-01 00:00:00

  • Ropivacaine continuous wound infusion versus epidural morphine for postoperative analgesia after cesarean delivery: a randomized controlled trial.

    abstract:BACKGROUND:The infusion of local anesthetic in the surgical wound is helpful in the multimodal management of postoperative pain. We hypothesized that local anesthetic wound infusion after cesarean delivery would provide better pain control than epidural morphine analgesia. METHODS:Healthy, term women scheduled for ele...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,随机对照试验

    doi:10.1213/ANE.0b013e3182368e87

    authors: O'Neill P,Duarte F,Ribeiro I,Centeno MJ,Moreira J

    更新日期:2012-01-01 00:00:00

  • An advanced specialty training program in anesthesiology: a special educational fellowship designed to return community anesthesiologists to clinical practice.

    abstract::We describe a program for community anesthesiologists designed to evaluate clinical skills and provide additional training in the latest technologies in anesthesiology. This educational program was established for previously trained anesthesiologists who require additional training for either remedial purposes or beca...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章

    doi:10.1213/01.ane.0000220903.33100.15

    authors: Larson CP Jr,Steadman RH

    更新日期:2006-07-01 00:00:00

  • Target-Controlled Infusions: Paths to Approval.

    abstract::Target-controlled infusion of IV anesthetic drugs is approved worldwide with the exception of the United States. The purpose of this special article is to review regulatory pathways that could lead to target-controlled infusion (TCI) clearance or approval in the United States. ...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,评审

    doi:10.1213/ANE.0000000000001018

    authors: Dryden PE

    更新日期:2016-01-01 00:00:00

  • Spinal anesthesia for repair of meningomyelocele in neonates.

    abstract::The use of spinal anesthesia for meningomyelocele repair in neonates has received minimal attention. Spinal anesthesia may lessen the stress response to surgery and decrease postoperative respiratory complications. We therefore examined the efficacy of spinal anesthesia in 14 neonates requiring repair of lumbar or sac...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章

    doi:10.1097/00000539-199509000-00011

    authors: Viscomi CM,Abajian JC,Wald SL,Rathmell JP,Wilson JT

    更新日期:1995-09-01 00:00:00