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Differentiating Drug-related and State-related Effects of Dexmedetomidine and Propofol on the Electroencephalogram.

Abstract：

BACKGROUND:Differentiating drug-related changes and state-related changes on the electroencephalogram during anesthetic-induced unconsciousness has remained a challenge. To distinguish these, we designed a rigorous experimental protocol with two drugs known to have distinct molecular mechanisms of action. We hypothesized that drug- and state-related changes can be separated. METHODS:Forty-seven healthy participants were randomized to receive dexmedetomidine (n = 23) or propofol (n = 24) as target-controlled infusions until loss of responsiveness. Then, an attempt was made to arouse the participant to regain responsiveness while keeping the drug infusion constant. Finally, the concentration was increased 1.5-fold to achieve presumable loss of consciousness. We conducted statistical comparisons between the drugs and different states of consciousness for spectral bandwidths, and observed how drug-induced electroencephalogram patterns reversed upon awakening. Cross-frequency coupling was also analyzed between slow-wave phase and alpha power. RESULTS:Eighteen (78%) and 10 (42%) subjects were arousable during the constant drug infusion in the dexmedetomidine and propofol groups, respectively (P = 0.011 between the drugs). Corresponding with deepening anesthetic level, slow-wave power increased, and a state-dependent alpha anteriorization was detected with both drugs, especially with propofol. The slow-wave and frontal alpha activities were momentarily disrupted as the subjects regained responsiveness at awakening. Negative phase-amplitude coupling before and during loss of responsiveness frontally and positive coupling during the highest drug concentration posteriorly were observed in the propofol but not in the dexmedetomidine group. CONCLUSIONS:Electroencephalogram effects of dexmedetomidine and propofol are strongly drug- and state-dependent. Changes in slow-wave and alpha activity seemed to best detect different states of consciousness.

journal_name

Anesthesiology

journal_title

Anesthesiology

authors

Scheinin A,Kallionpää RE,Li D,Kallioinen M,Kaisti K,Långsjö J,Maksimow A,Vahlberg T,Valli K,Mashour GA,Revonsuo A,Scheinin H

doi

10.1097/ALN.0000000000002192

subject

Has Abstract

pub_date

2018-07-01 00:00:00

pages

22-36

issue

eissn

0003-3022

issn

1528-1175

journal_volume

129

pub_type

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Differentiating Drug-related and State-related Effects of Dexmedetomidine and Propofol on the Electroencephalogram.