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Propofol and Remifentanil differentially modulate frontal electroencephalographic activity

(2010) ANESTHESIOLOGY. 113(2). p.292-304
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Abstract
Background: The purpose of this study was to evaluate a new, physiologically inspired method for the analysis of the electroencephalogram during propofol-remifentanil anesthesia. Based on fixed-order autoregressive moving-average modeling, this method was hypothesized to be capable of dissociating the effects that hypnotic and analgesic agents have on brain electrical activity. Methods: Raw electroencephalographic waves from a previously published study were reanalyzed. In this study, 45 American Society of Anesthesiologists status I patients were randomly allocated to one of three groups according to a specific target effect-site remifentanil concentration (0, 2, and 4 ng/ml). All patients received stepwise-increased targeted effect-site concentrations of propofol (Ce-PROP). At each step change in target Ce-PROP, the Observer's Assessment of Alertness/Sedation score was evaluated. Raw electroencephalograph was continuously acquired from frontal electrodes. Electroencephalography traces were analyzed using a fixed-order autoregressive moving average model to give derived measures of Cortical State and Cortical Input. Response surfaces were visualized and modeled using Hierarchical Linear Modeling. Results: Cortical State (a measure of cortical responsiveness) and Cortical Input (a measure of the magnitude of cortical input) were shown to respond differently to Ce-PROP and effect-site remifentanil concentration. Cortical Input decreased significantly with increasing effect-site remifentanil concentration, whereas Cortical State remained unchanged with increasing effect-site remifentanil concentration but decreased with increasing Ce-PROP. Conclusion: Because Cortical State responds principally to variations in Ce-PROP, it is a potential measure of hypnosis, whereas the dependence of Cortical Input on effect-site remifentanil concentration suggests that it may be useful as a measure of analgesic efficacy and the nociceptive-antinociceptive balance.
Keywords
NITROUS-OXIDE, HEALTHY-VOLUNTEERS, BISPECTRAL INDEX, SURGICAL STRESS INDEX, AUDITORY-EVOKED POTENTIALS, PHARMACODYNAMIC INTERACTION, PATIENT RESPONSIVENESS, APPROXIMATE ENTROPY, SPECTRAL-ANALYSIS, CONTROLLED-TRIAL

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Chicago
Liley, David TJ, Nicholas C Sinclair, Tarmo Lipping, Bjorn Heyse, HUGO VEREECKE, and Michel Struys. 2010. “Propofol and Remifentanil Differentially Modulate Frontal Electroencephalographic Activity.” Anesthesiology 113 (2): 292–304.
APA
Liley, D. T., Sinclair, N. C., Lipping, T., Heyse, B., VEREECKE, H., & Struys, M. (2010). Propofol and Remifentanil differentially modulate frontal electroencephalographic activity. ANESTHESIOLOGY, 113(2), 292–304.
Vancouver
1.
Liley DT, Sinclair NC, Lipping T, Heyse B, VEREECKE H, Struys M. Propofol and Remifentanil differentially modulate frontal electroencephalographic activity. ANESTHESIOLOGY. 2010;113(2):292–304.
MLA
Liley, David TJ, Nicholas C Sinclair, Tarmo Lipping, et al. “Propofol and Remifentanil Differentially Modulate Frontal Electroencephalographic Activity.” ANESTHESIOLOGY 113.2 (2010): 292–304. Print.
@article{1030796,
  abstract     = {Background: The purpose of this study was to evaluate a new, physiologically inspired method for the analysis of the electroencephalogram during propofol-remifentanil anesthesia. Based on fixed-order autoregressive moving-average modeling, this method was hypothesized to be capable of dissociating the effects that hypnotic and analgesic agents have on brain electrical activity.
Methods: Raw electroencephalographic waves from a previously published study were reanalyzed. In this study, 45 American Society of Anesthesiologists status I patients were randomly allocated to one of three groups according to a specific target effect-site remifentanil concentration (0, 2, and 4 ng/ml). All patients received stepwise-increased targeted effect-site concentrations of propofol (Ce-PROP). At each step change in target Ce-PROP, the Observer's Assessment of Alertness/Sedation score was evaluated. Raw electroencephalograph was continuously acquired from frontal electrodes. Electroencephalography traces were analyzed using a fixed-order autoregressive moving average model to give derived measures of Cortical State and Cortical Input. Response surfaces were visualized and modeled using Hierarchical Linear Modeling.
Results: Cortical State (a measure of cortical responsiveness) and Cortical Input (a measure of the magnitude of cortical input) were shown to respond differently to Ce-PROP and effect-site remifentanil concentration. Cortical Input decreased significantly with increasing effect-site remifentanil concentration, whereas Cortical State remained unchanged with increasing effect-site remifentanil concentration but decreased with increasing Ce-PROP.
Conclusion: Because Cortical State responds principally to variations in Ce-PROP, it is a potential measure of hypnosis, whereas the dependence of Cortical Input on effect-site remifentanil concentration suggests that it may be useful as a measure of analgesic efficacy and the nociceptive-antinociceptive balance.},
  author       = {Liley, David TJ and Sinclair, Nicholas C and Lipping, Tarmo and Heyse, Bjorn and VEREECKE, HUGO and Struys, Michel},
  issn         = {0003-3022},
  journal      = {ANESTHESIOLOGY},
  keyword      = {NITROUS-OXIDE,HEALTHY-VOLUNTEERS,BISPECTRAL INDEX,SURGICAL STRESS INDEX,AUDITORY-EVOKED POTENTIALS,PHARMACODYNAMIC INTERACTION,PATIENT RESPONSIVENESS,APPROXIMATE ENTROPY,SPECTRAL-ANALYSIS,CONTROLLED-TRIAL},
  language     = {eng},
  number       = {2},
  pages        = {292--304},
  title        = {Propofol and Remifentanil differentially modulate frontal electroencephalographic activity},
  url          = {http://dx.doi.org/10.1097/ALN.0b013e3181e3d8a6},
  volume       = {113},
  year         = {2010},
}

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