Depth of anaesthesia

Classic electroencephalographic parameters: Median frequency, spectral edge frequency etc

Even today many anaesthesiologists rely on parameters of the autonomic nervous system, such as blood pressure and heart rate to decide if a patient is adequately anaesthetized. It is thought that the electroencephalogram (EEG) may provide more information on the state of anaesthesia. Because full EEG analysis is not possible in the operating room, processed EEG parameters have been developed comprising complex information into a single value. Time and frequency domain parameters are calculated. The power spectrum results from a Fourier analysis and can be described by parameters such as median frequency, spectral edge frequency and others. It was noted, however, that anaesthetics at low doses increase frequency of the EEG, whereas at high doses the EEG is depressed. This biphasic response makes it difficult to clearly distinguish the exact anaesthetic state of a patient. Median frequency and spectral edge frequency have been studied in numerous studies. However, no sole indicator has been derived from the EEG that could serve as a descriptor of anaesthetic depth.

Monitoring of anaesthesia in neurophysiological experiments

Cortical activity can be substantially changed by the type of anaesthetic used, and by its dose level. For easy monitoring of depth of anaesthesia we describe the changes in electroencephalogram and electrocardiogram accompanying changes in depth of anaesthesia in the cat. Anaesthesia was induced by the volatile anaesthetic isoflurane. The high-frequency components (around 30 Hz) in the electroencephalogram disappear in deep anaesthesia. The electrocardiogram also shows substantial changes in contamination due to muscle fasciculations with anaesthesia level. Fasciculations appear as noise in the electrocardiogram. The amplitude of the electrical muscle activity contaminating the ECG can be easily used for the maintainance of a constant level of anaesthesia during a neurophysiological experiment.

EEG-controlled "overdosage" of anesthetics in a patient with a history of intra-anesthetic awareness

In spite of the ever-growing pharmacologic arsenal available for induction and maintenance of anesthesia, to our knowledge no treatment regimen exists that will provide full protection against intraoperative awareness. To date, no single monitoring technique is able to detect awareness or predict recall. Although the frequency of these complications is rare, the occurrence of any such event can be very distressful for the patient. Based on our clinical experience with a patient with a history of recall and a marked resistance to benzodiazepines, we present electroencephalogram-based anesthetic management as a technique to address this difficult problem.

Altered consciousness: pharmacology and phenomenology BAP Summer Meeting, York, July 1991: Sleep and general anaesthesia as altered states of consciousness

In this article parallels are drawn between sleep and anaesthesia. Both can be described as 'behavioural states' in which stimulation and inhibition of certain neuronal groups will give rise to specific psychological states. The neuronal mechanisms leading to these states are reviewed and compared. Sensory information flow through the thalamus is reduced in sleep and anaesthesia, the thalamic gating being controlled by other areas of the brain including the sensory cortex. Thus a feedback loop may exist with the brain determining its own level of arousal. Anaesthesia increases gating at the thalamus and thus specifically reduces arousal. Consciousness is a specific attribute of the brain and is not required for the processing of sensory stimuli and learning, both of which have been shown to occur during sleep and anaesthesia. The implications of these findings for monitoring awareness during anaesthesia are discussed.