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Mamach M, Wilke F, Durisin M, Beger FA, Finke M, Büchner A, Schultz B, Schultz A, Geworski L, Bengel FM, Lenarz T, Lesinski-Schiedat A, Berding G. Feasibility of 15O-water PET studies of auditory system activation during general anesthesia in children. EJNMMI Res 2018; 8:11. [PMID: 29404708 PMCID: PMC5799087 DOI: 10.1186/s13550-018-0362-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/11/2018] [Indexed: 11/10/2022] Open
Abstract
Background 15O-Water positron emission tomography (PET) enables functional imaging of the auditory system during stimulation via a promontory electrode or cochlear implant, which is not possible using functional magnetic resonance imaging (fMRI). Although PET has been introduced in this context decades ago, its feasibility when performed during general anesthesia has not yet been explored. However, due to a shift to earlier (and bilateral) auditory implantation, the need to study children during general anesthesia appeared, since they are not able to cooperate during scanning. Therefore, we evaluated retrospectively results of individual SPM (statistical parametric mapping) analysis of 15O-water PET in 17 children studied during general anesthesia and compared them to those in 9 adults studied while awake. Specifically, the influence of scan duration, smoothing filter kernel employed during preprocessing, and cut-off value used for statistical inferences were evaluated. Frequencies, peak heights, and extents of activations in auditory and extra-auditory brain regions (AR and eAR) were registered. Results It was possible to demonstrate activations in auditory brain regions during general anesthesia; however, the frequency and markedness of positive findings were dependent on some of the abovementioned influence factors. Scan duration (60 vs. 90 s) had no significant influence on peak height of auditory cortex activations. To achieve a similar frequency and extent of AR activations during general anesthesia compared to waking state, a lower cut-off for statistical inferences (p < 0.05 or p < 0.01 vs. p < 0.001) had to be applied. However, this lower cut-off was frequently associated with unexpected, “artificial” activations in eAR. These activations in eAR could be slightly reduced by the use of a stronger smoothing filter kernel during preprocessing of the data (e.g., [30 mm]3). Conclusions Our data indicate that it is feasible to detect auditory cortex activations in 15O-water PET during general anesthesia. Combined with the improved signal to noise ratios of modern PET scanners, this suggests reasonable prospects for further evaluation of the method for clinical use in auditory implant users. Adapted parameters for data analysis seem to be helpful to improve the proportion of signals in AR versus eAR.
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Affiliation(s)
- Martin Mamach
- Department of Nuclear Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.,Cluster of Excellence Hearing4all, Hannover Medical School, Hannover, Germany.,Department of Medical Physics and Radiation Protection, Hannover Medical School, Hannover, Germany
| | - Florian Wilke
- Department of Medical Physics and Radiation Protection, Hannover Medical School, Hannover, Germany
| | - Martin Durisin
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Frank A Beger
- Department of Anesthesiology and Intensive Care Medicine, Hospital Diakovere Annastift, Hannover, Germany
| | - Mareike Finke
- Cluster of Excellence Hearing4all, Hannover Medical School, Hannover, Germany.,Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Andreas Büchner
- Cluster of Excellence Hearing4all, Hannover Medical School, Hannover, Germany.,Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Barbara Schultz
- Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Arthur Schultz
- Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Lilli Geworski
- Department of Medical Physics and Radiation Protection, Hannover Medical School, Hannover, Germany
| | - Frank M Bengel
- Department of Nuclear Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thomas Lenarz
- Cluster of Excellence Hearing4all, Hannover Medical School, Hannover, Germany.,Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | | | - Georg Berding
- Department of Nuclear Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. .,Cluster of Excellence Hearing4all, Hannover Medical School, Hannover, Germany.
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Grouven U, Beger FA, Schultz B, Schultz A. Correlation of Narcotrend Index, entropy measures, and spectral parameters with calculated propofol effect-site concentrations during induction of propofol-remifentanil anaesthesia. J Clin Monit Comput 2005; 18:231-40. [PMID: 15779834 DOI: 10.1007/s10877-005-2917-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to compare the EEG parameter Narcotrend Index with the spectral and entropy-based EEG parameters median frequency, 95% spectral edge frequency, burst-compensated 95% spectral edge frequency, spectral entropy, amplitude entropy, and approximate entropy with regard to their ability to describe cerebral anaesthetic drug effects during induction of propofol-remifentanil anaesthesia. METHODS Three induction schemes were studied with 10 patients each receiving 2 mg propofol/kg/60s (group 1), 4 mg/kg/120s (group 2), and 4 mg/kg/240s (group 3). The EEG was recorded with the EEG monitor Narcotrend. To analyse the relation between drug effect and EEG parameters, Spearman rank correlation of the different EEG parameters with the calculated propofol effect-site concentration was computed. RESULTS In all groups Narcotrend Index showed the highest correlation with the propofol effect-site concentration and the lowest variability of individual correlation values. Furthermore, only the Narcotrend Index showed a monophasic behaviour over the entire time period analysed. In the group of entropy parameters approximate entropy yielded the best results. Among the spectral parameters the burst-compensated 95% spectral edge frequency had the highest correlation with the propofol effect-site concentration. It was markedly higher than for the standard spectral edge frequency. The correlations of median frequency and amplitude entropy with propofol effect-site concentration were the lowest. CONCLUSIONS. Changes in the propofol effect-site concentration during induction of anaesthesia were best described by the multivariate Narcotrend Index compared to conventional spectral EEG parameters and different entropy measures.
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Affiliation(s)
- Ulrich Grouven
- Department of Anaesthesiology, Klinikum Hannover Oststadt, Hannover Medical School, Hannover, Germany.
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Schultz A, Grouven U, Beger FA, Schultz B. The Narcotrend Index: Classification Algorithm, Correlation with Propofol Effect-Site Concentrations, and Comparison with Spectral Parameters / Der Narcotrend-Index: Klassifikationsalgorithmus, Korrelation mit Propofol-Effekt-Site-Konzentrationen und Vergleich mit Spektralparametern. BIOMED ENG-BIOMED TE 2004; 49:38-42. [PMID: 15106896 DOI: 10.1515/bmt.2004.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A reliable assessment of the depth of hypnosis during sedation and general anaesthesia using the EEG is a subject of current interest. The Narcotrend Index implemented in the latest version 4.0 of the EEG monitor Narcotrend provides an automatic classification of the EEG on a scale ranging from 100 (awake) to 0 (very deep hypnosis, EEG suppression). The classification algorithms implemented in the EEG monitor Narcotrend are described. In a study the correlation of the propofol effect-site concentration with the Narcotrend Index and with the traditional spectral parameters total power, relative power in the standard frequency bands delta, theta, alpha, and beta, median frequency, 95% spectral edge frequency, burst-compensated spectral edge frequency, and spectral entropy was investigated. The Narcotrend Index had the highest average correlation with the propofol effect-site concentration and the smallest variability of the individual correlation values. Moreover, the Narcotrend Index was the only parameter which showed a monophasic trend over the whole investigated time period. The Narcotrend monitor can make a significant contribution to the improvement of the quality of anaesthesia by adjusting the dosage of hypnotics to individual patient needs.
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Affiliation(s)
- A Schultz
- Arbeitsgruppe Informatik/Biometrie der Anästhesie, Klinikum Hannover Oststadt, Medizinische Hochschule Hannover, Germany.
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Abstract
BACKGROUND Age-related differences in the spectral composition of the EEG in induction and emergence times, and in drug consumption during propofol anaesthesia were investigated. METHODS The EEGs of 60 female patients between 22 and 85 years of age were monitored continuously during standardized induction of anaesthesia with 2 mg of propofol kg(-1)60 s(-1). The EEGs were visually assessed in 20-s epochs according to a scale from A (awake) to F (very deep hypnosis). Visual EEG classifications, spectral parameters, and induction times were compared between different age groups. Additionally, data of 546 patients included in a multicentre study with 4630 patients (EEG monitor Narcotrend, MT MonitorTechnik, Bad Bramstedt, Germany) were analyzed with regard to age-dependent changes of propofol consumption using target-controlled infusion (TCI). RESULTS During induction, patients older than 70 years reached significantly deeper EEG stages than younger patients, needed a longer time to reach the deepest EEG stage, and needed more time until a light EEG stage was regained. In patients aged 70 years and older, the total power, mainly in deep EEG stages, was significantly smaller due to a distinctly smaller absolute power of the delta frequency band. No single spectral parameter was able to reliably distinguish all EEG stages. During the steady state of anaesthesia, older patients needed less propofol for the maintenance of a defined stage of hypnosis than younger patients. CONCLUSION Older patients differ from younger ones regarding the hypnotic effect of propofol and the spectral patterns in the EEG. For an efficient automatic assessment of the EEG during anaesthesia a multivariable approach accounting for age-effects is indispensable.
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Affiliation(s)
- A Schultz
- Department of Anaesthesiology, Klinikum Hannover Oststadt, Hannover Medical School, Germany.
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Schultz B, Beger FA, Weber BP, Niclaus O, Lüllwitz E, Grouven U, Schultz A. Influence of EEG monitoring on intraoperative stapedius reflex threshold values in cochlear implantation in children. Paediatr Anaesth 2003; 13:790-6. [PMID: 14617120 DOI: 10.1046/j.1460-9592.2003.01154.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cochlear implantation is a widely used means of treating deafness and severe hearing disorders. The surgical procedure includes inserting the cochlear implant electrode array into the cochlea and embedding the corresponding signal receiver in the mastoid bone behind the ear. Postoperative fitting of the externally worn speech processor is very important for successful use of the cochlear implant. For this purpose, electrically elicited stapedius reflex threshold values can be used. However, stapedius reflex threshold values measured intraoperatively are influenced by anaesthetics. The goal of this retrospective study was to find out whether electroencephalogram (EEG) control of anaesthesia produces more reliable reflex threshold values as a basis for the fitting of the speech processor. METHODS Three groups of children, after surgery for cochlear implantation, were analysed with regard to the magnitude of intraoperative electrically elicited stapedius reflex threshold values and their deviations from postoperatively determined maximum comfortable levels (group 1: methohexital/remifentanil with EEG monitoring, n = 10; group 2: isoflurane/fentanyl with EEG monitoring, n = 9; group 3: isoflurane/fentanyl without EEG monitoring, n = 11). RESULTS Children with EEG monitoring had significantly lower electrically elicited stapedius reflex threshold values and also significantly lower differences between intraoperative stapedius reflex threshold values and postoperatively determined maximum comfortable levels. CONCLUSIONS Electroencephalogram monitoring in cochlear implantation is of considerable value in controlling anaesthesia and improving speech processor fitting based on more reliable intraoperative neurophysiological data.
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Affiliation(s)
- B Schultz
- Medizinische Hochschule Hannover, Zentrum Anästhesie, Hannover, Germany.
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Schultz A, Schultz B, Grouven U, Beger FA, Korsch G. Sharp transients in the EEGs of non-epileptic adult patients receiving sevoflurane. Pharm World Sci 2001; 23:82-5. [PMID: 11411450 DOI: 10.1023/a:1011276016529] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE In this article unexpected EEG findings are described which were observed during EEG monitoring under sevoflurane anesthesia. METHOD In seven non-epileptic adult patients sevoflurane was administered as inhalation anesthetic during routinely performed surgical operations. The EEG was recorded continuously as part of the standard monitoring process and served mainly as a dosage guide for anesthetics/narcotics. MAIN OUTCOME MEASURE Occurrence of sharp transients in the EEG resembling distinctive waves which can be seen in epileptic disorders. RESULTS In six of the seven patients under 8.0% sevoflurane, sharp transients were observed which appeared in very deep EEG stages, mostly with endtidal sevoflurane concentrations of 4.8-5.9%. The findings are in accordance with observations in non-epileptic children from our clinic. CONCLUSIONS The clinical significance of the observed EEG pattern under sevoflurane anesthesia is still unclear. Taking into consideration that convulsive and nonconvulsive status epilepticus can be followed by signs of brain damage, it would appear to be important to further investigate the phenomenon.
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Affiliation(s)
- A Schultz
- Medizinische Hochschule Hannover, Abt. Anaesthesie IV, Klinikum Hannover-Oststadt, Podbielskistrasse 380, D-30659 Hannover, Germany
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