Depth of Anesthesia During Multidrug Infusion: Separating the Effects of Propofol and Remifentanil Using the Spectral Features of EEG

General anesthesia is usually induced with a combination of drugs. In addition to the hypnotic agent, such as propofol, opioids are often used due to their synergistic hypnotic and analgesic properties. However, the effects of opioids on the EEG changes and the clinical state of the patient during anesthesia are complex and hinder the interpretation of the EEG-based depth of anesthesia indexes. In this paper, a novel technology for separating the anesthetic effects of propofol and an ultrashort-acting opioid, remifentanil, using the spectral features of EEG is proposed. By applying a floating search method, a well-performing feature set is achieved to estimate the effects of propofol during induction of anesthesia and to classify whether or not remifentanil has been coadministered. It is shown that including the detection of the presence of opioids to the estimated effect of propofol significantly improves the determination of the clinical state of the patient, i.e., if the patient will respond to a painful stimulation.

[1]  P. Sebel,et al.  Remifentanil Dose/Electroencephalogram Bispectral Response During Combined Propofol/Regional Anesthesia , 2002, Anesthesia and analgesia.

[2]  I. Rampil.  A Primer for EEG Signal Processing in Anesthesia , 1998, Anesthesiology.

[3]  Jukka Kortelainen,et al.  Effects of Remifentanil on the Spectrum and Quantitative Parameters of Electroencephalogram in Propofol Anesthesia , 2009, Anesthesiology.

[4]  T. Seppänen,et al.  Remifentanil Modifies the Relation of Electroencephalographic Spectral Changes and Clinical Endpoints in Propofol Anesthesia , 2008, Anesthesiology.

[5]  Juliana Barr,et al.  Remifentanil Versus Alfentanil: Comparative Pharmacokinetics and Pharmacodynamics in Healthy Adult Male Volunteers , 1996, Anesthesiology.

[6]  Josef Kittler,et al.  Floating search methods in feature selection , 1994, Pattern Recognit. Lett..

[7]  Hugo Vereecke,et al.  Ability of the Bispectral Index, Autoregressive Modelling with Exogenous Input-derived Auditory Evoked Potentials, and Predicted Propofol Concentrations to Measure Patient Responsiveness during Anesthesia with Propofol and Remifentanil , 2003, Anesthesiology.

[8]  Talmage D Egan,et al.  When Is a Bispectral Index of 60 Too Low?: Rational Processed Electroencephalographic Targets Are Dependent on the Sedative–Opioid Ratio , 2007, Anesthesiology.

[9]  V. Fodale,et al.  Remifentanil and the brain , 2008, Acta anaesthesiologica Scandinavica.

[10]  T. Seppänen,et al.  EEG Frequency Progression during Induction of Anesthesia: from Start of Infusion to Onset of Burst Suppression Pattern , 2007, 2007 29th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[11]  Peter S. Sebel,et al.  Bispectral Analysis Measures Sedation and Memory Effects of Propofol, Midazolam, Isoflurane, and Alfentanil in Healthy Volunteers , 1997, Anesthesiology.

[12]  M. Kost.  Moderate sedation/analgesia : core competencies for practice , 2004 .

[13]  E R John,et al.  Quantitative EEG changes associated with loss and return of consciousness in healthy adult volunteers anaesthetized with propofol or sevoflurane. , 2001, British journal of anaesthesia.

[14]  P. Neuvonen,et al.  Requirements of propofol at different end‐points without adjuvant and during two different steady infusions of remifentanil , 2005, Acta anaesthesiologica Scandinavica.

[15]  Eric Moulines,et al.  A blind source separation technique using second-order statistics , 1997, IEEE Trans. Signal Process..

[16]  Erik Olofsen,et al.  The Influence of Remifentanil on the Dynamic Relationship between Sevoflurane and Surrogate Anesthetic Effect Measures Derived from the EEG , 2002, Anesthesiology.

[17]  EEG spectral changes and onset of burst suppression pattern in propofol/remifentanil anesthesia , 2008, 2008 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[18]  T. Seppänen,et al.  Time–frequency properties of electroencephalogram during induction of anesthesia , 2008, Neuroscience Letters.

[19]  T. Sloan,et al.  Neurologic monitoring. , 1988, Critical care clinics.

[20]  Tapio Seppänen,et al.  Forecasting the Unresponsiveness to Verbal Command on the Basis of EEG Frequency Progression During Anesthetic Induction With Propofol , 2006, IEEE Transactions on Biomedical Engineering.

[21]  J. Sleigh,et al.  Monitoring consciousness: the current status of EEG-based depth of anaesthesia monitors. , 2007, Best practice & research. Clinical anaesthesiology.

[22]  Tarmo Lipping,et al.  Propofol and Remifentanil Differentially Modulate Frontal Electroencephalographic Activity , 2010, Anesthesiology.

[23]  M. Mertens,et al.  Strategies to Optimise Propofol-Opioid Anaesthesia , 2004, Clinical pharmacokinetics.

[24]  J G Bovill,et al.  The Pharmacodynamic Interaction of Propofol and Alfentanil during Lower Abdominal Surgery in Women , 1995, Anesthesiology.

[25]  J. Vuyk,et al.  Pharmacokinetic and pharmacodynamic interactions between opioids and propofol. , 1997, Journal of clinical anesthesia.

[26]  N. T. Smith,et al.  Performance of the ARX-derived Auditory Evoked Potential Index as an Indicator of Anesthetic Depth: A Comparison with Bispectral Index and Hemodynamic Measures during Propofol Administration , 2002, Anesthesiology.

[27]  Jukka Kortelainen,et al.  Isomap Approach to EEG-Based Assessment of Neurophysiological Changes During Anesthesia , 2011, IEEE Transactions on Neural Systems and Rehabilitation Engineering.