Skip to main content

Advertisement

SpringerLink
Log in

The effect of skin incision on the electroencephalogram during general anesthesia maintained with propofol or desflurane

  • Published:
Journal of Clinical Monitoring and Computing Aims and scope Submit manuscript

Abstract

Objective

A variety of effects of surgical incision on the electroencephalogram (EEG) during modern general anesthesia have been previously described; including both increases and decreases in both high and low frequencies in the EEG. What are the patterns commonly seen during routine clinical anesthesia?

Methods

We analyzed pre-frontal EEG data from a previously published study (116 adult patients having general anesthesia maintained with either desflurane or propofol) (Leslie et al. in Anesthesiology 111:547–555, 2009), The EEG was quantified using seven estimated parameters: slope and intercept of the underlying non-oscillatory (logarithmically transformed) power spectrum, amplitude and frequency of the episodic frontal alpha (EFA) oscillation, peak power in the delta waveband, high frequency variability index, and bispectral index (BIS). We compared a 30 s EEG segment from 2 min before, with that 2 min after the surgical incision.

Results

The pre-incision EEGs showed a wide spread of different values for the estimated EEG parameters, but the propofol group had increased EFA amplitude. Incision was associated with decreased EFA activity (p = 0.0004), and high frequency variability (p = 0.04, repeated measures ANOVA). The effects of the incision were independent of the type of drug used for maintenance of anesthesia, and on the pre-incision BIS. The loss of EFA tended to be associated with an increase in delta power (r = -0.39, p < 0.0001).

Conclusions

During anesthesia maintained with desflurane or propofol, surgical incision has modest effects on the EEG patterns. It does not cause an increase in high frequency power; the most consistent changes are a loss of EFA amplitude and burst suppression patterns. This effect is not strongly modified by the depth of anesthesia—as estimated by the BIS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Leslie K, Sleigh J, Paech MJ, Voss L, Lim CW, Sleigh C. Dreaming and electroencephalographic changes during anesthesia maintained with propofol or desflurane. Anesthesiology. 2009;111:547–55.

    Article  CAS  PubMed  Google Scholar 

  2. Bischoff P, Kochs E, Haferkorn D, Schulte am Esch J. Intraoperative EEG changes in relation to the surgical procedure during isoflurane-nitrous oxide anesthesia: hysterectomy versus mastectomy. J Clin Anesth. 1996;8:36–43.

    Article  PubMed  Google Scholar 

  3. Dutton RC, Smith WD, Smith NT. EEG Predicts movement response to surgical stimuli during general anesthesia with combinations of isoflurane, 70% N2O, and fentanyl. J Clin Monit. 1996;12:127–39.

    Article  CAS  PubMed  Google Scholar 

  4. Hagihira S, Takashina M, Mori T, Ueyama H, Mashimo T. Electroencephalographic bicoherence is sensitive to noxious stimuli during isoflurane or sevoflurane anesthesia. Anesthesiology. 2004;100:818–25.

    Article  CAS  PubMed  Google Scholar 

  5. Hayashi K, Sawa T, Matsuura M. Anesthesia depth-dependent features of electroencephalographic bicoherence spectrum during sevoflurane anesthesia. Anesthesiology. 2008;108:841–50.

    Article  CAS  PubMed  Google Scholar 

  6. Kochs E, Bischoff P, Pichlmeier U. Schulte am Esch J. Surgical stimulation induces changes in brain electrical activity during isoflurane/nitrous oxide anesthesia. A topographic electroencephalographic analysis. Anesthesiology. 1994;80:1026–34.

    Article  CAS  PubMed  Google Scholar 

  7. Kox WJ, von Heymann C, Heinze J, Prichep LS, John ER, Rundshagen I. Electroencephalographic mapping during routine clinical practice: cortical arousal during tracheal intubation? Anesthesia Analgesia. 2006;102:825–31.

    Article  PubMed  Google Scholar 

  8. Morimoto Y, Matsumoto A, Koizumi Y, Gohara T, Sakabe T, Hagihira S. Changes in the bispectral index during intraabdominal irrigation in patients anesthetized with nitrous oxide and sevoflurane. Anesthesia Analgesia. 2005;100:1370–4.

    Article  CAS  PubMed  Google Scholar 

  9. Otto KA, Mally P. Noxious stimulation during orthopaedic surgery results in EEG ‘arousal’ or ‘paradoxical arousal’ reaction in isoflurane-anesthetised sheep. Res Vet Sci. 2003;75:103–12.

    Article  PubMed  Google Scholar 

  10. Seitsonen ER, Korhonen IK, van Gils MJ, et al. EEG spectral entropy, heart rate, photoplethysmography and motor responses to skin incision during sevoflurane anesthesia. Acta Anesthesiol Scand. 2005;49:284–92.

    Article  CAS  Google Scholar 

  11. Gibson TJ, Johnson CB, Stafford KJ, Mitchinson SL, Mellor DJ. Validation of the acute electroencephalographic responses of calves to noxious stimulus with scoop dehorning. N Z Vet J. 2007;55:152–7.

    CAS  PubMed  Google Scholar 

  12. Rundshagen I, Schroder T, Heinze J, Prichep L, John ER, Kox WJ. Topographic electroencephalography: endotracheal intubation during anesthesia with propofol/fentanyl. Anasthesiol Intensivmed Notfallmed Schmerzther. 2005;40:633–9.

    Article  CAS  PubMed  Google Scholar 

  13. Wolter S, Friedel C, Bohler K, Hartmann U, Kox WJ, Hensel M. Presence of 14 Hz spindle oscillations in the human EEG during deep anesthesia. Clin Neurophysiol. 2006;117:157–68.

    Article  CAS  PubMed  Google Scholar 

  14. Ferenets R, Lipping T, Suominen P, et al. Comparison of the properties of EEG spindles in sleep and propofol anesthesia. Conf Proc IEEE Eng Med Biol Soc. 2006;1:6356–9.

    Article  PubMed  Google Scholar 

  15. Mukovski M, Chauvette S, Timofeev I, Volgushev M. Detection of active and silent states in neocortical neurons from the field potential signal during slow-wave sleep. Cereb Cortex. 2007;17:400–14.

    Article  PubMed  Google Scholar 

  16. MacKay EC, Sleigh JW, Voss LJ, Barnard JP. Episodic waveforms in the electroencephalogram during general anesthesia: a study of patterns of response to noxious stimuli. Anesthesia Intens Care. 2010;38:102–12.

    CAS  Google Scholar 

  17. Antognini JF, Carstens E. In vivo characterization of clinical anesthesia and its components. Br J Anesth. 2002;89:156–66.

    Article  CAS  Google Scholar 

  18. Alkire MT. Loss of effective connectivity during general anesthesia. Int Anesthesiol Clin. 2008;46:55–73.

    Article  CAS  PubMed  Google Scholar 

  19. Alkire MT, Hudetz AG, Tononi G. Consciousness and anesthesia. Science. 2008;322:876–80.

    Article  CAS  PubMed  Google Scholar 

  20. Fuentealba P, Timofeev I, Bazhenov M, Sejnowski TJ, Steriade M. Membrane bistability in thalamic reticular neurons during spindle oscillations. J Neurophysiol. 2005;93:294–304.

    Article  PubMed  Google Scholar 

  21. Steriade M. Grouping of brain rhythms in corticothalamic systems. Neuroscience. 2006;137:1087–106.

    Article  CAS  PubMed  Google Scholar 

  22. Steriade M, McCormick DA, Sejnowski TJ. Thalamocortical oscillations in the sleeping and aroused brain. Science. 1993;262:679–85.

    Article  CAS  PubMed  Google Scholar 

  23. Robinson RB, Siegelbaum SA. Hyperpolarization-activated cation currents: from molecules to physiological function. Annu Rev Physiol. 2003;65:453–80.

    Article  CAS  PubMed  Google Scholar 

  24. Franks NP. General anesthesia: from molecular targets to neuronal pathways of sleep and arousal. Nat Rev Neurosci. 2008;9:370–86.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesia, Waikato Clinical School of the University of Auckland, Waikato Hospital, Hamilton, 3206, New Zealand

    James W. Sleigh MB, ChB, MD, Dip App Stat, FANZCA & Logan Voss BSc (Hons), PhD

  2. Department of Anesthesia and Pain Management, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia

    Kate Leslie MBBS, MD, MEpi, FANZCA

  3. Department of Pharmacology, University of Melbourne, Melbourne, Australia

    Kate Leslie MBBS, MD, MEpi, FANZCA

Authors
  1. James W. Sleigh MB, ChB, MD, Dip App Stat, FANZCA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kate Leslie MBBS, MD, MEpi, FANZCA
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Logan Voss BSc (Hons), PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James W. Sleigh MB, ChB, MD, Dip App Stat, FANZCA.

Additional information

Sleigh JW, Leslie K, Voss L. The effect of skin incision on the electroencephalogram during general anesthesia maintained with propofol or desflurane.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sleigh, J.W., Leslie, K. & Voss, L. The effect of skin incision on the electroencephalogram during general anesthesia maintained with propofol or desflurane. J Clin Monit Comput 24, 307–318 (2010). https://doi.org/10.1007/s10877-010-9251-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10877-010-9251-3

Keywords

Search

Navigation