Pediatric Anesthesia Monitoring with the Help of EEG and ECG

This paper presents research regarding the monitoring of the brain and the adequacy of anesthesia during surgery. Particular variables are derived from EEG and ECG signals and are correlated to anesthetic gas (sevoflurane) concentration, in pediatric anesthesia. The methods used for parameter extraction are based on change detection theory and time-frequency representation. Preliminary results show that the expired anesthetic gas concentration modulates both the heart rate variability and the duration of the burst suppression. Monitors of the central nervous system and autonomic nervous system activities can be expected to be based on these variables.     

Investigation of the modulation between EEG alpha waves and slow/fast delta waves in children in different depths of Desflurane anesthesia

ObjectivesInvestigation of the amplitude modulation of alpha-band EEG oscillations (i.e., grouping of alpha-band activities) by delta-band EEG activities in various depths of anesthesia (DOA).MethodsThis modulation, which is a sort of phase dependent amplitude modulation, is studied in 10 children in various depths of Desflurane anesthesia. Two parameters are defined to quantify the modulation: strength of modulation (SOM) and phase of modulation (POM). SOM indicates to what extent delta and alpha activities are related to each other, and POM is the delta phase in which the alpha amplitude is maximal. These parameters are analyzed in different DOA for various formations of delta sub-bands.ResultsThe ability of POM and SOM were explored to characterize mechanisms contributing to delta activities and their correlation with the level of anesthesia. These parameters are influenced by DOA and frequency intervals of delta sub-bands. SOM takes higher values around certain frequency ranges of delta band. According to this, delta band comprises three main sub-bands in various unconsciousness levels. Although boundaries of these sub-bands change with DOA, they are almost in [0.1–0.5] Hz (very slow delta), [0.7–1.7] Hz (slow delta) and [2–4] Hz (fast delta) intervals. POMs relating to slow and fast delta bands increase with consciousness level. This is an indication that delta waves differently modulate alpha EEG activities (in terms of phase lag) in different DOA. In deep anesthesia, POM relating to fast delta correlates with DOA better than POM relating to slow delta does. In light anesthesia this correlation is inversed. Investigation regarding to different formations of delta sub-bands shows that POM relating to [1.8–4] Hz is a proper choice for distinguishing deep, moderate and light anesthesia.ConclusionSOM allows separating mechanisms underlying delta band activities, and POM can be seen as a complementary neurophysiologic-based parameter for quantifying DOA.     

Measurement of the lung and skin excretion of CO<Subscript>2</Subscript> during anesthesia

A mass spectrometer with capillary and membrane interfaces was used during anesthesia to deliver the gas mixture from the breathing circuit of the inhalation anesthesia machine (IAM) into the ionic source of an analyzer and to measure the concentration of CO₂ released from the skin in real time. The extent of the stress response during surgery correlated with the time course of changes in the concentrations of CO₂ released from the lungs and skin. The CO₂ concentration and the BIS index of changes in EEG frequency spectrum were measured simultaneously during intravenous total propofol–fentanyl anesthesia. The BIS index and the concentrations of CO₂ released from the lungs and skin were found to correlate with the most traumatic steps of the surgical procedure.     

Nervous control of respiration

Century-old notions on and formulations of the principle of external respiration control are discussed. The development of the main views on the mechanisms of action of individual nervous structures involved in respiratory control and their contributions is analyzed. A generalized scheme of the respiratory system control is proposed, according to which this autonomic and somatic system is composed of strictly defined afferent, central, and efferent components and is an open, multiextremal, adaptive, self-learning system based on a hierarchical principle. Ultimately, under any conditions of the vital activity of the body, the main regulator of the system (the respiratory center) optimally performs both deviation and perturbation control.     

Increase of slow periodic modulation of EEG in a patient with Alzheimer's disease.

The recently described slow oscillations of amplitude of theta and alpha waves of the EEG (with a frequency below 0.08 Hz) in healthy subjects are attributed to the autonomic nervous system with control at the brain stem level. In the present pilot study, the slow brain rhythms were analyzed in a patient with Alzheimer's disease and were compared to a healthy subject. Dynamic analysis of the EEG was performed using time-frequency mapping which gives simultaneous time and frequency representation of the brain signal. This method comprises a transform of the filtered EEG signal into its analytic form and application of the Wigner distribution modified by time and frequency smoothing. It has been shown that the envelope of both theta and alpha activities oscillates at 0.04 Hz and 0.07 Hz in the healthy subject and at 0.03 Hz and 0.06 Hz in a patient with Alzheimer's disease. The amplitude of the slow oscillations of theta activity was substantially higher in the patient with Alzheimer's disease as compared with the healthy subject. It is being proposed that the increase of slow brain rhythms in the patient with Alzheimer's disease reflects an abnormal activity of the autonomic nervous system. However, the underlying pathophysiological mechanisms need to be further studied.     

Application of a dissimilarity index of EEG and its sub-bands on prediction of induced epileptic seizures from rat's EEG signals

ObjectiveEpileptic seizures are defined as manifest of excessive and hyper-synchronous activity of neurons in the cerebral cortex that cause frequent malfunction of the human central nervous system. Therefore, finding precursors and predictors of epileptic seizure is of utmost clinical relevance to reduce the epileptic seizure induced nervous system malfunction consequences. Researchers for this purpose may even guide us to a deep understanding of the seizure generating mechanisms. The goal of this paper is to predict epileptic seizures in epileptic rats.MethodsSeizures were induced in rats using pentylenetetrazole (PTZ) model. EEG signals in interictal, preictal, ictal and postictal periods were then recorded and analyzed to predict epileptic seizures. Epileptic seizures were predicted by calculating an index in consecutive windows of EEG signal and comparing the index with a threshold. In this work, a newly proposed dissimilarity index called Bhattacharyya Based Dissimilarity Index (BBDI), dynamical similarity index and fuzzy similarity index were investigated.ResultsBBDI, dynamical similarity index and fuzzy similarity index were examined on case and control groups and compared to each other. The results show that BBDI outperforms dynamical and fuzzy similarity indices. In order to improve the results, EEG sub-bands were also analyzed. The best result achieved when the proposed dissimilarity index was applied on Delta sub-band that predicts epileptic seizures in all rats with a mean of 299.5 s.ConclusionThe dissimilarity of neural network activity between reference window and present window of EEG signal has a significant increase prior to an epileptic seizure and the proposed dissimilarity index (BBDI) can reveal this variation to predict epileptic seizures. In addition, analyzing EEG sub-bands results in more accurate information about constituent neuronal activities underlying the EEG since certain changes in EEG signal may be amplified when each sub-band is analyzed separately.SignificanceThis paper presents application of a dissimilarity index (BBDI) on EEG signals and its sub-bands to predict PTZ-induced epileptic seizures in rats. Based on the results of this work, BBDI will predict epileptic seizures more accurately and more reliably compared to current indices that increases epileptic patient comfort and improves patient outcomes.     

Features of Autonomic Regulation and the Character of Convulsions in Stammering Children

The neurophysiological mechanisms of convulsions were studied in the stammering syndrome. Electrophysiological, neurological, neuropsychological, and logopedic examinations were performed for 23 children aged 9–10 years with stammering. For comprehensive analysis, a neurophysiological classification was used to divide the stammering children into two groups: group I, which included patients with paroxysmal patterns recorded in the EEG, and group II, which included patients without paroxysmal EEG patterns. The analysis revealed a correlation of specific features of the autonomic regulation with the character of convulsions. Predominant malfunction of the parasympathetic part of the autonomic nervous system and tonic convulsions in stammering were found in the group I children. Malfunction of the sympathetic part of the autonomic nervous system and clonic convulsions in stammering were characteristic of group II children.     

Autonomic nervous system responses as performance indicators among volleyball players

Complex motor skills require planning and programming before execution. The autonomic nervous system (ANS) is thought to transcribe these central operations at the peripheral level: a motor act is thought to be simultaneously programmed by central and autonomic nervous structures. The aim of this study was to verify that autonomic responses reflect the quality of central motor programming leading to successful or failed performance when subjects are required to perform a complex motor skill. The specificity of the ANS response has already been demonstrated through direct recording from sympathetic fibres. It has also been demonstrated through several mental tasks and closed motor skills such as shooting: ANS responses have been shown to be capable of distinguishing success from failure. The aim of this experiment was to test whether ANS responses are capable of distinguishing two levels of achievement during the performance of a skill involving uncertainty (open skill). The subjects had to intercept a ball on a volleyball court, using the forearm receive and pass technique, in order to pass it on to a moving human target. The results were displayed in terms of accuracy: accurate passes were successful and inaccurate passes missed the target. Six autonomic variables were recorded simultaneously during the task: skin resistance and potential, skin blood flow and temperature, instantaneous heart rate and respiratory frequency. Results showed that autonomic variables were capable of distinguishing success from failure in 22 subjects out of 24. This made it possible to build up autonomic patterns characterising subjects' performances, and to confirm that autonomic functioning may reveal information processing in the central nervous system. Thus, the study of autonomic responses may constitute an inferential model of central nervous system functioning. Such a method could be used as an index for the control of mental preparation.     

Central nervous system involvement in the autonomic responses to psychological distress

Psychological distress can trigger acute coronary syndromes and sudden cardiac death in vulnerable patients. The primary pathophysiological mechanism that plays a role in stress-induced cardiac events involves the autonomic nervous system, particularly disproportional sympathetic activation and parasympathetic withdrawal. This article describes the relation between psychological distress and autonomic nervous system function, with a focus on subsequent adverse cardiovascular outcomes. The role of the central nervous system in these associations is addressed, and a systematic review is presented of studies examining the association between stress-induced central nervous system responses measured by neuroimaging techniques and autonomic nervous system activation. Results of the systematic review indicate that the primary brain areas involved in the autonomic component of the brain-heart association are the insula, medial prefrontal cortex, and cerebellum (based on 121 participants across three studies that fitted the inclusion criteria). Other areas involved in stress-induced autonomic modulation are the (anterior) cingulate cortex, parietal cortex, somatomotor cortex/precentral gyrus, and temporal cortex. The interaction between central and autonomic nervous system responses may have implications for further investigations of the brain-heart associations and mechanisms by which acute and chronic psychological distress increase the risk of myocardial infarction, cardiac arrhythmias, and sudden cardiac death.     

Bispectral Index Analysis of Opioid Immobilization of Rocky Mountain Elk

Abstract: We immobilized elk with either isoflurane to produce general anesthesia (control), 0.01 mg/kg carfentanil plus 0.1 mg/kg xylazine, or 0.25 mg/kg butorphanol plus 0.4 mg/kg azaperone plus 0.15 mg/kg medetomidine (BAM) and measured the bispectral index (BIS). The carfentanil-xylazine BIS (70.4 + 1.4) and the BAM BIS (60.2 + 1.5) were higher than the control BIS (47.2 + 4.1; P ≤ 0.001). These data indicate that opioids produce neuroleptanalgesia and not general anesthesia or sedation, which explains observed elk responses to these drugs.     

Nitric oxide-mediated central sympathetic excitation promotes CNS and pulmonary O2 toxicity

In hyperbaric oxygen (HBO(2)) at or above 3 atmospheres absolute (ATA), autonomic pathways link central nervous system (CNS) oxygen toxicity to pulmonary damage, possibly through a paradoxical and poorly characterized relationship between central nitric oxide production and sympathetic outflow. To investigate this possibility, we assessed sympathetic discharges, catecholamine release, cardiopulmonary hemodynamics, and lung damage in rats exposed to oxygen at 5 or 6 ATA. Before HBO(2) exposure, either a selective inhibitor of neuronal nitric oxide synthase (NOS) or a nonselective NOS inhibitor was injected directly into the cerebral ventricles to minimize effects on the lung, heart, and peripheral circulation. Experiments were performed on both anesthetized and conscious rats to differentiate responses to HBO(2) from the effects of anesthesia. EEG spikes, markers of CNS toxicity in anesthetized animals, were approximately four times as likely to develop in control rats than in animals with central NOS inhibition. In inhibitor-treated animals, autonomic discharges, cardiovascular pressures, catecholamine release, and cerebral blood flow all remained below baseline throughout exposure to HBO(2). In control animals, however, initial declines in these parameters were followed by significant increases above their baselines. In awake animals, central NOS inhibition significantly decreased the incidence of clonic-tonic convulsions or delayed their onset, compared with controls. The novel findings of this study are that NO produced by nNOS in the periventricular regions of the brain plays a critical role in the events leading to both CNS toxicity in HBO(2) and to the associated sympathetic hyperactivation involved in pulmonary injury.     

Prediction of Nociceptive Responses during Sedation by Linear and Non-Linear Measures of EEG Signals in High Frequencies

The level of sedation in patients undergoing medical procedures evolves continuously, affected by the interaction between the effect of the anesthetic and analgesic agents and the pain stimuli. The monitors of depth of anesthesia, based on the analysis of the electroencephalogram (EEG), have been progressively introduced into the daily practice to provide additional information about the state of the patient. However, the quantification of analgesia still remains an open problem. The purpose of this work is to improve the prediction of nociceptive responses with linear and non-linear measures calculated from EEG signal filtered in frequency bands higher than the traditional bands. Power spectral density and auto-mutual information function was applied in order to predict the presence or absence of the nociceptive responses to different stimuli during sedation in endoscopy procedure. The proposed measures exhibit better performances than the bispectral index (BIS). Values of prediction probability of P_k above 0.75 and percentages of sensitivity and specificity above 70% were achieved combining EEG measures from the traditional frequency bands and higher frequency bands.     

System analysis of heart rate variability,hemodynamics, and bioelectrical activity of the human brain at moderate altitudes

Heart rate variability (HRV), hemodynamics, cerebral α rhythm, and systemic relations between them have been investigated in 35 normal human subjects at the age of 37.2 ± 3.8 years. The results of comprehensive clinical, functional and instrumental HRV investigation, electroencephalography (EEG) using 21 monopolar electrodes, and blood pressure (BP) monitoring were embodied in mathematical models that describe the relations of these parameters, multiple regression equations, and generated 3D diagrams. It has been found that a relative increase in the LF range and a decrease in HF one are accompanied by elevations of BP. The EEG α amplitude has been depressed, and α index has decreased. The HRV reduction and modification of the α rhythm structure have been demonstrated to affect the BP values. These data indicate interactions and close relations between the autonomic and central nervous systems and BP.     

Relationship between cortical electrical and cardiac autonomic activities in the awake lizard, Gallotia galloti

ECG and EEG signals were simultaneously recorded in lizards, Gallotia galloti, both in control conditions and under autonomic nervous system (ANS) blockade, in order to evaluate possible relationships between the ANS control of heart rate and the integrated central nervous system activity in reptiles. The ANS blockers used were prazosin, propranolol, and atropine. Time-domain summary statistics were derived from the series of consecutive R-R intervals (RRI) of the ECG to measure beat-to-beat heart rate variability (HRV), and spectral analysis techniques were applied to the EEG activity to assess its frequency content. Both prazosin and atropine did not alter the power spectral density (PSD) of the EEG low frequency (LF: 0.5-7.5 Hz) and high frequency (HF: 7.6-30 Hz) bands, whereas propranolol decreased the PSD in these bands. These findings suggest that central beta-adrenergic receptor mechanisms could mediate the reptilian waking EEG activity without taking part any alpha(1)-adrenergic and/or cholinergic receptor systems. In 55% of the lizards in control conditions, and in approximately 43% of the lizards under prazosin and atropine, a negative correlation between the coefficient of variation of the series of RRI value (CV(RRI)) and the mean power frequency (MPF) of the EEG spectra was found, but not under propranolol. Consequently, the lizards' HRV-EEG-activity relationship appears to be independent of alpha(1)-adrenergic and cholinergic receptor systems and mediated by beta-adrenergic receptor mechanisms.     

Multivariate and multiorgan analysis of cardiorespiratory variability signals: the CAP sleep case.

Signals from different systems are analyzed during sleep on a beat-to-beat basis to provide a quantitative measure of synchronization with the heart rate variability (HRV) signal, oscillations of which reflect the action of the autonomic nervous system. Beat-to-beat variability signals synchronized to QRS occurrence on ECG signals were extracted from respiration, electroencephalogram (EEG) and electromyogram (EMG) traces. The analysis was restricted to sleep stage 2. Cyclic alternating pattern (CAP) periods were detected from EEG signals and the following conditions were identified: stage 2 non-CAP (2 NCAP), stage 2 CAP (2 CAP) and stage 2 CAP with myoclonus (2 CAP MC). The coupling relationships between pairs of variability signals were studied in both the time and frequency domains. Passing from 2 NCAP to 2 CAP, sympathetic activation is indicated by tachycardia and reduced respiratory arrhythmia in the heart rate signal. At the same time, we observed a marked link between EEG and HRV at the CAP frequency. During 2 CAP MC, the increased synchronization involved myoclonus and respiration. The underlying mechanism seems to be related to a global control system at the central level that involves the different systems.     

EEG Spectral Analysis of Relaxation Techniques

The acute central nervous system effects of relaxation techniques (RT) have not been systematically studied. We conducted a controlled, randomized study of the central nervous system effects of RT using spectral analysis of EEG activity. Thirty-six subjects were randomized to either RT or a music comparison condition. After listening to an RT audiotape or music audiotapes daily for 6 weeks, the acute central nervous system effects of RT and music were measured using power spectral analysis of alpha and theta EEG activity in all cortical regions. RT produced significantly greater increases in theta activity in multiple cortical regions compared to the music condition. These findings are consistent with widespread reductions in cortical arousal during RT. They extend previous findings and suggest that theta, and not alpha, EEG may be the most reliable marker of the central nervous system effects of RT. These findings demonstrate that RT produce greater reductions in central nervous system activity than a credible comparison condition. The findings suggest that RT represent a hypoactive central nervous system state that may be similar to Stage 1 sleep and that RT may exert their therapeutic effects, in part, through cerebral energy conservation/restoration.     

Dynamics of spatial synchronization of EEG parameters during relaxation and their relationship with regulation of heart rate

EEG parameters were analyzed in a wide frequency range for the estimation of the possible functional importance of different EEG components in the formation of relaxation. Sixty-five subjects aged 17–20 years were involved in the investigation. The relaxation session with monopolar EEG recording and autonomic parameters recording was carried out for each subject. During the relaxation significant changes were observed in all analyzed EEG ranges. Two types of changes of EEG coherence in the wakefulness-relaxation shift of state were distinguished, and correlation of the type of dynamics with the LF/HF ratio, showing the balance of sympathetic and parasympathetic parts of the autonomic nervous system, was found.     

Adaptive computer control of anesthesia in humans

This paper presents an efficient computer control technique for regulation of anesthesia in humans. The anesthetic used is propofol and the objective is to control the degree of hypnosis of the patient. The paper describes the basic hardware/software setup of the system and the closed-loop methodologies. The bispectral index (BIS) is considered as the feedback signal. The control methods proposed here are based in the use of proportional integral controllers with dead-time compensation to avoid undesirable oscillations in the BIS signal during the process. The compensation is based on the Smith predictor. To guarantee the applicability of the method to different patients, an adaptive module to tune the compensator is developed. Some real and simulated results are presented in this work to attest the efficiency of the methods used.     

Approach and Withdrawal Motivation in Schizophrenia: An Examination of Frontal Brain Asymmetric Activity

Although motivational disturbances are common in schizophrenia, their neurophysiological and psychological basis is poorly understood. This electroencephalography (EEG) study examined the well-established motivational direction model of asymmetric frontal brain activity in schizophrenia. According to this model, relative left frontal activity in the resting EEG reflects enhanced approach motivation tendencies, whereas relative right frontal activity reflects enhanced withdrawal motivation tendencies. Twenty-five schizophrenia outpatients and 25 healthy controls completed resting EEG assessments of frontal asymmetry in the alpha frequency band (8–12 Hz), as well as a self-report measure of behavioral activation and inhibition system (BIS/BAS) sensitivity. Patients showed an atypical pattern of differences from controls. On the EEG measure patients failed to show the left lateralized activity that was present in controls, suggesting diminished approach motivation. On the self-report measure, patients reported higher BIS sensitivity than controls, which is typically interpreted as heightened withdrawal motivation. EEG asymmetry scores did not significantly correlate with BIS/BAS scores or with clinical symptom ratings among patients. The overall pattern suggests a motivational disturbance in schizophrenia characterized by elements of both diminished approach and elevated withdrawal tendencies.     

Neuropeptide Y and peptide YY neuronal and endocrine systems

An extensive system of neuropeptide Y (NPY) containing neurons has recently been identified in the central and peripheral nervous system. In addition, NPY and a structurally related peptide, peptide YY (PYY), containing endocrine cells have been identified in the periphery. The NPY system is of particular interest as the peptide coexists with catecholamines in the central and sympathetic nervous system and adrenal medulla. Evidence has been presented which indicates that NPY may play important roles in regulating autonomic function.