Age-dependent electroencephalogram (EEG) patterns during sevoflurane general anesthesia in infants

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Abstract

Electroencephalogram (EEG) approaches may provide important information about developmental changes in brain-state dynamics during general anesthesia. We used multi-electrode EEG, analyzed with multitaper-spectral methods and video recording of body movement to characterize the spatiotemporal dynamics of brain activity in 36 infants 0-6 months old when awake, and during maintenance-of and emergence-from sevoflurane general anesthesia. During maintenance: 1)slow-delta oscillations were present in all ages; 2)theta and alpha oscillations emerged around 4months; 3)unlike adults, all infants lacked frontal alpha predominance and coherence. Alpha power was greatest during maintenance, compared to awake and emergence in infants at 4-6months. During emergence, theta and alpha power decreased with decreasing sevoflurane concentration in infants at 4-6months. These EEG dynamic differences are likely due to developmental factors including regional differences in synaptogenesis, glucose metabolism, and myelination across the cortex. We demonstrate the need to apply age-adjusted analytic approaches to develop neurophysiologic-based strategies for pediatric anesthetic state monitoring.

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Laura Cornelissen

Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, United States

For correspondence
laura.cornelissen@childrens.harvard.edu

Competing interests
No competing interests declared.
Seong-Eun Kim

Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, United States

Competing interests
No competing interests declared.
Patrick L Purdon

Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, United States

Competing interests
Patrick L Purdon, P.L.P. and E.N.B. have patents pending on brain monitoring during general anesthesia and sedation, and have a patent licensing agreement with Masimo Corporation .Application Numbers: P.L.P & E.N.B.: 20150080754, 20150011907, 20140323898, 20140323897, 20140316218, 20140316217, 20140187973, 20140180160; P.L.P: 20080306397.
Emery N Brown

Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, United States

Competing interests
Emery N Brown, P.L.P. and E.N.B. have patents pending on brain monitoring during general anesthesia and sedation, and have a patent licensing agreement with Masimo Corporation. Application Numbers: P.L.P & E.N.B.: 20150080754, 20150011907, 20140323898, 20140323897, 20140316218, 20140316217, 20140187973, 20140180160; P.L.P: 20080306397.
Charles B Berde

Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, United States

Competing interests
No competing interests declared.

Ethics

Human subjects: Boston Children's Hospital Institutional Review Board (IRB) approved the study (IRB Protocol Number: IRB-P00003544), and informed written consent was obtained from parents/legal guardians before each study. The study conformed to the standards set by the Declaration of Helsinki and Good Clinical Practice guidelines.

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This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.