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  • Th I fl f EEG P tt d A tTh I fl f EEG P tt d A tThe Influence of EEG Pattern and ArteThe Influence of EEG Pattern and ArteThe Influence of EEG Pattern and ArteThe Influence of EEG Pattern and ArteThe Influence of EEG Pattern and ArteThe Influence of EEG Pattern and ArteThe Influence of EEG Pattern and ArteA l i f 4 DifA l i f 4 Difan Anal sis of 4 Difan Analysis of 4 Difan Analysis of 4 Dif an Analysis of 4 Dif an Analysis of 4 Difan Analysis of 4 Difan Analysis of 4 Difan Analysis of 4 Difyy

    V lik K t hi i M D 1 G h d S h id M D 1 M tthi KVeliko Karatchiviev M D 1 Gerhard Schneider M D 1 Matthias KVeliko Karatchiviev M D 1 Gerhard Schneider M D 1 Matthias KVeliko Karatchiviev M D 1 Gerhard Schneider M D 1 Matthias KVeliko Karatchiviev, M.D. , Gerhard Schneider, M.D. , Matthias KVeliko Karatchiviev, M.D. , Gerhard Schneider, M.D. , Matthias K, , , ,

    1 D t t f A th i l I Witt /H d k U i1 Department of Anaesthesiology I Witten/Herdecke Univers1 Department of Anaesthesiology I Witten/Herdecke Univers1 Department of Anaesthesiology I Witten/Herdecke UniversDepartment of Anaesthesiology I, Witten/Herdecke UniversDepartment of Anaesthesiology I, Witten/Herdecke Universp gy ,p gyA th i l T h i h U iAnaesthesiology Technische UniveAnaesthesiology Technische UniveAnaesthesiology Technische UniveAnaesthesiology, Technische UniveAnaesthesiology, Technische Univegy,

    O B J E C T I V EO B J E C T I V EO B J E C T I V EO B J E C T I V EO B J E C T I V EO B J E C T I V E O J CAi f h d l h i fl f W l d h i d l di l d 30 b fAi f th t d t l t th i fl f W l d th i d l di l d 30 b fAim of the study was to evaluate the influence of We analysed the index values displayed 30s beforeAim of the study was to evaluate the influence of We analysed the index values displayed 30s beforeAim of the study was to evaluate the influence of We analysed the index values displayed 30s beforeAim of the study was to evaluate the influence of We analysed the index values displayed 30s beforeAim of the study was to evaluate the influence of We analysed the index values displayed 30s beforey y p yEEG t f t l l t d i d l f f d ft th fi t h f th ti tEEG artefacts on calculated index values of four and after the first change of the patients responseEEG artefacts on calculated index values of four and after the first change of the patients responseEEG artefacts on calculated index values of four and after the first change of the patient s responseEEG artefacts on calculated index values of four and after the first change of the patient s responseEEG artefacts on calculated index values of four and after the first change of the patient s responseg p pgdiff i ll il bl DOA (d h f d h 60 EEG h i di ldiff t i ll il bl DOA (d th f d th 60 EEG th t i di t ldifferent commercially available DOA (depth of and the 60s EEG sequences that immediatelydifferent commercially available DOA (depth of and the 60s EEG sequences that immediatelydifferent commercially available DOA (depth of and the 60s EEG sequences that immediatelydifferent commercially available DOA (depth of and the 60s EEG sequences that immediatelydifferent commercially available DOA (depth of and the 60s EEG sequences that immediatelyy ( p q y

    th i ) it d d th (Fi 1 l ft)anesthesia) monitors preceded them (Fig 1 left)anesthesia) monitors preceded them (Fig 1 left)anesthesia) monitors preceded them (Fig 1 left)anesthesia) monitors. preceded them (Fig. 1 left).anesthesia) monitors. preceded them (Fig. 1 left).) p ( g )M E T H O D S A i l l i f th EEGM E T H O D S A visual analysis of the EEG sequences wasM E T H O D S A visual analysis of the EEG sequences wasM E T H O D S A visual analysis of the EEG sequences wasM E T H O D S A visual analysis of the EEG sequences wasM E T H O D S A visual analysis of the EEG sequences wasy qy q

    ff d b th i d d t i ti t hperformed by three independent investigators whoD i th l i d ti d h f performed by three independent investigators whoD ring the slo ind ction and emergence phases of performed by three independent investigators whoDuring the slow induction and emergence phases of performed by three independent investigators, whoDuring the slow induction and emergence phases of performed by three independent investigators, whoDuring the slow induction and emergence phases of p y p g ,During the slow induction and emergence phases ofg g pl t d th f th f

    g g pevaluated them for the occurrence ofevaluated them for the occurrence ofl th i (S fl /R if t il evaluated them for the occurrence ofgeneral anesthesia (Sevoflurane/Remifentanil or evaluated them for the occurrence ofgeneral anesthesia (Sevoflurane/Remifentanil or evaluated them for the occurrence ofgeneral anesthesia (Sevoflurane/Remifentanil orgeneral anesthesia (Sevoflurane/Remifentanil orgeneral anesthesia (Sevoflurane/Remifentanil or

    f / h i i EEG (Fi 1 i h )g (

    t f t / h t i ti EEG tt (Fi 1 i ht)artefacts/characteristic EEG pattern (Fig 1 right)P f l /R if t il) ti t t d t artefacts/characteristic EEG pattern (Fig 1 right)Propofol /Remifentanil) patients ere req ested to artefacts/characteristic EEG pattern (Fig 1 right)Propofol /Remifentanil) patients were requested to artefacts/characteristic EEG pattern (Fig. 1 right).Propofol /Remifentanil) patients were requested to artefacts/characteristic EEG pattern (Fig. 1 right).Propofol /Remifentanil) patients were requested to p ( g g )Propofol /Remifentanil) patients were requested top ) p qp ) p qth i ti t h d i 30 i t l C l l t d i d l t th 30 i t l b fsqueeze the investigators hand in a 30s interval Calculated index values at the 30s intervals beforesqueeze the investigator s hand in a 30s interval Calculated index values at the 30s intervals beforesqueeze the investigator s hand in a 30s interval Calculated index values at the 30s intervals beforesqueeze the investigator s hand in a 30s interval, Calculated index values at the 30s intervals beforesqueeze the investigator s hand in a 30s interval, Calculated index values at the 30s intervals beforeq g ,

    th ll i t th i i d ft th fi t h f th ti tthus allowing to assess their responsiveness every and after the first change of the patients responsethus allowing to assess their responsiveness every and after the first change of the patients responsethus allowing to assess their responsiveness every and after the first change of the patient s responsethus allowing to assess their responsiveness every and after the first change of the patient s responsethus allowing to assess their responsiveness every and after the first change of the patient s responseg p y g p pg p y g p pf G f f fh lf i t Th d d EEG i l f th l d d d fi d if thhalf a minute The recorded EEG signal for these were analyzed and defined as erroneous if thehalf a minute The recorded EEG signal for these were analyzed and defined as erroneous if thehalf a minute The recorded EEG signal for these were analyzed and defined as erroneous if thehalf a minute. The recorded EEG signal for these were analyzed and defined as erroneous if thehalf a minute. The recorded EEG signal for these were analyzed and defined as erroneous if theg y

    i l t l d t th 4 it l hi h th 80 f i ti tsessions was later replayed to the 4 monitors value was higher than 80 for unresponsive patientssessions was later replayed to the 4 monitors value was higher than 80 for unresponsive patientssessions was later replayed to the 4 monitors value was higher than 80 for unresponsive patientssessions was later replayed to the 4 monitors. value was higher than 80 for unresponsive patients,sessions was later replayed to the 4 monitors. value was higher than 80 for unresponsive patients,p y g p p ,p y g p p60 fl th 60 f i ti tor lower than 60 or for responsive patientsor lower than 60 or for responsive patientsor lower than 60 or for responsive patientsor lower than 60 or for responsive patients.or lower than 60 or for responsive patients.p p

    A A2000 BIS BISA t A2000 BIS BIS Aspect A2000 BIS BIS Aspect A2000 BIS - BIS Aspect A2000 BIS - BISAspect A2000 BIS BISAspect A2000 BIS BISpSE t d l SE Entropy module SE Entropy module - SE Entropy module - SEEntropy module SEEntropy module SEpy

    CS CSCSI it CSI CSI monitor CSI CSI monitor - CSI CSI monitor - CSICSI monitor CSICSI monitor CSIN t d it NCT Narcotrend monitor NCT Narcotrend monitor NCT Narcotrend monitor - NCTNarcotrend monitor NCTNarcotrend monitor NCT

    " "" "s" s"" s s "" s s "s" u u s"s u u ss ou ou su o o uu o o ux u x o x o x ui l l d i d x o x i x i x omonitor calculated index x o x c x c x omonitor calculated index ex o ex c ex c ex omonitor calculated index e i e sc e sc e imonitor calculated index e ci e s e s e cid c d s d s d cd sc d n d n d scl

    d s d n d n d svalues n s n n n n n svalues n n n o n o n nvalues n n n o n o n n HFvalues i n i o i o i n HFi o i c i c i o HFo c c o EBEBo nc nc o EBEBco n n co EBEBc n n cc un un c" u u "" u u "u u" "" "

    di di di dipreceding preceding preceding precedingpreceding preceding preceding preceding EBpreceding preceding preceding preceding EBpreceding preceding preceding preceding EBp g p g p g p gG di EEG EEG EEG EEGEEG recording EEG EEG EEG EEGEEG recording EEG EEG EEG EEGEEG recording EEG EEG EEG EEGEEGrecording EEG EEG EEG EEGg

    i l / ftime to lost/return of s s s s s s s C stime to lost/return of s s s C s s s s C stime to lost/return of 0s 0 0s C 0 0s 0s 0s C 0timetolost/returnof 0 0 0 OC 0 0 0 0 OC 0 HF/ 0 60 0 O 0 0 0 0 O 0 HF HF90 6 30 O 3 90 60 30 O 3 HF HFi 9 6 3

    O 3 9 6 3 O 3 HFconsciousness 9 6 3 L +3 9 6 3 R +3 HFconsciousness L + R +consciousness + R +consciousness

    f " i "state of "consciousness"state of "consciousness"state of consciousnessstateof consciousness

    ti (30 i t l )time (30s intervals)time (30s intervals)time (30s intervals)time(30sintervals)( )

    ti t t ll i ?patient actually responsive ? + + + + + +patient actually responsive ? + +