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EEG power spectral density under Propofol and its association with burst suppression, a marker of cerebral fragility

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OBJECTIVE Under General Anesthesia (GA), age and Burst Suppression (BS) are associated with cognitive postoperative complications, yet how these parameters are related to per-operative EEG and hypnotic doses is unclear.… Click to show full abstract

OBJECTIVE Under General Anesthesia (GA), age and Burst Suppression (BS) are associated with cognitive postoperative complications, yet how these parameters are related to per-operative EEG and hypnotic doses is unclear. In this prospective study, we address this question comparing age and BS occurrences with a new score (BPTIVA) based on Propofol doses, EEG and alpha-band power spectral densities, evaluated for SEF95 = 8-13 Hz. METHODS 59 patients (55 [34-67] yr, 67% female) undergoing neuroradiology or orthopedic surgery were included. Total IntraVenous Anesthesia was used for Propofol and analgesics infusion. Cerebral activity was monitored from a frontal electrodes montage EEG. RESULTS BPTIVA was inversely correlated with age (Pearson r = -0.78, p < 0.001), and was significantly lower (p < 0.001) when BS occurred during the GA first minutes (induction). Additionally, the age-free BPTIVA score was better associated with BS at induction than age (AUC = 0.94 versus 0.82, p < 0.05). CONCLUSION We designed BPTIVA score based on hypnotics and EEG. It was correlated with age yet was better associated to BS occurring during GA induction, the latter being a cerebral fragility sign. SIGNIFICANCE This advocate for an approach based on evaluating the cerebral physiological age («brain age») to predict postoperative cognitive evolution.

Keywords: propofol; cerebral fragility; age; burst suppression; power spectral

Journal Title: Clinical Neurophysiology
Year Published: 2019

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