Electroencephalographic density spectral array monitoring during propofol sedation in teenagers, using the narcotrend electroencephalographic monitor.

Abstract

Recently published articles address concerns about the safe use of currently available index-based depth of hypnosis monitors. Electroencephalographic Density Spectral Array monitoring facilitates the interpretation of unprocessed electroencephalogram data, providing the anesthesiologist with real-time drug-specific information on hypnotic depth. The primary aim of this study was to investigate the clinical applicability of Density Spectral Array with a commercially available monitor as the Narcotrend EEG monitor in teenagers under procedural sedation using propofol. We performed a secondary analysis of EEG data. Unprocessed electroencephalogram data from 37 patients, aged 12-18 years, scheduled for gastrointestinal endoscopy under propofol sedation, were used for analysis. The relationship between non-steady state propofol concentrations and Density Spectral Array, represented by the four electroencephalographic frequency bands β, α, θ and δ was investigated. Increasing propofol concentration caused augmentation in the amplitude of frontal δ oscillations and a decrease in the amplitude of frontal β oscillations. The expression of α oscillations showed a biphasic pattern related to increasing the propofol concentration. Spearman correlation analysis showed a significant correlation between propofol concentration and relative EEG power in β (r -0.84, P<0.0001), θ (r 0.50, P=0.004) and δ (r 0.63, P<0.0001). We were able to show that DSA displayed in real time, on a commercially available DoA monitor (the Narcotrend EEG monitor), can provide the anesthesiologist with understandable information regarding the dose-dependent EEG effects of propofol in teenagers.