EEG can Predict Neurologic Outcome in Children Resuscitated from Cardiac Arrest / 대한소아신경학회지

PURPOSE: Early prediction of prognosis of children resuscitated from cardiac arrest is a major challenge. We investigated the utility of electroencephalography (EEG) and laboratory studies for predicting of neurologic outcome in children resuscitated from cardiac arrest. METHODS: We retrospectively analyzed medical records of patients who were resuscitated from cardiac arrest from 2006 to 2015 at the Gil Medical Center. Patients aged one month to 18 years were included. EEG analysis included background scoring, reactivity and seizure burden. EEG background was classified score 0 (normal/organized), score 1 (slow and disorganized), score 2 (discontinuous or burst suppression), and score 3 (suppressed and featureless). Neurologic outcome was evaluated by Pediatric Cerebral Performance Category (PCPC) at least 6 months after cardiac arrest. RESULTS: Total 26 patients were evaluated. Nine patients showed good neurologic outcome (PCPC 1, 2, 3) and 17 patients showed poor neurologic outcome (PCPC 4, 5, 6). Patients of poor neurologic outcome group showed EEG background score 3 in 88.2%, whereas 44.4% in patients of good neurologic outcome group (P=0.028). Electrographic ictal discharges except non-convulsive status epilepticus were presented in 44.4% of good neurologic outcome group and 5.9% of poor neurologic outcome group (P=0.034). Ammonia and lactate levels were higher and pH levels were lower in poor outcome group than good neurologic outcome group. CONCLUSION: Suppressed and featureless EEG background is associated with poor neurologic outcome and electrographic seizures are associated with good neurologic outcome.

Effect of esmolol on bispectral index in patients undergoing orotracheal intubation during induction of anesthesia / 中华麻醉学杂志

Objective To evaluate the effect of esmolol on bispectral index (BIS) in patients undergoing orotracheal intubation during induction of anesthesia and to investigate the mechanism of inhibiting the cardiovascular responses to tracheal intubation.Methode Forty patients in physical status of ASA Ⅰ or Ⅱ and aged 20-60 years were randomly divided into 2 groups ( n = 20 each): esmolol group (group E) and control group (group C). Anesthesia was induced with midazolam 0.1 mg/kg, fentanyl 5 μg/kg and vecuronium 0.1 mg/kg. In group E, esmolol 1 mg/kg was given intravenously before anesthesia induction and followed by an infusion of esmolol 250 μg· kg- 1·min-1, while a comparable volume of saline was given for group C. Mean arterial pressure (MAP), heart rate (HR) and BIS were recorded before esmolol administration, before induction of anesthesia, before orotracheal intubation, and at 1, 2 and 5 min after intubation, respectively.Results There were no significant differences in HR, MAP and BIS between the two groups before tracheal intubation. HR and MAP significantly increased after tracheal intubation in both groups, but BIS only in group C significantly increased after intubation.HR, MAP and BIS were significantly lower after intubation in group E than in group C ( P＜ 0.05).Conclusion Esmolol can decrease BIS during tracheal intubation and its antinociceptive property is related to the mechanism of inhibiting cardiovascular responses to tracheal intubation.

Spectral Analysis of EEG During Infusion of Propofol in the Rats / 대한마취과학회지

BACKGROUND: The dose-related effects of intravenous infusion of propofol on the rat EEG were evaluated quantitatively by spectral analysis of EEG recorded from the rat skull. METHODS: Propofol was infused into femoral vein at various concentrations ranging from 0 to 400 g/g body weight, and bipolar EEG was recorded from the rat skull and its spectrum were calculated by power spectrum analysis. The EEG electrodes were fixed at the right and left frontal, parieatal, and occipital bone on rat stereotaxic table. The density of each spectral bands(delta 1 3.25, theta 3.5 7.75, alpha 8 12.75, beta 13 31.75 Hz), total power density, median power frquency, and spectral edge frequency were derived from the spectra. RESULTS: In visual inspection of conventional EEG, low doses of propofol(100, 200 g/100 g) showed no significant changes except appearance of high frequency waves, but higher doses of propofol(300, 400 g/100 g) showed high amplitude with low frequency wave. In quantitative spectral analysis of EEG, low dose of propofol revealed no significant change except appearance of beta-waves in the frontal lobe especially. Significant EEG changes were identified during infusion of higher dose of propofol. 300 and 400 g/g of propofol revealed high amplitude and low frequency waves. Median power frequency and spectral edge frequency were significantly changed at 300 and 400 g/g of propofol in range 4.2Hz and 3.8Hz, and 12.4 Hz and 10.2 Hz respectively. CONCLUSIONS: Taken together, these findings suggest that analysis of EEG parameters derived from EEG power spectrum could be applied to determine the depth of propofol anesthesia in rats.