背景:基于前额叶皮层的脑电图(EEG)监测麻醉深度是实现帕金森病(PD)患者全麻下丘脑底核(STN)深部脑刺激(DBS)麻醉精确调控的重要手段。然而,以前没有研究对这些监测数据进行过深入调查.这里,我们旨在分析PD患者丙泊酚全麻DBS期间前额叶脑电图的特点,并确定麻醉深度监测得出的参数参考范围。此外,我们试图探讨术前住院期间3天使用苯二氮卓类药物是否会影响EEG参数的解释.
方法:我们纳入了43例PD患者的数据,这些患者在单中心使用异丙酚进行全身麻醉的整个过程中接受了STNDBS治疗和SedLine监测。18例患者(41.86%)在住院期间服用苯二氮卓类药物。我们将麻醉过程分为三个阶段:麻醉前的清醒状态,丙泊酚麻醉状态,微电极记录(MER)过程中的浅麻醉状态。我们分析了功率谱密度(PSD)和推导的参数,患者的前额叶脑电图,包括患者状态指数(PSI),左侧和右侧的频谱边缘频率(SEF),和抑制比。基线特征,术前用药,术前额叶影像特征,术前运动和非运动评估,术中生命体征,内部环境和麻醉信息,并列出了术后并发症。我们还根据住院期间手术前是否服用苯二氮卓类药物进行了比较。
结果:清醒状态的平均PSI,丙泊酚麻醉状态,MER状态分别为89.86±6.89、48.68±12.65和62.46±13.08。术前服用苯二氮卓类药物对PSI或SEF没有显著影响,但确实减少了压制的总时间,最大抑制比,以及MER期间β和γ的PSD。关于术后谵妄的发生和简易精神状态检查(MMSE)评分,两组之间没有显着差异(卡方检验,p=0.48;Mann-WhitneyU检验,p=0.30)。
结论:第一次,我们展示了麻醉监测深度的推导参数的参考范围和清醒状态下PD患者前额叶脑电图的特征,丙泊酚麻醉状态,MER期间浅麻醉。在手术前住院期间的3天内服用苯二氮卓类药物可减少MER期间β和γ的抑制和PSD,但不会显著影响麻醉医师对麻醉深度的观察,也不影响术后谵妄和MMSE评分。
BACKGROUND: Monitoring the depth of anesthesia by electroencephalogram (EEG) based on the prefrontal cortex is an important means to achieve accurate regulation of anesthesia for subthalamic nucleus (STN) deep brain stimulation (DBS) under general anesthesia in patients with Parkinson\'s disease (PD). However, no previous study has conducted an in-depth investigation into this monitoring data. Here, we aimed to analyze the characteristics of prefrontal cortex EEG during DBS with propofol general anesthesia in patients with PD and determine the reference range of parameters derived from the depth of anesthesia monitoring. Additionally, we attempted to explore whether the use of benzodiazepines in the 3 days during hospitalization before surgery impacted the interpretation of the EEG parameters.
METHODS: We included the data of 43 patients with PD who received STN DBS treatment and SedLine monitoring during the entire course of general anesthesia with propofol in a single center. Eighteen patients (41.86%) took benzodiazepines during hospitalization. We divided the anesthesia process into three stages: awake state before anesthesia, propofol anesthesia state, and shallow anesthesia state during microelectrode recording (MER). We analyzed the power spectral density (PSD) and derived parameters of the patients\' prefrontal EEG, including the patient state index (PSI), spectral edge frequency (SEF) of the left and right sides, and the suppression ratio. The baseline characteristics, preoperative medication, preoperative frontal lobe image characteristics, preoperative motor and non-motor evaluation, intraoperative vital signs, internal environment and anesthetic information, and postoperative complications are listed. We also compared the groups according to whether they took benzodiazepines before surgery during hospitalization.
RESULTS: The average PSI of the awake state, propofol anesthesia state, and MER state were 89.86 ± 6.89, 48.68 ± 12.65, and 62.46 ± 13.08, respectively. The preoperative administration of benzodiazepines did not significantly affect the PSI or SEF, but did reduce the total time of suppression, maximum suppression ratio, and the PSD of beta and gamma during MER. Regarding the occurrence of postoperative delirium and mini-mental state examination (MMSE) scores, there was no significant difference between the two groups (chi-square test, p = 0.48; Mann-Whitney U test, p = 0.30).
CONCLUSIONS: For the first time, we demonstrate the reference range of the derived parameters of the depth of anesthesia monitoring and the characteristics of the prefrontal EEG of patients with PD in the awake state, propofol anesthesia state, and shallow anesthesia during MER. Taking benzodiazepines in the 3 days during hospitalization before surgery reduces suppression and the PSD of beta and gamma during MER, but does not significantly affect the observation of anesthesiologists on the depth of anesthesia, nor affect the postoperative delirium and MMSE scores.