Effects of sevoflurane and propofol on electroencephalography during general anesthesia in patients with prolonged disorders of consciousness

doi:10.3877/cma.j.issn.2095-9141.2023.01.003

Abstract

Abstract:

Objective

To investigate the effects of sevoflurane inhalation anesthesia and propofol intravenous anesthesia on electroencephalogram (EEG) in patients with prolonged disorders of consciousness (pDoC) during perioperative period.

Methods

Twenty patients with pDoC who planned to undergo short-range electrical stimulation of the spinal cord (st-SCS) in Neurosurgery Department of The Seventh Medical Center of PLA General Hospital, and the Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University from January to August 2022, were prospectively included, and divided into sevoflurane group (10 cases) and propofol group (10 cases) according to the random number table. The 19-channel EEG equipment was used to record the changes of brain electrical activity before, during and after anesthesia in both groups.

Results

The EEG power spectra during anesthesia in both groups were characterized by an increase in δ power and a decrease in θ, β and γ power. After anesthesia, sevoflurane group had more fast wave activity (θ+α+β) and less slow wave activity (δ) than propofol group. The area under the ROC curve of EEG indicators which distinguish awake and anesthesia states showed that permutation entropy (PE) and permutation Lempel-Ziv complexity (PLZC) in the frontal lobe region were the best indicators of discrimination, propofol frontal lobe PE (AUC: 0.865) >sevoflurane frontal lobe PE (AUC: 0.815), propofol frontal lobe PLCZ (AUC: 0.865) >sevoflurane (AUC: 0.810).

Conclusion

Sevoflurane and propofol have similar effects on brain electrical activity in pDoC patients under anesthesia, but sevoflurane group has better performance than propofol group after awakening. EEG monitoring is of great significance to evaluate the state of consciousness during general anesthesia. The ratio of fast and slow wave power, PE and PLZC as EEG indicators to describe the depth of anesthesia shows strong applicability in patients with prolonged disorders of consciousness. The PE and PLZC of frontal lobe can distinguish awake from anesthesia best.

Key words: Prolonged disorders of consciousness, Sevoflurane, Propofol, Electroencephalogram

Qinghua Li, Chenyan Jin, Yanjun Wang, Yutong Zhuang, Jianghong He, Wenzhi Guo. Effects of sevoflurane and propofol on electroencephalography during general anesthesia in patients with prolonged disorders of consciousness[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2023, 09(01): 12-18.

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References 36

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项目	七氟醚组（n=10）	丙泊酚组（n=10）	χ²/t/Z值	P值
性别[例（%）]				1.000
男	8（80）	8（80）
女	2（20）	2（20）
病因[例（%）]				0.193
颅脑外伤	5（50）	1（10）
脑卒中	3（30）	6（60）
缺氧性脑病	2（20）	3（30）
年龄（岁，±s）	33.9±12.1	37.4±11.1	0.674	0.509
病程[d，M（P₂₅，P₇₅）]	142.50（84.75，165.75）	113.50（75.75，153.25）	-0.529	0.631

项目	七氟醚组（n=10）	丙泊酚组（n=10）	χ²/t/Z值	P值
性别[例（%）]				1.000
男	8（80）	8（80）
女	2（20）	2（20）
病因[例（%）]				0.193
颅脑外伤	5（50）	1（10）
脑卒中	3（30）	6（60）
缺氧性脑病	2（20）	3（30）
年龄（岁，±s）	33.9±12.1	37.4±11.1	0.674	0.509
病程[d，M（P₂₅，P₇₅）]	142.50（84.75，165.75）	113.50（75.75，153.25）	-0.529	0.631

指标	AUC区域	标准误	渐近显著性	95%CI
指标	AUC区域	标准误	渐近显著性	下限	上限
额叶PE	0.845	0.052	0.000	0.743	0.947
额叶PLCZ	0.845	0.054	0.000	0.739	0.951
顶叶PE	0.815	0.059	0.000	0.699	0.931
顶叶PLCZ	0.811	0.062	0.000	0.690	0.932
枕叶PE	0.805	0.064	0.000	0.680	0.930
枕叶PLCZ	0.793	0.068	0.000	0.660	0.925
枕叶（α+β+θ）/δ	0.788	0.061	0.000	0.668	0.907
中央区PE	0.781	0.063	0.000	0.657	0.905
中央区PLCZ	0.781	0.064	0.000	0.655	0.907
顶叶（α+β+θ）/δ	0.781	0.062	0.000	0.659	0.903
中央区（α+β+θ）/δ	0.763	0.064	0.001	0.636	0.889
额叶（α+β+θ）/δ	0.743	0.066	0.002	0.613	0.872
枕叶（α+β）/（θ+δ）	0.721	0.072	0.006	0.579	0.863
顶叶（α+β）/（θ+δ）	0.719	0.072	0.006	0.578	0.860
中央区（α+β）/（θ+δ）	0.709	0.074	0.009	0.563	0.854
顶叶α/δ	0.704	0.071	0.011	0.565	0.842
枕叶α/δ	0.703	0.072	0.011	0.562	0.843

指标	AUC区域	标准误	渐近显著性	95%CI
指标	AUC区域	标准误	渐近显著性	下限	上限
额叶PE	0.845	0.052	0.000	0.743	0.947
额叶PLCZ	0.845	0.054	0.000	0.739	0.951
顶叶PE	0.815	0.059	0.000	0.699	0.931
顶叶PLCZ	0.811	0.062	0.000	0.690	0.932
枕叶PE	0.805	0.064	0.000	0.680	0.930
枕叶PLCZ	0.793	0.068	0.000	0.660	0.925
枕叶（α+β+θ）/δ	0.788	0.061	0.000	0.668	0.907
中央区PE	0.781	0.063	0.000	0.657	0.905
中央区PLCZ	0.781	0.064	0.000	0.655	0.907
顶叶（α+β+θ）/δ	0.781	0.062	0.000	0.659	0.903
中央区（α+β+θ）/δ	0.763	0.064	0.001	0.636	0.889
额叶（α+β+θ）/δ	0.743	0.066	0.002	0.613	0.872
枕叶（α+β）/（θ+δ）	0.721	0.072	0.006	0.579	0.863
顶叶（α+β）/（θ+δ）	0.719	0.072	0.006	0.578	0.860
中央区（α+β）/（θ+δ）	0.709	0.074	0.009	0.563	0.854
顶叶α/δ	0.704	0.071	0.011	0.565	0.842
枕叶α/δ	0.703	0.072	0.011	0.562	0.843

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