Episodic waveforms in the electroencephalogram during general anaesthesia: a study of patterns of response to noxious stimuli.

Previous studies of the electroencephalogram (EEG) during anaesthesia have identified two distinct patterns of change in response to a noxious stimulus, a classical arousal pattern and a paradoxical arousal pattern. We developed methods of EEG analysis to quantify episodic EEG patterns--namely sleep spindle-like ('10 Hz-score') and burst-suppression-like fluctuations in high frequencies ('high frequency variation index')--and used traditional power spectral quantification of non-episodic delta waves. We studied 30 healthy adult patients undergoing elective surgery under general anaesthesia with propofol, fentanyl (1.0, 2.5 or 4.0 microg/kg, n=10 for each group), muscle relaxant and sevoflurane. Prefrontal EEG data were recorded during the operation and analysed for changes in episodic patterns before and after noxious stimuli (intubation and incision). Before noxious stimuli, the EEG patterns varied markedly between patients and were not strongly correlated to calculated effect-site concentrations of fentanyl, propofol or sevoflurane. Noxious stimuli reduced the 10 Hz-score from 0.25 to 0.20 (P = 0.01) after intubation and from 0.33 to 0.27 (P = 0.01) after incision; and high frequency variation index from 2.8 to 2.0 (P=0.02) after incision--the classical arousal pattern. The nociception-induced reduction in spindles was greater in the low-dose fentanyl group (P = 0.01). There was less tachycardia in the high-dose fentanyl group (P = 0.002). It is possible to quantify such episodic EEG patterns during general anaesthesia and in this study noxious stimulation tended to reduce the prevalence of these patterns.