Effect of Ketamine on the Bispectral Index, Spectral Edge Frequency, and Surgical Pleth Index During Propofol-Remifentanil Anesthesia: An Observational Prospective Trial.
Journal
Anesthesia and analgesia
ISSN: 1526-7598
Titre abrégé: Anesth Analg
Pays: United States
ID NLM: 1310650
Informations de publication
Date de publication:
01 Nov 2024
01 Nov 2024
Historique:
medline:
1
11
2024
pubmed:
1
11
2024
entrez:
1
11
2024
Statut:
aheadofprint
Résumé
Ketamine administration during stable propofol anesthesia is known to be associated with an increase in bispectral index (BIS) but a "deepening" in the level of hypnosis. This study aimed to evaluate the association between the effect-site concentration of ketamine (CeK) and 2 electroencephalogram (EEG)-derived parameters, the BIS and spectral edge frequency (SEF95), after the administration of a ketamine bolus. Secondary aims included investigating the BIS and SEF95 variations with time and changes in the surgical pleth index (SPI). We conducted an observational, prospective, single-center study analyzing intraoperative data from 14 adult female patients undergoing breast oncologic surgery. During stable propofol-remifentanil target-controlled infusion (TCI) anesthesia, a ketamine analgesic bolus was delivered with the target CeK set to 1 μg.mL-1 (Domino model) corresponding to a dose of 0.57 mg.kg-1 (interquartile range [IQR] 0.56-0.57 mg.kg-1). Once the CeK reached a value of 1 μg.mL-1, the target CeK was set to 0 μg.mL-1. We determined the median BIS, SEF95, and SPI trends with time and as a function of the modeled CeK. BIS and SEF95 showed no significant change from when ketamine was administered to when CeK=1 μg.mL-1, but a significant increase was observed at lower CeKs. The maximum BIS was reached at 16.0 minutes [10.2-22.7 minutes] after CeK=1 μg.mL-1, at CeK=0.22 μg.mL-1 [0.12-0.41 μg.mL-1]. The peak SEF95 value was observed at 10.0 minutes [8.62-14.1 minutes] after CeK=1 μg.mL-1, at CeK=0.43 μg.mL-1 [0.25-0.50 μg.mL-1]. No significant association was found between CeK and the registered SPI values. Our results show that BIS and SEF95, but not SPI, follow a CeK-dependent trend after administering a ketamine bolus. Interestingly, their peak values were not reached at CeK=1 μg.mL-1, but after several minutes after the drug infusion at CeKs in the 0.2 to 0.5 μg.mL-1 range. This may be explained by the specific pharmacodynamics of ketamine and its varying effects at different concentrations, as well as by the time delay associated with the calculation of the BIS.
Sections du résumé
BACKGROUND
BACKGROUND
Ketamine administration during stable propofol anesthesia is known to be associated with an increase in bispectral index (BIS) but a "deepening" in the level of hypnosis. This study aimed to evaluate the association between the effect-site concentration of ketamine (CeK) and 2 electroencephalogram (EEG)-derived parameters, the BIS and spectral edge frequency (SEF95), after the administration of a ketamine bolus. Secondary aims included investigating the BIS and SEF95 variations with time and changes in the surgical pleth index (SPI).
METHODS
METHODS
We conducted an observational, prospective, single-center study analyzing intraoperative data from 14 adult female patients undergoing breast oncologic surgery. During stable propofol-remifentanil target-controlled infusion (TCI) anesthesia, a ketamine analgesic bolus was delivered with the target CeK set to 1 μg.mL-1 (Domino model) corresponding to a dose of 0.57 mg.kg-1 (interquartile range [IQR] 0.56-0.57 mg.kg-1). Once the CeK reached a value of 1 μg.mL-1, the target CeK was set to 0 μg.mL-1. We determined the median BIS, SEF95, and SPI trends with time and as a function of the modeled CeK.
RESULTS
RESULTS
BIS and SEF95 showed no significant change from when ketamine was administered to when CeK=1 μg.mL-1, but a significant increase was observed at lower CeKs. The maximum BIS was reached at 16.0 minutes [10.2-22.7 minutes] after CeK=1 μg.mL-1, at CeK=0.22 μg.mL-1 [0.12-0.41 μg.mL-1]. The peak SEF95 value was observed at 10.0 minutes [8.62-14.1 minutes] after CeK=1 μg.mL-1, at CeK=0.43 μg.mL-1 [0.25-0.50 μg.mL-1]. No significant association was found between CeK and the registered SPI values.
CONCLUSIONS
CONCLUSIONS
Our results show that BIS and SEF95, but not SPI, follow a CeK-dependent trend after administering a ketamine bolus. Interestingly, their peak values were not reached at CeK=1 μg.mL-1, but after several minutes after the drug infusion at CeKs in the 0.2 to 0.5 μg.mL-1 range. This may be explained by the specific pharmacodynamics of ketamine and its varying effects at different concentrations, as well as by the time delay associated with the calculation of the BIS.
Identifiants
pubmed: 39485729
doi: 10.1213/ANE.0000000000007255
pii: 00000539-990000000-01018
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Anesthesia Research Society.
Déclaration de conflit d'intérêts
Conflicts of Interest, Funding: Please see DISCLOSURES at the end of this article.
Références
Brinck EC, Tiippana E, Heesen M, et al. Perioperative intravenous ketamine for acute postoperative pain in adults. Cochrane Database Syst Rev. 2018;12:CD012033.
Brown EN, Pavone KJ, Naranjo M. Multimodal general anesthesia: theory and practice. Anesth Analg. 2018;127:1246–1258.
Bi Y, Ye Y, Zhu Y, Ma J, Zhang X, Liu B. The effect of ketamine on acute and chronic wound pain in patients undergoing breast surgery: a meta-analysis and systematic review. Pain Pract. 2021;21:316–332.
Purdon PL, Sampson A, Pavone KJ, Brown EN. Clinical electroencephalography for anesthesiologists: Part I: background and basic signatures. Anesthesiology. 2015;123:937–960.
Tsuda N, Hayashi K, Hagihira S, Sawa T. Ketamine, an NMDA-antagonist, increases the oscillatory frequencies of alpha-peaks on the electroencephalographic power spectrum. Acta Anaesthesiol Scand. 2007;51:472–481.
Faraoni D, Salengros J-C, Engelman E, Ickx B, Barvais L. Ketamine has no effect on bispectral index during stable propofol-remifentanil anaesthesia. Br J Anaesth. 2009;102:336–339.
Sengupta S, Ghosh S, Rudra A, Kumar P, Maitra G, Das T. Effect of ketamine on bispectral index during propofol--fentanyl anesthesia: a randomized controlled study. Middle East J Anaesthesiol. 2011;21:391–395.
Al-Rifai Z, Mulvey D. Principles of total intravenous anaesthesia: practical aspects of using total intravenous anaesthesia. BJA Educ. 2016;16:276–280.
Domino EF, Zsigmond EK, Domino LE, Domino KE, Kothary SP, Domino SE. Plasma levels of ketamine and two of its metabolites in surgical patients using a gas chromatographic mass fragmentographic assay. Anesth Analg. 1982;61:87–92.
Absalom AR, Lee M, Menon DK, et al. Predictive performance of the Domino, Hijazi, and Clements models during low-dose target-controlled ketamine infusions in healthy volunteers. Br J Anaesth. 2007;98:615–623.
Jildenstål P, Bäckström A, Hedman K, Warrén-Stomberg M. Spectral edge frequency during general anaesthesia: a narrative literature review. J Int Med Res. 2022;50:3000605221118682.
Struys MM, Vanpeteghem C, Huiku M, Uutela K, Blyaert NB, Mortier EP. Changes in a surgical stress index in response to standardized pain stimuli during propofol-remifentanil infusion. Br J Anaesth. 2007;99:359–367.
Eleveld DJ, Colin P, Absalom AR, Struys MMRF. Pharmacokinetic-pharmacodynamic model for propofol for broad application in anaesthesia and sedation. Br J Anaesth. 2018;120:942–959.
Minto CF, Schnider TW, Egan TD, et al. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. Anesthesiology. 1997;86:10–23.
Linassi F, Zanatta P, Spano L, Burelli P, Farnia A, Carron M. Schnider and eleveld models for propofol target-controlled infusion anesthesia: a clinical comparison. Life (Basel). 2023;13:2065.
Fuller PM, Sherman D, Pedersen NP, Saper CB, Lu J. Reassessment of the structural basis of the ascending arousal system. J Comp Neurol. 2011;519:933–956.
Hans P, Dewandre PY, Brichant JF, Bonhomme V. Comparative effects of ketamine on Bispectral Index and spectral entropy of the electroencephalogram under sevoflurane anaesthesia. Br J Anaesth. 2005;94:336–340.
Kreuzer M, Stern MA, Hight D, et al. Spectral and entropic features are altered by age in the electroencephalogram in patients under sevoflurane anesthesia. Anesthesiology. 2020;132:1003–1016.
McDonald John H. Handbook of Biological Statistics. Sparky House Publishing; 2009
Vereecke HE, Struys MM, Mortier EP. A comparison of bispectral index and ARX-derived auditory evoked potential index in measuring the clinical interaction between ketamine and propofol anaesthesia. Anaesthesia. 2003;58:957–961.
Hirota K, Kubota T, Ishihara H, Matsuki A. The effects of nitrous oxide and ketamine on the bispectral index and 95% spectral edge frequency during propofol-fentanyl anaesthesia. Eur J Anaesthesiol. 1999;16:779–783.
Moga MM, Herbert H, Hurley KM, Yasui Y, Gray TS, Saper CB. Organization of cortical, basal forebrain, and hypothalamic afferents to the parabrachial nucleus in the rat. J Comp Neurol. 1990;295:624–661.
Boon JA, Milsom WK. NMDA receptor-mediated processes in the Parabrachial/Kölliker fuse complex influence respiratory responses directly and indirectly via changes in cortical activation state. Respir Physiol Neurobiol. 2008;162:63–72.
Sleigh J, Pullon RM, Vlisides PE, Warnaby CE. Electroencephalographic slow wave dynamics and loss of behavioural responsiveness induced by ketamine in human volunteers. Br J Anaesth. 2019;123:592–600.
Akeju O, Song AH, Hamilos AE, et al. Electroencephalogram signatures of ketamine anesthesia-induced unconsciousness. Clin Neurophysiol. 2016;127:2414–2422.
Ching S, Cimenser A, Purdon PL, Brown EN, Kopell NJ. Thalamocortical model for a propofol-induced alpha-rhythm associated with loss of consciousness. Proc Natl Acad Sci U S A. 2010;107:22665–22670.
Zanner R, Pilge S, Kochs EF, Kreuzer M, Schneider G. Time delay of electroencephalogram index calculation: analysis of cerebral state, bispectral, and Narcotrend indices using perioperatively recorded electroencephalographic signals. Br J Anaesth. 2009;103:394–399.
Ferreira AL, Mendes JG, Nunes CS, Amorim P. Evaluation of Bispectral Index time delay in response to anesthesia induction: an observational study. Braz J Anesthesiol. 2019;69:377–382.
Soehle M, Dittmann A, Ellerkmann RK, Baumgarten G, Putensen C, Guenther U. Intraoperative burst suppression is associated with postoperative delirium following cardiac surgery: a prospective, observational study. BMC Anesthesiol. 2015;15:61.
Linassi F, Maran E, Spano L, Zanatta P, Carron M. Anaesthetic depth and delirium after major surgery. Comment on Br J Anaesth 2022; 127: 704-12. Br J Anaesth. 2022;129:e33–e35.
Linassi F, Maran E, Kreuzer M, Zanatta P, Carron M. Intraoperative electroencephalographic burst suppression may help to identify patients at risk for long-term adverse outcome: findings from a case of homozygous twins. Anaesth Crit Care Pain Med. 2020;39:629–630.
Green SM, Roback MG, Kennedy RM, Krauss B. Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update. Ann Emerg Med. 2011;57:449–461.
Linassi F, Kreuzer M, Maran E, et al. Age influences on Propofol estimated brain concentration and entropy during maintenance and at return of consciousness during total intravenous anesthesia with target-controlled infusion in unparalyzed patients: an observational prospective trial. PLoS One. 2020;15:e0244145.
Obert DP, Schweizer C, Zinn S, et al. The influence of age on EEG-based anaesthesia indices. J Clin Anesth. 2021;73:110325.
Barreto Chang OL, Kreuzer M, Morgen DF, Possin KL, García PS. Ketamine-associated intraoperative electroencephalographic signatures of elderly patients with and without preoperative cognitive impairment. Anesth Analg. 2022;135:683–692.
Desborough JP. The stress response to trauma and surgery. Br J Anaesth. 2000;85:109–117.
Cusack B, Buggy DJ. Anaesthesia, analgesia, and the surgical stress response. BJA Educ. 2020;20:321–328.
Coyle CM, Laws KR. The use of ketamine as an antidepressant: a systematic review and meta-analysis. Hum Psychopharmacol. 2015;30:152–163.
Freeman MP, Papakostas GI, Hoeppner B, et al. Sex differences in response to ketamine as a rapidly acting intervention for treatment resistant depression. J Psychiatr Res. 2019;110:166–171.
Zheng W, Yang XH, Gu LM, et al. Gender differences in the antianhedonic effects of repeated ketamine infusions in patients with depression. Front Psychiatry. 2022;13:981981.