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The sensory thalamus and cerebral motor cortex are affected concurrently during induction of anesthesia with propofol: a case series with intracranial electroencephalogram recordings

  • Olivier Verdonck
  • Sean J. Reed
  • Jeffery Hall
  • Jean Gotman
  • Gilles PlourdeEmail author
Case Reports / Case Series

Abstract

Purpose

Brain imaging studies suggest that loss of consciousness induced by general anesthetics is associated with impairment of thalamic function. There is, however, limited information on the time course of these changes. We recently obtained intracranial electroencephalogram (EEG) recordings from the ventroposterolateral (VPL) nucleus of the thalamus and from the motor cortex during induction of anesthesia in three patients to study the time course of the alterations of cortical and thalamic function.

Clinical features

The patients were American Society of Anesthesiologists physical status I-II males aged 33-57 yr with intractable central pain caused by brachial plexus injury (patient 1 and 2) or insular infarct (patient 3). Anesthesia was induced with propofol (2.5-3.1 mg·kg−1 over 30-45 sec) followed, after loss of consciousness, by rocuronium for tracheal intubation. The data retained for analysis are from one minute before the start of propofol to 110 sec later during ventilation of the patients’ lungs before tracheal intubation. Spectral analysis was used to measure absolute EEG power. Propofol caused significant increases of cortical and thalamic power in the delta to beta frequency bands (1-30 Hz). These increases of cortical and thalamic power occurred either concomitantly or within seconds of each other. Propofol also caused a decrease in cortical and thalamic high-gamma (62-200 Hz) power that also followed a similar time course.

Conclusion

We conclude that induction of anesthesia with propofol in these patients was associated with concurrent alterations of cortical and sensory thalamic activity.

Keywords

Rocuronium General Anesthetic Brachial Plexus Injury Gamma Power Bipolar Montage 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Le thalamus sensoriel et le cortex moteur cérébral sont simultanément affectés pendant l’induction de l’anesthésie au propofol: une série de cas fondée sur des enregistrements d’électroencéphalogrammes intracrâniens

Résumé

Objectif

Selon les études d’imagerie cérébrale, la perte de conscience induite par les anesthésiques généraux serait associée à une détérioration de la fonction du thalamus. Toutefois, nous ne disposons que d’informations limitées quant au profil temporel de ces modifications. Nous avons récemment obtenu les enregistrements d’électroencéphalogrammes (EEG) intracrâniens du noyau ventro-postéro-latéral (VPL) du thalamus et du cortex moteur pendant l’induction de l’anesthésie chez trois patients afin d’étudier le profil temporel des modifications des fonctions corticale et thalamique.

Éléments cliniques

Les patients étaient des hommes de statut physique I-II selon l’American Society of Anesthesiologists âgés de 33 à 57 ans et souffrant de douleur centrale réfractaire causée par une lésion du plexus brachial (patients 1 et 2) ou d’un infarctus insulaire (patient 3). L’anesthésie a été induite avec du propofol (2,5-3,1 mg·kg−1 sur 30-45 sec), lequel fut suivi, après la perte de conscience, par du rocuronium pour l’intubation trachéale. Les données retenues pour analyse couvrent la période allant d’une minute avant l’administration du propofol à 110 sec plus tard, pendant la ventilation des poumons des patients avant l’intubation trachéale. Nous avons utilisé une analyse spectrale pour mesurer la puissance absolue de l’EEG. Le propofol a provoqué des augmentations considérables de la puissance corticale et thalamique dans les bandes de fréquence delta à bêta (1-30 Hz). Ces augmentations de puissance corticale et thalamique sont survenues soit simultanément, soit à quelques secondes d’intervalle. Le propofol a également provoqué une réduction de la puissance corticale et thalamique gamma élevée (62-200 Hz), laquelle a également suivi un profil temporel semblable.

Conclusion

Nous concluons que l’induction de l’anesthésie au propofol chez ces patients a été associée à des modifications simultanées de l’activité corticale et thalamique sensorielle.

Notes

Acknowledgements

We thank José A. Correa, Director, McGill Statistical Consulting Service, for designing and conducting the statistical analysis. We thank the EEG technologists, Lorraine Allard and Nicole Drouin, for their expert help. We also thank the OR staff and our anesthesiologist colleagues involved with these patients for their cooperation. Finally, our warmest thanks go to the patients and their families for making this report possible. Olivier Verdonck was supported by a Preston Robb Fellowship from the Montreal Neurological Institute.

Conflicts of interest

None declared.

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Copyright information

© Canadian Anesthesiologists' Society 2014

Authors and Affiliations

  • Olivier Verdonck
    • 1
    • 3
  • Sean J. Reed
    • 1
    • 4
  • Jeffery Hall
    • 2
  • Jean Gotman
    • 2
  • Gilles Plourde
    • 1
    Email author
  1. 1.Department of Anesthesia, Montreal Neurological Institute and HospitalMcGill UniversityMontrealCanada
  2. 2.Department of Neurology and Neurosurgery, Montreal Neurological Institute and HospitalMcGill UniversityMontrealCanada
  3. 3.Département d’anesthésiologieHôpital MaisonneuveMontrealCanada
  4. 4.Department of Neurology and Neurosurgery, Douglas Mental Health InstituteMcGill UniversityMontrealCanada

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