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Predicting unconsciousness after propofol administration: qCON, BIS, and ALPHA band frequency power

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Abstract

During anesthesia induction with propofol the level of arousal progressively decreases until reaching loss of consciousness (LOC). In addition, there is a shift of alpha activity from parieto-occipital to frontal zones, defined as anteriorization. Whilst monitoring LOC and anteriorization would be useful to improve propofol dosage and patient safety, the current devices for anesthetic depth monitoring are unable to detect these events. The aim of this study was to observe LOC and anteriorization during anesthesia induction with propofol by applying electrodes placed in the frontal and parietal areas. Bispectral index (BIS) and quantium consciousness index (qCON) monitors were simultaneously employed. BIS™ and qCON sensors were placed in the frontal and parieto-occipital regions of 10 alopecic patients who underwent anesthesia with propofol, alfentanil, and remifentanil. The initial biophase target of propofol was 2.5 mcg/mL which was gradually increased until reaching LOC. Wilcoxon signed-rank test was used to study differences in alpha power and qCON/BIS indices along the study; and Pk value to evaluate predictive capability of anteriorization of BIS, qCON, and alpha waves. Parietal BIS and qCON values became significantly higher than frontal values 15 min after loss of eye reflex. Anteriorization was observed with both monitors. Pk values for BIS and qCON were strongly predictive of frontal alpha absolute power. During anesthesia induction with propofol it is possible to identify anteriorization with BIS and qCON in the frontal and parieto-occipital regions. Both indices showed different patterns which need to be further studied.

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Acknowledgements

We are grateful for the collaboration of the surgeons Marcel Segura and Jaime Jimeno for their help in selecting the cases. We also want to thank Stephanie Lonsdale for her help in translating the manuscript.

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Authors and Affiliations

  1. Anesthesiology Department, Parc Salut Mar, Institut Hospital del Mar D’Investigacions Mèdiques (IMIM), Barcelona, Spain

    Juan L. Fernández-Candil, Susana Pacreu Terradas, Esther Vilà Barriuso & Luis Moltó García

  2. Vascular Surgery Department, Hospital de Getafe, Madrid, Spain

    Marina García Cogollo

  3. Anesthesiology Department, Parc Salut Mar, Institut Hospital del Mar D’Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain

    Lluís Gallart Gallego

Authors
  1. Juan L. Fernández-Candil
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  2. Susana Pacreu Terradas
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  3. Esther Vilà Barriuso
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  4. Luis Moltó García
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  5. Marina García Cogollo
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  6. Lluís Gallart Gallego
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Correspondence to Juan L. Fernández-Candil.

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All procedures performed in this study were in accordance with the Ethics Committee of Hospital del Mar (2013/5173/I) and with the 1964 Helsinki declaration and its later amendments.

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Informed consent was obtained from all individual participants included in this study.

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Fernández-Candil, J.L., Terradas, S.P., Barriuso, E.V. et al. Predicting unconsciousness after propofol administration: qCON, BIS, and ALPHA band frequency power. J Clin Monit Comput 35, 723–729 (2021). https://doi.org/10.1007/s10877-020-00528-5

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  • DOI: https://doi.org/10.1007/s10877-020-00528-5

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