Monitoring sedation levels by EEG spectral analysis

Real-time electroencephalographic power spectra were obtained for a group of 37 volunteers undergoing sedation with enflurane at different concentrations in air. In part one, 17 subjects were given 0.5%, 0.75%, and 1.0% for 4 min at each level, and recovery after 5 min was assessed by the Trieger method. There was considerable variation in subject response to the different doses, but adequate sedation was indicated by the presence of a strong alpha rhythm (9-11 Hz) and suppression of frequencies below 5 Hz. Overdose was indicated by an initial shift in the alpha frequency to a lower value (6-7 Hz) followed by the appearance of delta waves (0.5-4 Hz) and loss of alpha waves. In part two, 20 volunteers inhaled enflurane at 0.5% for 10 min to allow adequate absorption, followed by a 10-min recovery period. Equal numbers showed sedation or a failure to respond to enflurane at this concentration. In the responders, sedation was accompanied by a marked shift in the ratio of the power in two frequency bands: 1-4 Hz and 8-12 Hz. Progress of the frequency band power ratio followed closely the state of the subject into sedation, overdose, and recovery. This measure was further improved by the use of multivariate analysis, which showed good discrimination of the alert, sedated, and overdosed states of the subject.