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Electroencephalographic features of discontinuous activity in anesthetized infants and children
Uday Agrawal1, Charles B Berde1, Laura Cornelissen1
1Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
Insights
Discontinuous electroencephalographic activity in children under general anesthesia indicates a younger or more deeply anesthetized brain state. Its spectral features change with age, potentially reflecting neurodevelopmental processes.
Area of Science:
- Pediatric Anesthesiology
- Neuroscience
- Developmental Neuroscience
Background:
- Discontinuous electroencephalographic (EEG) activity is linked to brain inactivation.
- It's observed in pathology and general anesthesia, but its role in term children under anesthesia is less understood.
- This study explores EEG discontinuity in children during general anesthesia.
Purpose of the Study:
- To investigate the spectral features of discontinuous EEG activity in children under general anesthesia.
- To understand how these features relate to age and anesthetic depth.
- To explore potential neurodevelopmental implications.
Main Methods:
- Post-hoc analysis of EEG data from 65 children under general anesthesia (age < 40 months).
- Comparison of power spectra between children with and without discontinuous activity using multitaper spectral methods.
- Analysis of amplitude and spectral features during and after discontinuous activity, examining age-related variations.
Main Results:
- Increased anesthetic depth and younger age correlated with more time spent in discontinuous activity.
- Children with discontinuity received higher propofol doses.
- Distinct spectral patterns, including decreased high-frequency power before discontinuity and age-varying band power during discontinuity, were observed.
Conclusions:
- Discontinuous EEG activity in children under general anesthesia signifies a younger or more deeply anesthetized brain state.
- The spectral characteristics of this activity evolve with age.
- These evolving features may serve as indicators of neurodevelopment.
Background:
Discontinuous electroencephalographic activity in children is thought to reflect brain inactivation. Discontinuity has been observed in states of pathology, where it is predictive of adverse neurological outcome, as well as under general anesthesia. Though in preterm-infants discontinuity reflects normal brain development, less is known regarding its role in term children, particularly in the setting of general anesthesia. Here, we conduct a post-hoc exploratory analysis to investigate the spectral features of discontinuous activity in children under general anesthesia.
Methods:
We previously recorded electroencephalography in children less than forty months of age under general anesthesia (n = 65). We characterized the relationship between age, anesthetic depth, and discontinuous activity, and used multitaper spectral methods to compare the power spectra of subjects with (n = 35) and without (n = 30) discontinuous activity. In the subjects with discontinuous activity, we examined the amplitude and power spectra associated with the discontinuities and analyzed how these variables varied with age.
Results:
Cumulative time of discontinuity was associated with increased anesthetic depth and younger age. In particular, age-matched children with discontinuity received higher doses of propofol during induction as compared with children without discontinuity. In the tens of seconds preceding the onset of discontinuous activity, there was a decrease in high-frequency power in children four months and older that could be visually observed with spectrograms. During discontinuous activity, there were distinctive patterns of amplitude, spectral edge, and power in canonical frequency bands that varied with age. Notably, there was a decline in spectral edge in the seconds immediately following each discontinuity.
Conclusion:
Discontinuous activity in children reflects a state of a younger or more deeply anesthetized brain, and characteristic features of discontinuous activity evolve with age and may reflect neurodevelopment.
