PDF
Abstract
General anesthesia typically involves three key components: amnesia, analgesia, and immobilization. Monitoring the depth of anesthesia (DOA) during surgery is crucial for personalizing anesthesia regimens and ensuring precise drug delivery. Since general anesthetics act primarily on the brain, this organ becomes the target for monitoring DOA. Electroencephalogram (EEG) can record the electrical activity generated by various brain tissues, enabling anesthesiologists to monitor the DOA from real-time changes in a patient's brain activity during surgery. This monitoring helps to optimize anesthesia medication, prevent intraoperative awareness, and reduce the incidence of cardiovascular and other adverse events, contributing to anesthesia safety. Different anesthetic drugs exert different effects on the EEG characteristics, which have been extensively studied in commonly used anesthetic drugs. However, due to the limited understanding of the biological basis of consciousness and the mechanisms of anesthetic drugs acting on the brain, combined with the effects of various factors on existing EEG monitors, DOA cannot be accurately expressed via EEG. The lack of patient reactivity during general anesthesia does not necessarily indicate unconsciousness, highlighting the importance of distinguishing the mechanisms of consciousness and conscious connectivity when monitoring perioperative anesthesia depth. Although EEG is an important means of monitoring DOA, continuous optimization is necessary to extract characteristic information from EEG to monitor DOA, and EEG monitoring technology based on artificial intelligence analysis is an emerging research direction.
Keywords
consciousness
/
deep learning structure
/
electroencephalogram
/
the depth of anesthesia monitoring
Cite this article
Download citation ▾
Xiaolan He, Tingting Li, Xiao Wang.
Research progress on the depth of anesthesia monitoring based on the electroencephalogram.
Ibrain, 2025, 11(1): 32-43 DOI:10.1002/ibra.12186
| [1] |
Urban BW, Bleckwenn M. Concepts and correlations relevant to general anaesthesia. Br J Anaesth. 2002; 89(1): 3-16.
|
| [2] |
Sanders RD, Tononi G, Laureys S, Sleigh JW, Warner DS. Unresponsiveness ≠ unconsciousness. Anesthesiology. 2012; 116(4): 946-959.
|
| [3] |
Thilen SR, Weigel WA, Todd MM, et al. 2023 American Society of Anesthesiologists Practice Guidelines for monitoring and antagonism of neuromuscular blockade: a report by the American Society of Anesthesiologists Task Force on neuromuscular blockade. Anesthesiology. 2023; 138(1): 13-41.
|
| [4] |
Scheinin A, Kantonen O, Alkire M, et al. Foundations of human consciousness: imaging the twilight zone. J Neurosci. 2021; 41(8): 1769-1778.
|
| [5] |
Macduffie K, Mashour GA. Dreams and the temporality of consciousness. Am J Psychol. 2010; 123(2): 189-197.
|
| [6] |
Mashour GA, Roelfsema P, Changeux JP, Dehaene S. Conscious processing and the global neuronal workspace hypothesis. Neuron. 2020; 105(5): 776-798.
|
| [7] |
Tononi G, Boly M, Massimini M, Koch C. Integrated information theory: from consciousness to its physical substrate. Nat Rev Neurosci. 2016; 17(7): 450-461.
|
| [8] |
Redinbaugh MJ, Phillips JM, Kambi NA, et al. Thalamus modulates consciousness via layer-specific control of cortex. Neuron. 2020; 106(1):66-75.e12.
|
| [9] |
Bharioke A, Munz M, Brignall A, et al. General anesthesia globally synchronizes activity selectively in layer 5 cortical pyramidal neurons. Neuron. 2022; 110(12):2024-2040.e10.
|
| [10] |
Pal D, Mashour GA. General anesthesia and the cortical stranglehold on consciousness. Neuron. 2022; 110(12): 1891-1893.
|
| [11] |
Leslie K, Skrzypek H, Paech MJ, Kurowski I, Whybrow T. Dreaming during anesthesia and anesthetic depth in elective surgery patients. Anesthesiology. 2007; 106(1): 33-42.
|
| [12] |
Raja SN, Carr DB, Cohen M, et al. The revised international association for the study of pain definition of pain: concepts, challenges, and compromises. Pain. 2020; 161(9): 1976-1982.
|
| [13] |
García PS, Kreuzer M, Hight D, Sleigh JW. Effects of noxious stimulation on the electroencephalogram during general anaesthesia: a narrative review and approach to analgesic titration. Br J Anaesth. 2021; 126(2): 445-457.
|
| [14] |
Graça R, Lobo Fa. Analgesia Nociception Index (ANI) and ephedrine: a dangerous liasion. J Clin Monit Comput. 2021; 35(4): 953-954.
|
| [15] |
Ledowski T, Bromilow J, Paech Mj, Storm H, Hacking R, Schug SA. Monitoring of skin conductance to assess postoperative pain intensity. Br J Anaesth. 2006; 97(6): 862-865.
|
| [16] |
Sabourdin N, Barrois J, Louvet N, et al. Pupillometry-guided intraoperative remifentanil administration versus standard practice influences opioid use. Anesthesiology. 2017; 127(2): 284-292.
|
| [17] |
Ledowski T, Schmitz-Rode I. Predicting acute postoperative pain by the qNOX score at the end of surgery: a prospective observational study. Br J Anaesth. 2020; 124(2): 222-226.
|
| [18] |
Rhudy Jl, France CR. Defining the nociceptive flexion reflex (NFR) threshold in human participants: a comparison of different scoring criteria. Pain. 2007; 128(3): 244-253.
|
| [19] |
Chan MTV, Hedrick TL, Egan TD, et al. American Society for enhanced recovery and perioperative quality initiative joint consensus statement on the role of neuromonitoring in perioperative outcomes: electroencephalography. Anesth Analg. 2020; 130(5): 1278-1291.
|
| [20] |
Biasiucci A, Franceschiello B, Murray MM. Electroencephalography. Curr Biol. 2019; 29(3): R80-R85.
|
| [21] |
Haas LF. Hans Berger (1873–1941), Richard Caton (1842–1926), and electroencephalography. J Neurol Neurosurg Psychiatry. 2003; 74(1): 99.
|
| [22] |
Müller-Putz GR. Electroencephalography. In Nick FR, José del RM, eds. Handbook of clinical neurology. Vol. 168. Elsevier; 2020: 249-262.
|
| [23] |
Buzsáki G, Anastassiou CA, Koch C. The origin of extracellular fields and currents—EEG, ECoG, LFP and spikes. Nat Rev Neurosci. 2012; 13(6): 407-420.
|
| [24] |
Beniczky S, Schomer DL. Electroencephalography: basic biophysical and technological aspects important for clinical applications. Epileptic Disord. 2020; 22(6): 697-715.
|
| [25] |
Zivin L, Marsan CA. Incidence and prognostic significance of “epileptiform” activity in the eeg of non-epileptic subjects. Brain. 1968; 91(4): 751-778.
|
| [26] |
Amin U, Nascimento FA, Karakis I, Schomer D, Benbadis SR. Normal variants and artifacts: importance in EEG interpretation. Epileptic Disord. 2023; 25(5): 591-648.
|
| [27] |
Mathias SV, Bensalem-Owen M. Artifacts that can be misinterpreted as interictal discharges. J Clin Neurophysiol. 2019; 36(4): 264-274.
|
| [28] |
Purdon PL, Sampson A, Pavone KJ, Brown EN. Clinical electroencephalography for anesthesiologists. Anesthesiology. 2015; 123(4): 937-960.
|
| [29] |
Hight DF, Kaiser HA, Sleigh JW, Avidan MS. An updated introduction to electroencephalogram-based brain monitoring during intended general anesthesia. Can J Anaesth. 2020; 67(12): 1858-1878.
|
| [30] |
Myles P, Leslie K, McNeil J, Forbes A, Chan M. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet. 2004; 363(9423): 1757-1763.
|
| [31] |
Ebensperger M, Kreuzer M, Kratzer S, Schneider G, Schwerin S. Continuity with caveats in anesthesia: state and response entropy of the EEG. J Clin Monit Comput. 2024; 38: 1057-1068.
|
| [32] |
Kreuer S, Biedler A, Larsen R, Schoth S, Altmann S, Wilhelm W. The Narcotrend™—a new EEG monitor designed to measure the depth of anaesthesia. Der Anaesthesist. 2001; 50(12): 921-925.
|
| [33] |
Prichep LS, Gugino LD, John ER, et al. The patient state index as an indicator of the level of hypnosis under general anaesthesia. Br J Anaesth. 2004; 92(3): 393-399.
|
| [34] |
Abdel-Ghaffar HS, Abdel-Wahab AH, Roushdy MM. Using the perfusion index to predict changes in the depth of anesthesia in children compared with the a-line autoregression index: an observational study. Braz J Anesthesiol. 2024; 74(5):744169.
|
| [35] |
Wu G, Zhang L, Wang X, Yu A, Zhang Z, Yu J. Effects of indexes of consciousness (IoC1 and IoC2) monitoring on remifentanil dosage in modified radical mastectomy: a randomized trial. Trials. 2016; 17: 167.
|
| [36] |
Johansen JW. Update on Bispectral Index monitoring. Best Pract Res Clin Anaesthesiol. 2006; 20(1): 81-99.
|
| [37] |
Evered LA, Chan MTV, Han R, et al. Anaesthetic depth and delirium after major surgery: a randomised clinical trial. Br J Anaesth. 2021; 127(5): 704-712.
|
| [38] |
Whitlock EL, Gross ER, King CR, Avidan MS. Anaesthetic depth and delirium: a challenging balancing act. Br J Anaesth. 2021; 127(5): 667-671.
|
| [39] |
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(3): 394-399.
|
| [40] |
Mathur S, Patel J, Goldstein S, Hendrix JM, Jain A. Bispectral Index. In StatPearls [Internet]. StatPearls Publishing; 2023. Accessed January 3, 2024. https://pubmed2.ilibs.cn/books/NBK539809/.
|
| [41] |
Ibrahim AE, Taraday JK, Kharasch ED. Bispectral index monitoring during sedation with sevoflurane, midazolam, and propofol. Anesthesiology. 2001; 95(5): 1151-1159.
|
| [42] |
Akeju O, Pavone KJ, Westover MB, et al. A comparison of propofol- and dexmedetomidine-induced electroencephalogram dynamics using spectral and coherence analysis. Anesthesiology. 2014; 121(5): 978-989.
|
| [43] |
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(3): 336-340.
|
| [44] |
Ahuja S, Luedi MM. Too little or too much anesthesia: age paradox of electroencephalogram indices. J Clin Anesth. 2021; 73:110358.
|
| [45] |
Bannister CF, Brosius KK, Sigl JC, Meyer BJ, Sebel PS. The effect of bispectral index monitoring on anesthetic use and recovery in children anesthetized with sevoflurane in nitrous oxide. Anesth Analg. 2001; 92(4): 877-881.
|
| [46] |
Mathew JP, Weatherwax KJ, East CJ, White WD, Reves JG. Bispectral analysis during cardiopulmonary bypass: the effect of hypothermia on the hypnotic state. J Clin Anesth. 2001; 13(4): 301-305.
|
| [47] |
Revuelta M, Paniagua P, Campos JM, et al. Validation of the index of consciousness during sevoflurane and remifentanil anaesthesia: a comparison with the bispectral index and the cerebral state index. Br J Anaesth. 2008; 101(5): 653-658.
|
| [48] |
Melia U, Gabarron E, Agustí M, et al. Comparison of the qCON and qNOX indices for the assessment of unconsciousness level and noxious stimulation response during surgery. J Clin Monit Comput. 2017; 31(6): 1273-1281.
|
| [49] |
Drover D, Ortega HR. Patient state index. Best Pract Res Clin Anaesthesiol. 2006; 20(1): 121-128.
|
| [50] |
Chen X, Tang J, White PF, et al. A comparison of patient state index and bispectral index values during the perioperative period. Anesth Analg. 2002; 95(6): 1669-1674.
|
| [51] |
Dinu AR, Rogobete AF, Popovici SE, et al. Impact of general anesthesia guided by state entropy (SE) and response entropy (RE) on perioperative stability in elective laparoscopic cholecystectomy Patients—A prospective observational randomized monocentric study. Entropy. 2020; 22(3):356.
|
| [52] |
Wheeler P, Hoffman WE, Baughman VL, Koenig H. Response entropy increases during painful stimulation. J Neurosurg Anesthesiol. 2005; 17(2): 86-90.
|
| [53] |
Bein B. Entropy. Best Pract Res Clin Anaesthesiol. 2006; 20(1): 101-109.
|
| [54] |
Kreuer S, Wilhelm W. The Narcotrend monitor. Best Pract Res Clin Anaesthesiol. 2006; 20(1): 111-119.
|
| [55] |
De Cosmo G, Aceto P, Clemente A, Congedo E. Auditory evoked potentials. Minerva Anestesiol. 2004; 70(5): 293-297.
|
| [56] |
Morimoto Y, Sakabe T. [Auditory evoked potentials]. Masui (Jpn J Anesthesiol). 2006; 55(3): 314-321.
|
| [57] |
Arigliani M, Toraldo DM, Ciavolino E, et al. The use of middle latency auditory evoked potentials (MLAEP) as methodology for evaluating sedation level in propofol-drug induced sleep endoscopy (DISE) procedure. Int J Environ Res Public Health. 2021; 18(4):2070.
|
| [58] |
Hight D, Kreuzer M, Ugen G, et al. Five commercial “depth of anaesthesia” monitors provide discordant clinical recommendations in response to identical emergence-like EEG signals. Br J Anaesth. 2023; 130(5): 536-545.
|
| [59] |
Tiefenthaler W, Colvin J, Steger B, et al. How bispectral index compares to spectral entropy of the EEG and a-line ARX index in the same patient. Open Med. 2018; 13: 583-596.
|
| [60] |
Kissin I. Depth of anesthesia and bispectral index monitoring. Anesth Analg. 2000; 90(5): 1114-1117.
|
| [61] |
Choi RY, Coyner AS, Kalpathy-Cramer J, Chiang MF, Campbell JP. Introduction to machine learning, neural networks, and deep learning. Transl Vis Sci Technol. 2020; 9(2):14.
|
| [62] |
Hashimoto DA, Witkowski E, Gao L, Meireles O, Rosman G. Artificial intelligence in anesthesiology. Anesthesiology. 2020; 132(2): 379-394.
|
| [63] |
Georgevici AI, Terblanche M. Neural networks and deep learning: a brief introduction. Intensive Care Med. 2019; 45(5): 712-714.
|
| [64] |
Kriegeskorte N, Golan T. Neural network models and deep learning. Curr Biol. 2019; 29(7): R231-R236.
|
| [65] |
Song B, Zhou M, Zhu J. Necessity and importance of developing AI in anesthesia from the perspective of clinical safety and information security. Med Sci Monit. 2023; 29: e938835.
|
| [66] |
Craik A, He Y, Contreras-Vidal Jl. Deep learning for electroencephalogram (EEG) classification tasks: a review. J Neural Eng. 2019; 16(3):031001.
|
| [67] |
Lopes S, Rocha G, Guimarães-Pereira L. Artificial intelligence and its clinical application in anesthesiology: a systematic review. J Clin Monit Comput. 2024; 38(2): 247-259.
|
| [68] |
Shi M, Huang Z, Xiao G, Xu B, Ren Q, Zhao H. Estimating the depth of anesthesia from EEG signals based on a deep residual shrinkage network. Sensors. 2023; 23(2):1008.
|
| [69] |
Afshar S, Boostani R, Sanei S. A combinatorial deep learning structure for precise depth of anesthesia estimation from EEG signals. IEEE J Biomed Health Inform. 2021; 25(9): 3408-3415.
|
| [70] |
Park Y, Han SH, Byun W, Kim JH, Lee HC, Kim SJ. A real-time depth of anesthesia monitoring system based on deep neural network with large EDO tolerant EEG analog Front-End. IEEE Trans Biomed Circuits Syst. 2020; 14(4): 825-837.
|
| [71] |
Shalbaf A, Saffar M, Sleigh JW, Shalbaf R. Monitoring the depth of anesthesia using a new adaptive neurofuzzy system. IEEE J Biomed Health Inform. 2018; 22(3): 671-677.
|
| [72] |
Mathis MR, Kheterpal S, Najarian K. Artificial intelligence for anesthesia: what the practicing clinician needs to know. Anesthesiology. 2018; 129(4): 619-622.
|
| [73] |
Haight Tj, Eshaghi A. Deep learning algorithms for brain imaging: from black box to clinical toolbox? Neurology. 2023; 100(12): 549-550.
|
RIGHTS & PERMISSIONS
2024 The Authors. Ibrain published by Affiliated Hospital of Zunyi Medical University and Wiley-VCH GmbH.