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TECHNOLOGY, COMPUTING, AND SIMULATION

Electroencephalographic Mapping During Routine Clinical Practice: Cortical Arousal During Tracheal Intubation?

Wolfgang J. Kox, MD^*, Christian von Heymann, MD, Judith Heinze, Leslie S. Prichep, PhD, E. Roy John, PhD, and Ingrid Rundshagen, MD

*University Hospital of Muenster, Muenster, Germany; Department of Anesthesiology, University Hospital Charité, Humboldt University of Berlin, Campus Charité Mitte, Berlin, Germany; Brain Research Laboratories, NYU School of Medicine, New York, NY; Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY

Address correspondence and reprint requests to Ingrid Rundshagen, MD, Department of Anesthesiology, University Hospital Charité, Campus Charité Mitte, Schumannstr. 20/21, D-10117 Berlin, Germany. Address e-mail to ingrid.rundshagen{at}charite.de.

We used quantitative analysis of the electroencephalogram (EEG) in 42 patients to assess the effect of tracheal intubation after induction of anesthesia with etomidate and sufentanil using standard clinical practice. The EEG was recorded from eight bipolar electrode derivations and Z-transformed relative to age expected normative data for relative power in the delta, theta, alpha, and beta frequency bands. Tracheal intubation resulted in classical cortical arousal, as indicated by acceleration of the EEG frequencies. Significant effects were seen in all frequency bands, most pronounced in the alpha frequency band, with the largest increase bilaterally in the fronto-temporal regions (F-values: Delta – 9.592, P < 0.001; theta – 1.691, P < 0.001; alpha – 18.439, P < 0.001; beta – 4.504, P < 0.001). Changes in alpha and delta power during induction of anesthesia were correlated with the dose of etomidate (P < 0.05). Changes in alpha after tracheal intubation were correlated at the parietooccipital brain regions to the dose of sufentanil (P < 0.05). Individual titration of the dose of etomidate and sufentanil, as during routine clinical practice, is not sufficient to block the strong noxious stimulation of tracheal intubation and results in cortical arousal. The clinical impact of this cortical wake-up phenomenon is undetermined.

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