Decrease of the peak heights of EEG bicoherence indicated insufficiency of analgesia during surgery under general anesthesia

• Published in: Journal of anesthesia 2024-12, Vol.38 (6), p.855-864
• Main Authors: UNO, Rieko, HAGIHIRA, Satoshi, AIHARA, Satoshi, KAMIBAYASHI, Takahiko
• Format: Article
• Language: English
• Subjects: Adult; Aged; Analgesia - methods; Analgesics, Opioid - administration & dosage; Anesthesia, General - methods; Anesthesiology; Anesthetics, Intravenous - administration & dosage; Critical Care Medicine; Electroencephalography - drug effects; Electroencephalography - methods; Emergency Medicine; Female; Fentanyl - administration & dosage; Humans; Intensive; Male; Medicine; Medicine & Public Health; Middle Aged; Monitoring, Intraoperative - methods; Original Article; Pain Medicine; Sevoflurane - administration & dosage
• ISSN: 0913-8668; 1438-8359; 1438-8359
• DOI: 10.1007/s00540-024-03406-5

Background Studies show that the two peak heights of electroencephalographic bicoherence (pBIC-high, pBIC-low) decrease after incision and are restored by fentanyl administration. We investigated whether pBICs are good indicators for adequacy of analgesia during surgery. Methods After local ethical committee approval, we enrolled 50 patients (27–65 years, ASA-PS I or II) who were scheduled elective surgery. Besides standard anesthesia monitors, to assess pBICs, we used a BIS monitor and freeware Bispectrum Analyzer for A2000. Fentanyl 5 µg/kg was completely administered before incision, and anesthesia was maintained with sevoflurane. After skin incision, when the peak of pBIC-high or pBIC-low decreased by 10% in absolute value (named LT10-high and LT10-low groups in order) or when either peak decreased to below 20% (BL20-high and BL20-low groups), an additional 1 g/kg of fentanyl was administered to examine its effect on the peak that showed a decrease. Results The mean values and standard deviation for pBIC-high 5 min before fentanyl administration, at the time of fentanyl administration, and 5 min after fentanyl administration for LT10-high group were 39.8% (10.9%), 26.9% (10.5%), and 35.7% (12.5%). And those for pBIC-low for LT10-low group were 39.5% (6.0%), 26.8% (6.4%) and 35.0% (7.0%). Those for pBIC-high for BL20-high group were 26.3% (5.6%), 16.5% (2.6%), and 25.7% (7.0%). And those for pBIC-low for BL20-low group were 26.7% (4.8%), 17.4% (1.8%) and 26.9% (5.7%), respectively. Meanwhile, at these trigger points, hemodynamic parameters didn’t show significant changes. Conclusion Superior to standard anesthesia monitoring, pBICs are better indicators of analgesia during surgery. Trial registry Clinical trial Number and registry URL: UMIN ID: UMIN000042843 https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno  = R000048907