Quantifying cortical activity during general anesthesia using wavelet analysis

TitleQuantifying cortical activity during general anesthesia using wavelet analysis
Publication TypeJournal Article
Year of Publication2006
AuthorsZikov, T., S. Bibian, G. A. Dumont, M. Huzmezan, and C. R. Ries
JournalBiomedical Engineering, IEEE Transactions on
Pagination617 -632
Date Publishedapr.
KeywordsAdult, Algorithms, Anesthesia, anesthetic drugs, Anesthetics, awake state, BIS monitor, brain, central nervous system monitoring, closed-loop control, Computer-Assisted, Consciousness, cortical activity, Diagnosis, Drug Therapy, drugs, electroencephalography, feedback sensor, Female, General, general anesthesia, Humans, Intraoperative, isoelectric state, linear time invariant transfer function, Male, maximal cortical depression, medical signal processing, Middle Aged, monitoring, neurophysiology, patient consciousness level, pharmacodynamic models, Reproducibility of Results, Sensitivity and Specificity, single-channel electroencephalogram, stationary wavelet transform, statistical analysis, transfer functions, wavelet analysis, wavelet transforms

This paper reports on a novel method for quantifying the cortical activity of a patient during general anesthesia as a surrogate measure of the patient's level of consciousness. The proposed technique is based on the analysis of a single-channel (frontal) electroencephalogram (EEG) signal using stationary wavelet transform (SWT). The wavelet coefficients calculated from the EEG are pooled into a statistical representation, which is then compared to two well-defined states: the awake state with normal EEG activity, and the isoelectric state with maximal cortical depression. The resulting index, referred to as the wavelet-based anesthetic value for central nervous system monitoring (WAVCNS), quantifies the depth of consciousness between these two extremes. To validate the proposed technique, we present a clinical study which explores the advantages of the WAVCNS in comparison with the BIS monitor (Aspect Medical Systems, MA), currently a reference in consciousness monitoring. Results show that the WAVCNS and BIS are well correlated (r=0.969) during periods of steady-state despite fundamental algorithmic differences. However, in terms of dynamic behavior, the WAVCNS offers faster tracking of transitory changes at induction and emergence, with an average lead of 15-30 s. Furthermore, and conversely to the BIS, the WAVCNS regains its preinduction baseline value when patients are responding to verbal command after emergence from anesthesia. We conclude that the proposed analysis technique is an attractive alternative to BIS monitoring. In addition, we show that the WAVCNS dynamics can be modeled as a linear time invariant transfer function. This index is, therefore, well suited for use as a feedback sensor in advisory systems, closed-loop control schemes, and for the identification of the pharmacodynamic models of anesthetic drugs.


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