Electroencephalographic changes related to cortico-subcortical decoupling during propofol-induced loss of consciousness: A secondary analysis of a prospective observational study - 05/09/25
, Rachel Nuttall c , Lluís Gallart a, b, k, ⁎ , Gerhard Schneider c , Laura Blanco-Hinojo d, Gerard Martínez-Vilavella d, Jesus Pujol d , Irina Adalid a , Sebastian Berger c , Daniel Bujosa e , Joan Deus d, f , Pedro Luis Gambús g, Sebastian Jaramillo g , Luis Moltó a , Juan Felipe Ortega h , Susana Pacreu a , Víctor Pérez-Sola i, j , Esther Vilà a Abstract |
Background |
Cortico-subcortical decoupling has been observed in functional magnetic resonance imaging (fMRI) during slow propofol-induced loss of consciousness (LOC). However, corresponding electroencephalography (EEG) free of the cardioballistic and fMRI artifacts is essential for translating decoupling observations to clinical monitoring.
Objective |
To describe artifact-corrected EEG changes corresponding to cortico-subcortical decoupling at LOC.
Design |
Secondary analysis of a prospective observational study.
Setting |
Tertiary-care hospital, data collection from June 2017 to January 2019.
Participants |
Nineteen healthy volunteers receiving a targeted propofol infusion.
Interventions |
Frontal EEG was recorded synchronously with clinical signs and fMRI. Gradient artifact correction was based on iterative peak detection. Cardioballistic artifact correction was accomplished with a recently described algorithmic method based on peak detection combined with temporal constraints.
Main outcome measures |
The qCON index and frontal EEG before and after decoupling at LOC.
Results |
Algorithm-filtered EEG tracings were suitable for analysis in 16 subjects. Propofol-induced LOC was achieved at a median (IQR) target plasma concentration of 4.5 (3.91 to 4.61) μg/mL and an effect-site concentration of 4.0 (2.94 to 4.31) μg/mL. The qCON index remained over 80 before decoupling and gradually decreased to values below 60 afterwards. Frontal alpha band power increased significantly from a median of 0.07 (0.03 to 0.15) 30 s before decoupling to 0.48 (0.08 to 0.58) 30 s after decoupling ( p < 0.001).
Conclusions |
Cortico-subcortical decoupling related to propofol-induced LOC coincides with a gradual decrease in the qCON index and an increase in frontal alpha power. These results help translate fMRI findings to bedside settings.
Registered at EudraCT (reference 2016–004833-25). Principal Investigator: Juan L. Fernández-Candil. Date of registration: January 4, 2017. Start Date: June 13, 2017.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Highlights |
• | Cortico-subcortical decoupling occurs in propofol-induced loss of consciousness (LOC). |
• | qCON index and alpha power changed during cortico-subcortical decoupling at LOC. |
• | These synchronic findings facilitate the advances in bedside LOC monitoring. |
Keywords : Propofol, Loss of consciousness, Electroencephalogram, Artifacts, Filtering, Functional magnetic resonance imaging, Anesthesia, Sedation
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Vol 106
Article 111926- septembre 2025 Retour au numéro
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