Abstract
There has been renewed interest in utilizing electroencephalogram (EEG)/processed
EEG to assess the response to noxious stimuli under general anesthesia (GA). We are
submitting multiple observations that explore the intriguing phenomenon of the transient
burst suppression pattern (BSP) in the density spectral array (DSA) of the SedLine
Masimo during intense noxious stimulation under GA. Three patients underwent spine
surgery under sevoflurane/total intravenous anesthesia with adequate depth. Sudden
transient BSP was noted on the DSA during an intense noxious stimulus. Traditionally,
BSP on the processed EEG/DSA under GA in a hemodynamically stable patient indicates
excessive hypnosis. It is usually treated by reducing the dose of a hypnotic agent.
Decreasing the depth of anesthesia (DOA) in the presence of intense pain can have
adverse consequences, especially in high-risk patients. Awareness of processed EEG/DSA
changes associated with intense noxious stimuli, helps the anesthesiologist to titrate
analgesia without altering DOA.
Keywords
electroencephalography - general anesthesia - neurophysiological monitoring - pain
