The present review discusses a well-established method for characterizing resting-state activity of the human brain using multichannel electroencephalography (EEG). This method involves the ...examination of electrical microstates in the brain, which are defined as successive short time periods during which the configuration of the scalp potential field remains semi-stable, suggesting quasi-simultaneity of activity among the nodes of large-scale networks. A few prototypic microstates, which occur in a repetitive sequence across time, can be reliably identified across participants. Researchers have proposed that these microstates represent the basic building blocks of the chain of spontaneous conscious mental processes, and that their occurrence and temporal dynamics determine the quality of mentation. Several studies have further demonstrated that disturbances of mental processes associated with neurological and psychiatric conditions manifest as changes in the temporal dynamics of specific microstates. Combined EEG-fMRI studies and EEG source imaging studies have indicated that EEG microstates are closely associated with resting-state networks as identified using fMRI. The scale-free properties of the time series of EEG microstates explain why similar networks can be observed at such different time scales. The present review will provide an overview of these EEG microstates, available methods for analysis, the functional interpretations of findings regarding these microstates, and their behavioral and clinical correlates.
•EEG microstates are short time periods of stable scalp potential fields.•EEG microstates are generated by a network of approximately simultaneously active sources.•EEG microstates might represent the neural correlates of the contents of consciousness.•The temporal dynamics of EEG microstates is altered in cognitive and mental diseases.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
The electroencephalogram (EEG) is one of the oldest technologies to measure neuronal activity of the human brain. It has its undisputed value in clinical diagnosis, particularly (but not exclusively) ...in the identification of epilepsy and sleep disorders and in the evaluation of dysfunctions in sensory transmission pathways. With the advancement of digital technologies, the analysis of EEG has moved from pure visual inspection of amplitude and frequency modulations over time to a comprehensive exploration of the temporal and spatial characteristics of the recorded signals. Today, EEG is accepted as a powerful tool to capture brain function with the unique advantage of measuring neuronal processes in the time frame in which these processes occur, namely in the sub-second range. However, it is generally stated that EEG suffers from a poor spatial resolution that makes it difficult to infer to the location of the brain areas generating the neuronal activity measured on the scalp. This statement has challenged a whole community of biomedical engineers to offer solutions to localize more precisely and more reliably the generators of the EEG activity. High-density EEG systems combined with precise information of the head anatomy and sophisticated source localization algorithms now exist that convert the EEG to a true neuroimaging modality. With these tools in hand and with the fact that EEG still remains versatile, inexpensive and portable, electrical neuroimaging has become a widely used technology to study the functions of the pathological and healthy human brain. However, several steps are needed to pass from the recording of the EEG to 3-dimensional images of neuronal activity. This review explains these different steps and illustrates them in a comprehensive analysis pipeline integrated in a stand-alone freely available academic software: Cartool. The information about how the different steps are performed in Cartool is only meant as a suggestion. Other EEG source imaging software may apply similar or different approaches to the different steps.
Propofol is an intravenous hypnotic drug that is used for induction and maintenance of sedation and general anaesthesia. It exerts its effects through potentiation of the inhibitory neurotransmitter ...γ-aminobutyric acid (GABA) at the GABA
A
receptor, and has gained widespread use due to its favourable drug effect profile. The main adverse effects are disturbances in cardiopulmonary physiology. Due to its narrow therapeutic margin, propofol should only be administered by practitioners trained and experienced in providing general anaesthesia. Many pharmacokinetic (PK) and pharmacodynamic (PD) models for propofol exist. Some are used to inform drug dosing guidelines, and some are also implemented in so-called target-controlled infusion devices, to calculate the infusion rates required for user-defined target plasma or effect-site concentrations. Most of the models were designed for use in a specific and well-defined patient category. However, models applicable in a more general population have recently been developed and published. The most recent example is the general purpose propofol model developed by Eleveld and colleagues. Retrospective predictive performance evaluations show that this model performs as well as, or even better than, PK models developed for specific populations, such as adults, children or the obese; however, prospective evaluation of the model is still required. Propofol undergoes extensive PK and PD interactions with both other hypnotic drugs and opioids. PD interactions are the most clinically significant, and, with other hypnotics, tend to be additive, whereas interactions with opioids tend to be highly synergistic. Response surface modelling provides a tool to gain understanding and explore these complex interactions. Visual displays illustrating the effect of these interactions in real time can aid clinicians in optimal drug dosing while minimizing adverse effects. In this review, we provide an overview of the PK and PD of propofol in order to refresh readers’ knowledge of its clinical applications, while discussing the main avenues of research where significant recent advances have been made.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Dexmedetomidine is an α
2
-adrenoceptor agonist with sedative, anxiolytic, sympatholytic, and analgesic-sparing effects, and minimal depression of respiratory function. It is potent and highly ...selective for α
2
-receptors with an α
2
:α
1
ratio of 1620:1. Hemodynamic effects, which include transient hypertension, bradycardia, and hypotension, result from the drug’s peripheral vasoconstrictive and sympatholytic properties. Dexmedetomidine exerts its hypnotic action through activation of central pre- and postsynaptic α
2
-receptors in the locus coeruleus, thereby inducting a state of unconsciousness similar to natural sleep, with the unique aspect that patients remain easily rousable and cooperative. Dexmedetomidine is rapidly distributed and is mainly hepatically metabolized into inactive metabolites by glucuronidation and hydroxylation. A high inter-individual variability in dexmedetomidine pharmacokinetics has been described, especially in the intensive care unit population. In recent years, multiple pharmacokinetic non-compartmental analyses as well as population pharmacokinetic studies have been performed. Body size, hepatic impairment, and presumably plasma albumin and cardiac output have a significant impact on dexmedetomidine pharmacokinetics. Results regarding other covariates remain inconclusive and warrant further research. Although initially approved for intravenous use for up to 24 h in the adult intensive care unit population only, applications of dexmedetomidine in clinical practice have been widened over the past few years. Procedural sedation with dexmedetomidine was additionally approved by the US Food and Drug Administration in 2003 and dexmedetomidine has appeared useful in multiple off-label applications such as pediatric sedation, intranasal or buccal administration, and use as an adjuvant to local analgesia techniques.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Recent advances in signal analysis have engendered EEG with the status of a true brain mapping and brain imaging method capable of providing spatio-temporal information regarding brain (dys)function. ...Because of the increasing interest in the temporal dynamics of brain networks, and because of the straightforward compatibility of the EEG with other brain imaging techniques, EEG is increasingly used in the neuroimaging community. However, the full capability of EEG is highly underestimated. Many combined EEG-fMRI studies use the EEG only as a spike-counter or an oscilloscope. Many cognitive and clinical EEG studies use the EEG still in its traditional way and analyze grapho-elements at certain electrodes and latencies. We here show that this way of using the EEG is not only dangerous because it leads to misinterpretations, but it is also largely ignoring the spatial aspects of the signals. In fact, EEG primarily measures the electric potential field at the scalp surface in the same way as MEG measures the magnetic field. By properly sampling and correctly analyzing this electric field, EEG can provide reliable information about the neuronal activity in the brain and the temporal dynamics of this activity in the millisecond range. This review explains some of these analysis methods and illustrates their potential in clinical and experimental applications.
► EEG is a cost-effective, easy-to-use brain imaging method. ► EEG spatial analyses render unambiguous neurophysiologic interpretability. ► EEG source imaging can be readily applied in clinical and experimental settings.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Electroencephalography (EEG) is a powerful method of studying the electrophysiology of the brain with high temporal resolution. Several analytical approaches to extract information from the EEG ...signal have been proposed. One method, termed microstate analysis, considers the multichannel EEG recording as a series of quasi-stable "microstates" that are each characterized by a unique topography of electric potentials over the entire channel array. Because this technique simultaneously considers signals recorded from all areas of the cortex, it is capable of assessing the function of large-scale brain networks whose disruption is associated with several neuropsychiatric disorders. In this review, we first introduce the method of EEG microstate analysis. We then review studies that have discovered significant changes in the resting-state microstate series in a variety of neuropsychiatric disorders and behavioral states. We discuss the potential utility of this method in detecting neurophysiological impairments in disease and monitoring neurophysiological changes in response to an intervention. Finally, we discuss how the resting-state microstate series may reflect rapid switching among neural networks while the brain is at rest, which could represent activity of resting-state networks described by other neuroimaging modalities. We conclude by commenting on the current and future status of microstate analysis, and suggest that EEG microstates represent a promising neurophysiological tool for understanding and assessing brain network dynamics on a millisecond timescale in health and disease.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
As most of us are aware, almost every facet of our society is becoming, for better or worse, progressively more technology-dependent. Technological advancement has made autonomous systems, also known ...as robots, an integral part of our life in several fields, including medicine. The application of robots in anesthesia could be classified into 3 types of robots. The first ones are pharmacological robots. These robots are based on closed-loop systems that allow better-individualized anesthetic drug titration for optimal homeostasis during general anesthesia and sedation. Recent evidence also demonstrates that autonomous systems could control hemodynamic parameters proficiently outperforming manual control in the operating room. The second type of robot is mechanical. They enable automated motorized reproduction of tasks requiring high manual dexterity level. Such robots have been advocated to be more accurate than humans and, thus, could be safer for the patient. The third type is a cognitive robot also known as decision support system. This type of robot is able to recognize crucial clinical situation that requires human intervention. When these events occur, the system notifies the attending clinician, describes relevant related clinical observations, proposes pertinent therapeutic options and, when allowed by the attending clinician, may even administer treatment. It seems that cognitive robots could increase patients’ safety. Robots in anesthesia offer not only the possibility to free the attending clinicians from repetitive tasks but can also reduce mental workload allowing them to focus on tasks that require human intelligence such as analytical and clinical approach, lifesaving decision-making capacity, and interpersonal interaction. Nevertheless, further studies have yet to be done to test the combination of these 3 types of robots to maintain simultaneously the homeostasis of multiple biological variables and to test the safety of such combination on a large-scale population.
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