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. 2023 Jul 14:17:1144141.
doi: 10.3389/fnins.2023.1144141. eCollection 2023.

EEG response of dexmedetomidine during drug induced sleep endoscopy

Lichy Han  1 , David R Drover  1 , Marianne C Chen  1 , Amit R Saxena  1 , Sarah L Eagleman  2 , Vladimir Nekhendzy  1 , Angelica Pritchard  1 , Robson Capasso  3
Affiliations

EEG response of dexmedetomidine during drug induced sleep endoscopy

Lichy Han et al. Front Neurosci. .

Abstract

Introduction: Dexmedetomidine is one of the anesthetics of choice for drug induced sleep endoscopy (DISE), with advantages including limited respiratory depression, analgesia, and decreased incidence of emergence delirium. However, challenges with determining sedation levels and prolonged recovery have limited its usage. An improved understanding of the effect of dexmedetomidine on the level of sedation and the corresponding electroencephalographic (EEG) changes could help overcome these barriers.

Methods: Fifty-one patients received dexmedetomidine sedation with Richmond Agitation-Sedation Scale (RASS) score assessment and continuous EEG monitoring via SedLine for DISE. We constructed a pharmacokinetic model to determine continuous dexmedetomidine blood concentration. From the SedLine, we extracted the patient state index (PSI), and from the EEG we calculated the spectral edge frequency 95% (SEF95) and the correlation dimension (CD), a type of fractal dimension used to assess the complexity of a system. These metrics were subsequently compared against one another and with the dexmedetomidine concentration.

Results: Our pharmacokinetic model yielded a two-compartment model with volumes of 51.8 L and 106.2 L, with clearances of 69.5 and 168.9 L/h, respectively, and a time to effect of 9 min, similar to prior studies. Based on this model, decreasing RASS score, SEF95, CD, and PSI were all significantly associated with increasing dexmedetomidine concentration (p < 0.001, p = 0.006, p < 0.001 respectively). The CD, SEF95, and PSI better captured the effects of increasing dexmedetomidine concentration as compared to the RASS score. Simulating dexmedetomidine concentration based on titration to target levels derived from CD and PSI confirmed commonly used dexmedetomidine infusion dosages.

Conclusion: Dexmedetomidine use for DISE confirmed previous pharmacokinetic models seen with dexmedetomidine. Complex EEG metrics such as PSI and CD, as compared to RASS score and SEF95, better captured changes in brain state from dexmedetomidine and have potential to improve the monitoring of dexmedetomidine sedation.

Keywords: dexmedetomidine; drug induced sleep endoscopy; electroencephalography; level of sedation; pharmacology.

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Conflict of interest statement

DD was a consultant for Masimo Inc. RC was a consultant for SAB – Bryte LLC and Invicta Medical. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Dexmedetomidine (DEX) concentrations; RASS scores; and SEF95, CD, and PSI derived from EEG for a representative patient. The top panel depicts the measured dexmedetomidine concentration with red dots, and the simulated concentration in pink derived from our pharmacokinetic model. The middle panel shows the RASS score (blue), CD (green), SEF95 (purple), and PSI (orange) throughout the procedure. The bottom panel is the spectrogram of the processed EEG data.
Figure 2
Figure 2
Spectral density plots (left column) stratified by dexmedetomidine concentration, RASS score, SEF95, CD, and PSI. The varying shades of each color represent increasing sedation from light to dark. Difference of each quartile from the quartile representing the least sedation (right column). Changes in power seen with increasing sedation are represented from light to dark.
Figure 3
Figure 3
RASS score (A), SEF95 (B), CD (C), and PSI (D) versus dexmedetomidine (DEX) concentration. SEF95, CD, and PSI are depicted as rolling mean in the colored solid line, the standard deviation in the shaded area, with local polynomial regression (LOESS) fitting shown in black.
Figure 4
Figure 4
Visualization of the relationship between the RASS score versus SEF95 (A), CD (B), and PSI (C). Decreasing RASS scores are significantly associated with decreasing SEF95, CD, and PSI, particularly for deeper levels of sedation. The boxes represent the median with interquartile range, whereas the whiskers represent the remainder of the range.
Figure 5
Figure 5
Simulated blood dexmedetomidine concentrations based on commonly used regimens of 0.2, 0.4, 0.6, 0.8, 1, and 1.2 mcg/kg/h infusion after a 1.5 mcg/kg bolus for a 70 kg patient. Blood concentration levels of 0.407 ng/mL and 0.878 ng/mL, selected based on the correlation dimension analysis, are shown by the horizontal dashed green lines. Blood concentration levels of 0.399 ng/mL and 0.723 ng/mL, selected based on the PSI, are shown by the horizontal dotted orange lines.
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