The posterior dominant rhythm: an electroencephalographic biomarker for cognitive recovery after general anaesthesia

Alyssa K Labonte; MohammadMehdi Kafashan; Emma R Huels; Stefanie Blain-Moraes; Mathias Basner; Max B Kelz; George A Mashour; Michael S Avidan; Ben Julian A Palanca; ReCCognition Study Group

doi:10.1016/j.bja.2022.01.019

The posterior dominant rhythm: an electroencephalographic biomarker for cognitive recovery after general anaesthesia

Br J Anaesth. 2023 Feb;130(2):e233-e242. doi: 10.1016/j.bja.2022.01.019. Epub 2022 Feb 17.

Authors

Alyssa K Labonte¹, MohammadMehdi Kafashan², Emma R Huels³, Stefanie Blain-Moraes⁴, Mathias Basner⁵, Max B Kelz⁶, George A Mashour⁷, Michael S Avidan⁸, Ben Julian A Palanca⁹; ReCCognition Study Group

Collaborators

ReCCognition Study Group:
Maxwell Muench, Vijay Tarnal, Giancarlo Vanini, E Andrew Ochroch, Rosemary Hogg, Marlon Schwarz, Ellen Janke, Goodarz Golmirzaie, Paul Picton, Andrew R McKinstry-Wu

Affiliations

¹ Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Division of Biology and Biomedical Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
² Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Center on Biological Rhythms and Sleep, Washington University School of Medicine in St. Louis, Missouri.
³ Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Department of Anesthesiology, Center for Consciousness Science and Neuroscience Graduate Program, University of Michigan Medical School, Ann Arbor, MI, USA.
⁴ School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.
⁵ Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
⁶ Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
⁷ Department of Anesthesiology, Center for Consciousness Science and Neuroscience Graduate Program, University of Michigan Medical School, Ann Arbor, MI, USA.
⁸ Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Center on Biological Rhythms and Sleep, Washington University School of Medicine in St. Louis, Missouri; Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
⁹ Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Division of Biology and Biomedical Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Center on Biological Rhythms and Sleep, Washington University School of Medicine in St. Louis, Missouri; Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA. Electronic address: palancab@wustl.edu.

Abstract

Background: The posterior dominant rhythm (PDR) was the first oscillatory pattern noted in the EEG. Evoked by wakeful eyelid closure, these oscillations dissipate over seconds during loss of arousal. The peak frequency of the PDR maintains stability over years, suggesting utility as a state biomarker in the surveillance of acute cognitive impairments. This EEG signature has not been systematically investigated for tracking cognitive dysfunction after anaesthetic-induced loss of consciousness.

Methods: This substudy of Reconstructing Consciousness and Cognition (NCT01911195) investigated the PDR and cognitive function in 60 adult volunteers randomised to either 3 h of isoflurane general anaesthesia or resting wakefulness. Serial measurements of EEG power and cognitive task performance were assessed relative to pre-intervention baseline. Mixed-effects models allowed quantification of PDR and neurocognitive trajectories after return of responsiveness (ROR).

Results: Individuals in the control group showed stability in the PDR peak frequency over several hours (median difference/inter-quartile range [IQR] of 0.02/0.20 Hz, P=0.39). After isoflurane general anaesthesia, the PDR peak frequency was initially reduced at ROR (median difference/IQR of 0.88/0.65 Hz, P<0.001). PDR peak frequency recovered at a rate of 0.20 Hz h^-1. After ROR, the PDR peak frequency correlated with reaction time and accuracy on multiple cognitive tasks (P<0.001).

Conclusion: The temporal trajectory of the PDR peak frequency could be a useful perioperative marker for tracking cognitive dysfunction on the order of hours after surgery, particularly for cognitive domains of working memory, visuomotor speed, and executive function.

Clinical trial registration: NCT01911195.

Keywords: alpha oscillations; anaesthesia; biomarker; cognitive function; electroencephalography; posterior dominant rhythm.

MeSH terms

Adult
Alpha Rhythm
Anesthesia, General
Anesthetics* / pharmacology
Cognition
Electroencephalography
Humans
Isoflurane* / pharmacology

Substances

Isoflurane
Anesthetics

Associated data

ClinicalTrials.gov/NCT01911195

Grants and funding

R01 AG057901/AG/NIA NIH HHS/United States