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Reza Gorji, MD; Ryan Burns, CINM; Fenghua Li, MD
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| DSA analysis of the event. |
Answer: The patient is a 54-year-old female undergoing craniotomy for clipping of the MCA and ACom aneurysms. Anesthesia consisted of total intravenous anesthesia consisting of propofol and remifentanil. The first 40 seconds of the EEG monitoring strip shows a slow EEG waveform and burst suppression. There is some extraneous noise that can be seen around 0:20 to 0:30. Just after 0:40 the top channel (Fp1-F3) starts showing a consistent 5.5Hz frequency that starts with an amplitude of 50uV that steadily increases to 200uV. From 0:40 to 0:50 the 5.5Hz frequency sequentially enters each channel of our recordings. From 0:50 to 1:45 there is a large amount of activity; an increase of fast frequencies of approximately 23Hz are seen with the 5.5Hz frequency still prominent. All channels’ amplitudes are approximately 200uV.
The seizure activity was stopped by a propofol bolus which then returned the EEG to burst suppression.
This event has been reported in the literature.
The DSA analysis shows a burst suppression state with most frequencies below 13Hz. There is a rapid increase in the density of fast frequencies which can be seen as the increase of red on the X axis of frequency. For a short time, all frequencies are fully saturated and quickly return to their previous states after the bolus of Propofol.
