Heightened propofol sensitivity and distinct electroencephalographic signatures in patients with valvular heart disease.

OBJECTIVE

The significant association between anesthetic sensitivity and postoperative outcomes in patients with valvular heart disease (VD) underscores the critical need for more reliable depth-of-anesthesia monitoring. This study sought to investigate propofol sensitivity and establish specific electroencephalography (EEG) biomarkers to guide safer anesthesia delivery in this high-risk population.

METHODS

In this prospective observational trial, 40 patients (20 VD vs. 20 non-cardiac controls) received Schnider model-guided propofol target-controlled infusion. Primary outcome was effect-site propofol concentration at loss of consciousness (CeLOC). Prefrontal EEG dynamics (spectral power, bicoherence, burst suppression) were analyzed.

RESULTS

VD patients exhibited 34% lower CeLOC versus controls (2.8 vs. 4.25 µg/mL; p = 0.0001). EEG revealed distinct neurosignatures: elevated β and θ power (β: 3.16 vs. 1.68, p = 0.0303; θ: 1.21 vs. 0.88, p = 0.0166), higher spectral power ratio (SPR: 1.38 vs. 1.98; p = 0.022), and intensified burst suppression (ratio: 0.11 vs. 0.32; p < 0.0001). Bicoherence analysis demonstrated impaired cross-frequency coupling in β and δ bands (β: 40.95 vs. 34.75, p = 0.0253; δ:43.5 vs. 30.95, p < 0.0001).

CONCLUSIONS

VD is associated with heightened propofol sensitivity and distinct EEG signatures, including patterns suggestive of thalamocortical dysrhythmia and cortical suppression. These findings suggest that disease-specific EEG monitoring may inform the development of precision anesthesia protocols for cardiac populations.