Clinical Neurology and Neuroscience

Submit a Manuscript

Publishing with us to make your research visible to the widest possible audience.

Propose a Special Issue

Building a community of authors and readers to discuss the latest research and develop new ideas.

Research Article |

Mechanism of Burst-Suppression During General Anesthesia: Review of Narrative Literature

Burst suppression is an electroencephalography pattern that is characterized by periods of high-voltage electrical activity alternating with periods of no activity in the brain. The pattern is found in patients with inactivated brain states, such as from general anaesthesia, coma, or hypothermia. The pseudo-rhythmic pattern of burst suppression is dictated by extracellular calcium depletion and the ability of neurons to restore the concentration. Bursts are accompanied by depletion of extracellular cortical calcium ions to levels that inhibit synaptic transmission, which leads to suppression periods. During suppression, neuronal pumps restore the calcium ion concentrations to normal levels, thus causing the cortex to be subject to the process again. As the brain becomes more inactive, burst periods become shorter and suppression periods become longer. The shortening of bursts and lengthening of suppression is caused by the central nervous system's inability to properly regulate calcium levels due to increased blood brain permeability.

Burst-Suppression, Electroencephalography Pattern, Cerebral Blood Flow Velocity

APA Style

Mansoj, H. M., Basse, A. M., Sow, A. D. (2024). Mechanism of Burst-Suppression During General Anesthesia: Review of Narrative Literature. Clinical Neurology and Neuroscience, 8(1), 1-7. https://doi.org/10.11648/j.cnn.20240801.11

ACS Style

Mansoj, H. M.; Basse, A. M.; Sow, A. D. Mechanism of Burst-Suppression During General Anesthesia: Review of Narrative Literature. Clin. Neurol. Neurosci. 2024, 8(1), 1-7. doi: 10.11648/j.cnn.20240801.11

AMA Style

Mansoj HM, Basse AM, Sow AD. Mechanism of Burst-Suppression During General Anesthesia: Review of Narrative Literature. Clin Neurol Neurosci. 2024;8(1):1-7. doi: 10.11648/j.cnn.20240801.11

Copyright © 2023 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Derbyshire AJ, Rempel B, Forbes A, Lambert EF. The Effects of Anesthetics on Action Potentials in the Cerebral Cortex of the Cat. American Journal of Physiology-Legacy Content [Internet]. 1936 [cité 26 déc 2023]; 116(3).
2. Swank RL, Watson CW. Effects of barbiturates and ether on spontaneous electrical activity of dog brain. J Neurophysiol. mars 1949; 12(2): 137-60.
3. Plummer GS, Ibala R, Hahm E, Year J, Gitlin J, Deng H, And al. Electroencephalogram dynamics during general anesthesia predict tea later impact and duration of burst-suppression during cardiopulmonary bypass. Clin Neurophysiol Off J Int Fed Clin Neurophysiol. Jan 2019; 130 (1): 55-60.
4. Ching S, Purdon PL, Vijayan S, Kopell NJ, Brown EN. A neurophysiological-metabolic model for burst suppression. Proc Natl Acad Sci U S A. févr 2012; 109(8): 3095100.
5. Amzica F. What does burst suppression really mean? Epilepsy Behav EB. August 2015; 49: 234-7.
6. Purdon PL, Sampson A, Pavone KJ, Brown EN. Clinical Electroencephalography for Anesthesiologists: Part I: Background and Basic Signatures. Anesthesiology. oct 2015; 123(4): 937-60.
7. Shanker A, Abel JH, Schamberg G, Brown EN. Etiology of Burst Suppression EEG Patterns. Front Psychol. 2021; 12: 673529.
8. Inouye SK, Robinson T, Blaum C, Busby-Whitehead J, Boustani M, Chalian A, et al. Postoperative delirium in older adults: best practice statement from the American Geriatrics Society. Journal of the American College of Surgeons. 2015; 220(2): 136-148e1.
9. Gunning D, Obal D, Chen CXH, Bell M, Jillings C. Comparing current post-cardiac surgery delirium management practices to the National Institute for Health and Clinical Excellence (NICE) 2010 clinical guideline on delirium: diagnosis, prevention, and management. 2012;
10. MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Systematic Reviews. 29 mars 2021; 10(1): 89.
11. ZAUGG (Vincent), ZAUGG (Vincent), SAVOLDELLI (Virginia), SABATIER (Brigitte), DURIEUX (Rock). Improve THE practice And the organization of the care: methodology of the journals systematic. Improve Prat Organ Care Methodology Rev Systematic. 2014.
12. King L, Hawe P, Wise M. Making Dissemination a Two-Way Process. Health Promotion International. 1 janv 1998; 13(3): 237-44.
13. Y li-Hankala A, Jäntti V, Pyykkö I, Lindgren L. Vibration stimulus induced EEG bursts in isoflurane anaesthesia. Electroencephalogr Clin Neurophysiol. oct 1993; 87(4): 215-20.
14. Sakabe T, Matsumoto M. Chapter 5 - EFFECTS OF ANESTHETIC AGENTS AND OTHER DRUGS ON CEREBRAL BLOOD FLOW, METABOLISM, AND INTRACRANIAL PRESSURE. In: Cottrell JE, Young WL, éditeurs. Cottrell and Young’s Neuroanesthesia. Fifth Edition. Philadelphia: Mosby; 2010. p. 78-94.
15. Tsuji T, Chiba S. Mechanism of vascular responsiveness to barbiturates in isolated and perfused canine basilar arteries. Neurosurgery. août 1987; 21(2): 1616.
16. Rigas P, Castro-Alamancos MA. Thalamocortical Up states: differential effects of intrinsic and extrinsic cortical inputs on persistent activity. J Neurosci Off J Soc Neuroscience. 18 Apr 2007; 27(16): 4261-72.
17. Echlin FA, Arnett V, Zoll J. Paroxysmal high voltage discharges from isolated and partially isolated human and animal cerebral cortex. Electroencephalogr Clin Neurophysiol. May 1952; 4(2): 147-64.
18. Henry THIS, Scoville WB. Deletion-burst activity from isolated cerebral cortex in man. Electroencephalogr Clin Neurophysiol. Feb 1952; 4(1): 1-22.
19. Hughes JR. Extreme stereotypy in the burst suppression pattern. Clin EEG Electroencephalogr. Oct 1986; 17(4): 162-8.
20. Hille B. Ion channels of excitable membranes (Sinauer, Sunderland, MA). 2001.
21. Massimini M, Amzica F. Extracellular calcium fluctuations and intracellular potential in tea cortex during tea slow sleep oscillation. J Neurophysiol. March 2001; 85(3): 1346-50.
22. Steriade M, Amzica F, Contreras D. Cortical and thalamic cellular correlates of electroencephalographic burst-suppression. Electroencephalogr Clin Neurophysiol. Jan 1994; 90(1): 1-16.
23. Heinemann U, Pumain A. Effects of tetrodotoxin we changes in extracellular free calcium induced by repetitive electrical stimulation and iontophoretic application of excitatory amino acids in the sensorimotor cortex of cats. Neuroscience Lett. 1 Jan 1981; 21(1): 87-91.
24. Bollmann JH, Helmchen F, Borst JG, Sakmann B. Postsynaptic Ca2+ influx mediated by three different pathways during synaptic transmission at a calyx-type synapse. J Neurosci. 15 déc 1998; 18(24): 10409-19.
25. King RD, West MC, Montague PR, Eagleman DM. Do extracellular Ca2+ signals carry information through neural tissue? Trends Neurosci. Jan 2000; 23(1): 12-3.
26. Kuffler SW, Nicholas JG. GLIAL CELLS IN TEA CENTRAL NERVOUS SYSTEM OF THE LEECH; THEIR MEMBRANE POTENTIAL AND POTASSIUM THRILLED. Naunyn Schmiedebergs arch Exp Pathol Pharmakol. 25 may 1964; 248: 216-22.
27. Kuffler SW, Nicholls JG, Orkand RK. Physiological properties of glial cells in the central nervous system of amphibia. J Neurophysiol. juill 1966; 29(4): 768-87.
28. Somjen GG. Extracellular potassium in the mammalian central nervous system system. Annu Rev Physiol. 1979; 41: 159-77.
29. Ballanyi K, Grafe P, ten Bruggencate G. Ion activities and potassium uptake mechanisms of glial cells in guinea-pig olfactory cortex slices. J Physiol. Jan 1987; 382: 159-74.
30. Amzica F, Massimini M, Manfridi A. Spatial buffering during slow and paroxysmal sleep oscillations in cortical networks of glial cells in vivo. J Neurosci Off J Soc Neurosci. Feb 1 2002; 22(3): 1042-53.
31. Somjen GG. Ions in the brain: normal function, seizures, and stroke. Oxford University Press; 2004.
32. Kocsis JD, Malenka R. C., Waxman SG. Effects of extracellular potassium concentration we tea excitability of tea parallel fibers of tea rat cerebellum. J Physiol. Jan 1983; 334: 225-44.
33. Nusser Z. AMPA and NMDA receptors: similarities and differences in their synaptics distribution. Curr Opin Neurobiol. June 2000; 10(3): 337-41.
34. Lazar LM, Milrod LM, Solomon GE, Labar DR. Asynchronous pentobarbital-induced burst suppression with corpus callosum hemorrhage. Clin Neurophysiol. juin 1999; 110(6): 1036-40.
35. Orkand RK, Nicholls JG, Kuffler SW. Effect of nerve impulses on the membrane potential of glial cells in the central nervous system of amphibia. J Neurophysiol. juill 1966; 29(4): 788-806.
36. Amzica F, Massimini M, Manfridi A. Spatial Buffering during Slow and Paroxysmal Sleep Oscillations in Cortical Networks of Glial Cells In Vivo. J Neurosci. 1 févr 2002; 22(3): 1042.
37. Gajda Z, Szupera Z, Blazsó G, Szente M. Quinine, a blocker of neuronal cx36 channels, suppresses seizure activity in rat neocortex in vivo. Epilepsia. oct 2005; 46(10): 1581-91.
38. Rouach NOT, Segal M, Koulakoff HAS, Giaume VS, Avignone E. Carbenoxolone blockade of neuronal network activity in culture is not mediated by year action on gap junctions. J Physiol. Dec 15 2003; 553 (Pt 3): 729-45.
39. Beydoun A, Yen CE, Drury I. Variance of interburst intervals in burst deletion. Electroencephalogr Clin Neurophysiol. dec 1991; 79(6): 435-9.
40. Antognini JF, Barter L, Carstens E. Overview movement as an index of anesthetic depth in humans and experimental animals. Comp Med. oct 2005; 55(5): 413-8.
41. Heinke W, Koelsch S. The effects of anesthetics on brain activity and cognitive function. Curr Opin Anaesthesiol. dec 2005; 18(6): 625-31.
42. Steriade Mr. Grouping of brain rhythms in corticothalamic systems. Neuroscience. 2006; 137(4): 1087-106.
43. Wang L, Zhu QL, Wang GZ, Deng TZ, Chen R, Liu MH, et al. The protective roles of mitochondrial ATP-sensitive potassium channels during hypoxia-ischemia-reperfusion in brain. Neurosci Lett. 10 mars 2011; 491(1): 63.
44. May R, Hunt K. Pharmacological and pathological modulation of cerebral physiology. Anaesthesia & Intensive Care Medicine. 1 janv 2020; 21(1): 51-5.
45. Vandesteene A, Trempont V, Engelman E, Deloof T, Focroul M, Schoutens A, et al. Effect of propofol on cerebral blood flow and metabolism in man. Anaesthesia. mars 1988; 43 Suppl: 423.
46. Young GB. The EEG in coma. J Clin Neurophysiol. sept 2000; 17(5): 473-85.
47. Edgren E, Enblad P, Grenvik A, Lilja A, Valind S, Wiklund L, et al. Cerebral blood flow and metabolism after cardiopulmonary resuscitation. A pathophysiologic and prognostic positron emission tomography pilot study. Resuscitation. mai 2003; 57(2): 161-70.
48. Marion D. W., Penrod THE, Kelly SF, Obrist WD, Kochanek PM, Palmer AM, And al. Treatment of traumatic brain injury with moderate hypothermia. NOT English J Med. 20 Feb 1997; 336 (8): 540-6.
49. Jiang JY. Clinical study of mild hypothermia treatment for severe traumatic brain injury. J Neurotrauma. mars 2009; 26(3): 399-406.
50. Williams YEAR, Gray RG, Poulton K, Ramani P, Whitehouse WP. HAS case of Ohtahara syndrome with cytochrome oxidase deficiency. Dev Med Child Neurol. august 1998; 40(8): 568-70.
51. Hirsch N, Taylor C. Pharmacological and pathological modulation of cerebral physiology. Anaesthesia & Intensive Care Medicine. 1 sept 2010; 11(9): 349.
52. Steriade M, Amzica F, Contreras D. Cortical and thalamic cellular correlates of electroencephalographic burst-suppression. Electroencephalogr Clin Neurophysiol. janv 1994; 90(1): 1-16.
53. Kroeger D, Amzica F. Hypersensitivity of the anesthesia-induced comatose brain. J Neurosci. Sept 2007; 27(39): 10597-607.
54. Amzica F. Basic physiology of burst-suppression. Epilepsy. Dec 2009; 50 Suppl 12: 38–9.
55. Brenner RP. Tea electroencephalogram in altered states of consciousness. Neurol Clin. august 1985; 3(3): 615-31.
56. Aon MA, Cortassa S, O’Rourke B. Mitochondrial oscillations in physiology and pathophysiology. Adv Exp Med Biol. 2008; 641: 98-117.
57. Zhou L, Cortassa S, Wei AC, Aon MA, Winslow RL, O’Rourke B. Modeling cardiac action potential shortening driven by oxidative stress-induced mitochondrial oscillations in guinea pig cardiomyocytes. Biophys J. 7 oct 2009; 97(7): 1843-52.
58. Stecker MM. Neurophysiology of surgical procedures for repair of the aortic arch. J Clin Neurophysiol Off Publ Am Electroencephalogr Soc. august 2007; 24(4): 310-5.
59. Contreras D, Steriade M. Cellular basis of EEG slow rhythms: a study of dynamic corticothalamic relationships. J Neurosci. janv 1995; 15(1 Pt 2): 604-22.