Density Spectral Array Patterns During Total Intravenous Anesthesia with Intravenous Lidocaine for Craniotomy: An Illustrative Two-Case Series.
Riyadh Firdaus, Jonathan Wiradinata, Lara Aristya et al.
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Case in brief
Two adults undergoing craniotomy for tumor resection received propofol-remifentanil total intravenous anesthesia, bilateral scalp block, and intravenous lidocaine. Frontal bispectral index and density spectral array (DSA) were monitored. One patient maintained an alpha-delta pattern at the lowest anesthetic targets used; the other showed greater delta dominance, reduced alpha and beta activity, and intermittent burst suppression, persisting after propofol reduction. Both had transient beta-power increases associated with surgical stimulation, although electromyographic contribution could not be excluded. No hemodynamic instability or lidocaine-attributable adverse effects were observed.
What made this case unusual
The two patients showed notably different DSA patterns during similar anesthetic techniques, including intermittent burst suppression in one patient despite reduced propofol. The observations cannot establish that lidocaine caused these patterns or that they reflect a dose response.
Diagnostic / clinical pearl
Interpret DSA patterns during TIVA with lidocaine in clinical context: differences between patients and possible electromyographic contributions limit attribution to lidocaine alone.