Poster #59 - Novel Ambulatory Quantitative EEG Assessments in Ecologically-salient Contexts: Pediatric Preoperative Anxiety

• In Event: 1-115 - Poster Session 03
  In Poster Session: PS 03 Section - Developmental Psychopathology

Integrative Statement

Background: Preparing to undergo surgery is stressful, with up to 75% of 6 million children experiencing preoperative anxiety (Perry et al, 2012). Preoperative anxiety predicts adverse outcomes in children, including higher anesthetic dosages for induction, greater postoperative pain and analgesic usage, and delayed wound healing (Kain et al., 1996).
Given the negative impact of preoperative anxiety, research has begun to focus on identifying, predicting, and managing at-risk children. Unfortunately, existing assessment tools for preoperative anxiety are labor and time intensive, susceptible to biases, or unable to track dynamic changes in anxiety state.
Recent innovations in portable, ambulatory EEG technologies, such as the Muse (InteraXon, Toronto, Canada), now allow for the more efficient quantitative assessment of continuous brain activity outside of traditional laboratory contexts. The Muse is a dry sensor, wireless, ambulatory EEG headband which has demonstrated reliability in relation to traditional medical systems (Hashemi et al., 2016; Krigolson et al., 2017), and allows for simple noninvasive, and continuous monitoring of children’s brain activity in real time.
Therefore, the objectives of the present study were: 1) to conduct a pilot study to establish proof-of-concept of whether quantitative EEG measures could be assessed in children preparing for surgery in a busy preoperative clinic setting and; 2) to examine the preliminary psychometric properties of the ambulatory EEG measure by examining its test-retest reliability, internal consistency, and concurrent validity.
Methods: Using the Muse, we measured anterior alpha power continuously for 40 mins from the frontal and temporal brain regions in 31 children ages 8 to 13 preparing for elective surgery during two separate visits: a preoperative visit approximately one week before surgery (Visit 1), and the day of surgery in the preoperative holding area (Visit 2). We also measured preoperative anxiety using self-reported Children’s Perioperative Multidimensional Anxiety Scale (CPMAS; Chow et al., 2016) and observer-rated modified Yale Preoperative Anxiety Scale (mYPAS; Kain et al., 1997) during Visit 2.
Results: Anterior EEG alpha power demonstrated very good internal consistency (Cronbach’s alpha ranging from .95 to .98; Table 1) and good test-retest reliability (rs = .66 to .89, ps <0.01; Table 2). Moreover, a concurrent association between average overall frontal EEG alpha power and CPMAS (r = -.45, p = .04, n = 22) was found.
Discussion: Consistent with laboratory studies, reductions in overall frontal EEG alpha power was concurrently associated with increases self-reported anxiety. Although further testing is warranted, these findings provide preliminary evidence of the feasibility, reliability, and validity of potentially using ambulatory EEG measures to track preoperative anxiety in busy preoperative clinics. The implications for using ambulatory quantitative EEG to assess and manage children’s preoperative anxiety are discussed. In addition to the practical implications of using ambulatory EEG measures in the preoperative context, the present findings have theoretical implications for understanding the influence of different ecological contexts on brain-behavior relations. Although the use of quantitative EEG in the preoperative context is limited, these present preliminary findings are congruent with previous laboratory findings that demonstrate links between frontal EEG alpha power and tracking anxiety.

Authors

• Cheryl Chow, McMaster University
  Presenting Author

• Richard Xu, McMaster University
  Non-Presenting Author

• Kristie L. Poole, McMaster University
  Non-Presenting Author

• Graeme Moffat, InteraXon Inc.
  Non-Presenting Author

• Ryan J. Van Lieshout, McMaster University
  Non-Presenting Author

• Norman Buckley, McMaster University
  Non-Presenting Author

• Louis Schmidt, McMaster University
  Non-Presenting Author