[Epileptogenic potential of sevoflurane]

Induction au masque facial avec le sévoflurane chez l'enfant : le point sur les nouvelles modalités

The delay for loss of consciousness can be shortened by using high concentration sevoflurane > 6% and by adding N2O during inhalation induction with sevoflurane in paediatrics. Mean time for tracheal tube insertion is lower than 5 min in the majority of studies. This shorter delay is not associated with any significant increase in clinical side effects. However, recent studies have demonstrated the epileptogenic effect of high effect site sevoflurane concentration (occurrence of spike wave on the EEG). Inhalation induction with high alveolar sevoflurane concentration is questionable mainly when it is associated with hyperventilation. Positive pressure ventilation or pressure support ventilation make it possible to maintain normocapnia and to monitor FeSevo. Adding a narcotic decreases the target cerebral concentration required to perform tracheal intubation and consequently the risk of spike wave occurrence.

[Occurrence of epileptiform crisis in child under sevoflurane anaesthesia]

A case report is presented of an unknown epileptic child, who developed convulsive movements during inhalation of 3.9% sevoflurane for 45 minutes associated with moderate hyperventilation. Epilepsy was discovered on the EEG, which was performed postoperatively.