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Phase Lag Entropy as a Surrogate Measurement of Hypnotic Depth during Sevoflurane Anesthesia. Medicina (B Aires) 2021; 57:medicina57101034. [PMID: 34684071 PMCID: PMC8541175 DOI: 10.3390/medicina57101034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: Phase lag entropy, an electroencephalographic monitor, evaluates the variety in temporal patterns of phase relationship between frontal and prefrontal brain region. Phase lag entropy can reflect the depth of anesthesia induced by propofol, but the association between sevoflurane and phase lag entropy has not been elucidated. This study examined the effect of sevoflurane on phase lag entropy during induction of general anesthesia. We also explored the pharmacodynamic model between end-tidal anesthetic concentration and electroencephalographic monitor. Materials and Methods: A total of 20 patients were enrolled. General anesthesia was produced by escalating the sevoflurane (1 vol% up to 8 vol%). The relationship between phase lag entropy and end-tidal anesthetic concentration was analyzed. A non-linear mixed-effects model was used to get the relationship of pharmacodynamics between the end-tidal sevoflurane concentration and phase lag entropy. Mean blood pressure, heart rate, and the modified observer’s assessment of alertness/sedation scale were also recorded during sevoflurane anesthesia. Results: As level of sedation increased, phase lag entropy decreased. A significant correlation was showed between phase lag entropy and end-tidal sevoflurane concentration (r = −0.759, p < 0.001). The correlation coefficient between the modified observer’s assessment of alertness/sedation scale and phase lag entropy was 0.731 (p < 0.001). The pharmacodynamic factors assessed by the sigmoid Emax model were E0 = 84.9, Emax = 42, Ce50 = 1.81, γ = 4.78, and ke0 = 0.692. The prediction probability of phase-lag entropy for measuring the modified observer’s assessment of alertness/sedation scale and end-tidal sevoflurane concentration were 0.764 and 0.789, respectively. With the increasing concentration of sevoflurane, mean blood pressure decreased, but heart rate did not change. Conclusions: The continuing escalation in end-tidal sevoflurane concentration caused a decline in phase lag entropy. Phase lag entropy can serve as an indicator of hypnotic depth in patients receiving sevoflurane anesthesia.
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Stasiowski MJ, Duława A, Król S, Marciniak R, Kaspera W, Niewiadomska E, Krawczyk L, Ładziński P, Grabarek BO, Jałowiecki P. Polyspikes and Rhythmic Polyspikes During Volatile Induction of General Anesthesia With Sevoflurane Result in Bispectral Index Variations. Clin EEG Neurosci 2020; 54:289-304. [PMID: 33241952 DOI: 10.1177/1550059420974571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although electroencephalography (EEG)-based indices may show artifactual values, raw EEG signal is seldom used to monitor the depth of volatile induction of general anesthesia (VIGA). The current analysis aimed to identify whether bispectral index (BIS) variations reliably reflect the actual depth of general anesthesia during presence of different types of epileptiform patterns (EPs) in EEGs during induction of general anesthesia. METHODS Sixty patients receiving either VIGA with sevoflurane using increasing concentrations (group VIMA) or vital capacity (group VCRII) technique or intravenous single dose of propofol (group PROP) were included. Monitoring included facial electromyography (fEMG), fraction of inspired sevoflurane (FiAA), fraction of expired sevoflurane (FeAA), minimal alveolar concentration (MAC) of sevoflurane, BIS, standard EEG, and hemodynamic parameters. RESULTS In the PROP group no EPs were observed. During different stages of VIGA with sevoflurane in the VIMA and VCRII groups, presence of polyspikes and rhythmic polyspikes in patients' EEGs resulted in artifactual BIS values indicating a false awareness/wakefulness from anesthesia, despite no concomitant change of FiAA, FeAA, and MAC of sevoflurane. Periodic epileptiform discharges did not result in aberrant BIS values. CONCLUSION Our results suggest that raw EEG correlate it with values of BIS, FiAA, FeAA, and MAC of sevoflurane during VIGA. It seems that because artifactual BIS values indicating false awareness/wakefulness as a result of presence of polyspikes and rhythmic polyspikes in patients' EEGs may be misleading to an anesthesiologist, leading to unintentional administration of toxic concentration of sevoflurane in ventilation gas.
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Affiliation(s)
- Michał J Stasiowski
- Department of Anesthesiology and Intensive Therapy, SMDZ in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Anna Duława
- Department of Anesthesiology and Intensive Care, Railway District Hospital Katowice, Medical University of Silesia, Katowice, Poland
| | - Seweryn Król
- Department of Anesthesiology and Intensive Therapy, SMDZ in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Radosław Marciniak
- Department of Anesthesiology and Intensive Therapy, SMDZ in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Wojciech Kaspera
- Department of Neurosurgery, Regional Hospital in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Ewa Niewiadomska
- Department of Epidemiology and Biostatistics, School of Public Health in Bytom, Medical University of Silesia, Katowice, Poland
| | - Lech Krawczyk
- Department of Anesthesiology and Intensive Therapy, SMDZ in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Piotr Ładziński
- Department of Neurosurgery, Regional Hospital in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Beniamin O Grabarek
- Department of Clinical Trials, Maria Sklodowska-Curie National Research Institute of Oncology Krakow Branch, Krakow, Poland.,Department of Histology, Cytophysiology and Embryology, Faculty of Medicine in Zabrze, University of Technology in Katowice, Zabrze, Poland
| | - Przemysław Jałowiecki
- Department of Anesthesiology and Intensive Therapy, SMDZ in Zabrze, Medical University of Silesia, Zabrze, Poland
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Stasiowski M, Duława A, Szumera I, Marciniak R, Niewiadomska E, Kaspera W, Krawczyk L, Ładziński P, Grabarek BO, Jałowiecki P. Variations in Values of State, Response Entropy and Haemodynamic Parameters Associated with Development of Different Epileptiform Patterns during Volatile Induction of General Anaesthesia with Two Different Anaesthetic Regimens Using Sevoflurane in Comparison with Intravenous Induct: A Comparative Study. Brain Sci 2020; 10:brainsci10060366. [PMID: 32545600 PMCID: PMC7349226 DOI: 10.3390/brainsci10060366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/27/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Raw electroencephalographic (EEG) signals are rarely used to monitor the depth of volatile induction of general anaesthesia (VIGA) with sevoflurane, even though EEG-based indices may show aberrant values. We aimed to identify whether response (RE) and state entropy (SE) variations reliably reflect the actual depth of general anaesthesia in the presence of different types of epileptiform patterns (EPs) in EEGs during induction of general anaesthesia. MATERIALS AND METHODS A randomized, prospective clinical study was performed with 60 patients receiving VIGA using sevoflurane with the increasing concentrations (group VIMA) or the vital capacity (group VCRII) technique or an intravenous single dose of propofol (group PROP). Facial electromyography (fEMG), fraction of inspired sevoflurane (FiAA), fraction of expired sevoflurane (FeAA), minimal alveolar concentration (MAC) of sevoflurane, RE and SE, and standard electroencephalographic evaluations were performed in these patients. RESULTS In contrast to periodic epileptiform discharges, erroneous SE and RE values in the patients' EEGs were associated with the presence of polyspikes (PS) and rhythmic polyspikes (PSR), which were more likely to indicate toxic depth rather than false emergence from anaesthesia with no changes in the FiAA, FeAA, and MAC of sevoflurane. CONCLUSION Calculated RE and SE values may be misleading during VIGA when EPs are present in patients' EEGs. During VIGA with sevoflurane, we recommend monitoring raw EEG data in scientific studies to correlate it with potentially erroneous RE and SE values and the end-tidal concentration of sevoflurane in everyday clinical practice, when monitoring raw EEG is not available, because they can mislead anaesthesiologists to reduce sevoflurane levels in the ventilation gas and result in unintentional true emergence from anaesthesia. Further studies are required to investigate the behaviour of EEG-based indices during rapid changes in sevoflurane concentrations at different stages of VIGA and the influence of polyspikes and rhythmic polyspikes on the transformation of EEG signals into a digital form.
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Affiliation(s)
- Michał Stasiowski
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (I.S.); (R.M.); (L.K.); (P.J.)
- Correspondence: ; Tel.: +48323682331
| | - Anna Duława
- Department of Anaesthesiology and Intensive Care, Railway District Hospital Katowice, 40-055 Katowice, Poland;
| | - Izabela Szumera
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (I.S.); (R.M.); (L.K.); (P.J.)
| | - Radosław Marciniak
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (I.S.); (R.M.); (L.K.); (P.J.)
| | - Ewa Niewiadomska
- Department of Epidemiology and Biostatistics, School of Public Health in Bytom, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Wojciech Kaspera
- Department of Neurosurgery, Regional Hospital in Sosnowiec, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (W.K.); (P.Ł.)
| | - Lech Krawczyk
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (I.S.); (R.M.); (L.K.); (P.J.)
| | - Piotr Ładziński
- Department of Neurosurgery, Regional Hospital in Sosnowiec, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (W.K.); (P.Ł.)
| | - Beniamin Oskar Grabarek
- Department of Clinical Trials, Maria Sklodowska-Curie National Research Institute of Oncology Krakow Branch, 31-115 Katowice, Poland;
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine in Zabrze, University of Technology in Katowice, 41-800 Zabrze, Poland
| | - Przemysław Jałowiecki
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (I.S.); (R.M.); (L.K.); (P.J.)
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Abt M, Dinklo T, Rothfuss A, Husar E, Dannecker R, Kallivroussis K, Peck R, Doessegger L, Wandel C. A Framework Proposal to Follow-Up on Preclinical Convulsive Signals of a New Molecular Entity in First-in-Human Studies Using Electroencephalographic Monitoring. Clin Pharmacol Ther 2019; 106:968-980. [PMID: 30993670 PMCID: PMC6851537 DOI: 10.1002/cpt.1455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/18/2019] [Indexed: 01/11/2023]
Abstract
Traditionally, in dose-escalating first-in-human (FiH) studies, a dose cap with a 10-fold safety margin to the no observed effect level in animals is implemented if convulsive events are observed in animals. However, the convulsive risk seen in animals does not generally translate to humans. Several lines of evidence are summarized indicating that in a dose-escalating setting, electroencephalographic epileptiform abnormalities occur at lower doses than clinical convulsive events. Therefore, we propose to consider the occurrence of epileptiform abnormalities in toxicology studies as premonitory signals for convulsions in dose-escalating FiH studies. Compared with the traditional dose-cap approach, this may allow the exploration of higher doses in FiH and, subsequently, phase II studies without compromising human safety. Similarly, the presence or absence of electroencephalographic epileptiform abnormalities may also aid the assessment of proconvulsive risk in situations of increased perpetrator burden as potentially present in pharmacokinetic and/or pharmacodynamic drug-drug interactions.
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Affiliation(s)
- Markus Abt
- Department of BiometricsF. Hoffmann‐La Roche AGBaselSwitzerland
| | - Theo Dinklo
- Roche Pharma Research and Early DevelopmentRoche Innovation Center BaselF. Hoffmann‐La Roche AGBaselSwitzerland
| | - Andreas Rothfuss
- Roche Pharma Research and Early DevelopmentRoche Innovation Center BaselF. Hoffmann‐La Roche AGBaselSwitzerland
| | - Elisabeth Husar
- Roche Pharma Research and Early DevelopmentRoche Innovation Center BaselF. Hoffmann‐La Roche AGBaselSwitzerland
| | | | | | - Richard Peck
- Roche Pharma Research and Early DevelopmentRoche Innovation Center BaselF. Hoffmann‐La Roche AGBaselSwitzerland
| | | | - Christoph Wandel
- Department of Safety & Risk ManagementF. Hoffmann‐La Roche AGBaselSwitzerland
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Shavit CW, Rollins MD, Ferschl MB. Maternal convulsion during high-dose sevoflurane anaesthesia for open foetal surgery. Br J Anaesth 2018; 118:634-635. [PMID: 28403424 DOI: 10.1093/bja/aex067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sonkajärvi E, Rytky S, Alahuhta S, Suominen K, Kumpulainen T, Ohtonen P, Karvonen E, Jäntti V. Epileptiform and periodic EEG activities induced by rapid sevoflurane anaesthesia induction. Clin Neurophysiol 2018; 129:638-645. [DOI: 10.1016/j.clinph.2017.12.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 11/09/2017] [Accepted: 12/09/2017] [Indexed: 10/18/2022]
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Yamakawa T, Inoue T, He Y, Fujii M, Suzuki M, Niwayama M. Development of an implantable flexible probe for simultaneous near-infrared spectroscopy and electrocorticography. IEEE Trans Biomed Eng 2014; 61:388-95. [PMID: 23996535 DOI: 10.1109/tbme.2013.2279888] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A combination of near-infrared spectroscopy (NIRS) and electrocorticography (ECoG) provides beneficial information on cortical activity from different aspects. Integration of such multimodal measurement capability into a single apparatus and the direct measurement of cortical activity during chronic subdural implantation may be a powerful means for clinical diagnosis and neuroscience. However, an optical fiber-based NIRS probe cannot be miniaturized for implantation into the brain, and the light-scattering effect of ECoG electrodes in NIRS measurements is unknown. We describe here the development of a flexible probe, small enough for chronic subdural implantation, for simultaneous NIRS and ECoG. Two light-emitting diodes of different wavelengths and two photodiodes were mounted on a polyimide-based flexible substrate, and ECoG electrodes were formed with a design minimizing artifacts in NIRS recording. The fabricated probe measured ECoGs at sufficient spatial resolution and submicromolar changes in hemoglobin concentrations in in vivo experiments with acute implantation into a rat. Comparison of measured changes in hemoglobin concentrations for different source-detector distances reveals the reliability of the measured values and the practicality of the simulation model. The proposed intracranial multimodality probe may provide beneficial evidence for pre- and intrasurgical assessment of neurosurgery and reveal the interaction of electrophysiology and hemodynamics at high spatial resolution without artifacts due to scalp blood flow.
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Kreuzer I, Osthaus WA, Schultz A, Schultz B. Influence of the sevoflurane concentration on the occurrence of epileptiform EEG patterns. PLoS One 2014; 9:e89191. [PMID: 24586585 PMCID: PMC3935848 DOI: 10.1371/journal.pone.0089191] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 01/16/2014] [Indexed: 12/04/2022] Open
Abstract
Objectives and Aim This study was performed to analyse the effects of different sevoflurane concentrations on the incidence of epileptiform EEG activity during induction of anaesthesia in children in the clinical routine. Background It was suggested in the literature to use sevoflurane concentrations lower than 8% to avoid epileptiform activity during induction of anaesthesia in children. Methods 100 children (age: 4.6±3.0 years, ASA I–III, premedication with midazolam) were anaesthetized with 8% sevoflurane for 3 min or 6% sevoflurane for 5 min in 100% O2 via face mask followed by 4% sevoflurane until propofol and remifentanil were given for intubation. EEGs were recorded continuously and were analysed visually with regard to epileptiform EEG patterns. Results From start of sevoflurane until propofol/remifentanil administration, 38 patients (76%) with 8% sevoflurane had epileptiform EEG patterns compared to 26 patients (52%) with 6% (p = 0.0106). Epileptiform potentials tended to appear later in the course of the induction with 6% than with 8%. Up to an endtidal concentration of 6% sevoflurane, the number of children with epileptiform potentials was similar in both groups (p = 0.3708). The cumulative number of children with epileptiform activity increased with increasing endtidal sevoflurane concentrations. The time from start of sevoflurane until loss of consciousness was similar in patients with 8% and 6% sevoflurane (42.2±17.5 s vs. 44.9 s ±14.0 s; p = 0.4073). An EEG stage of deep anaesthesia with continuous delta waves <2.0 Hz appeared significantly earlier in the 8% than in the 6% group (64.0±22.2 s vs. 77.9±20.0 s, p = 0.0022). Conclusion The own analysis and data from the literature show that lower endtidal concentrations of sevoflurane and shorter administration times can be used to reduce epileptiform activity during induction of sevoflurane anaesthesia in children.
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Affiliation(s)
- Ines Kreuzer
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - W. Alexander Osthaus
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Arthur Schultz
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
- * E-mail:
| | - Barbara Schultz
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
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Abstract
A wide range of substances, including drugs and illicit compounds, increase the risk of epileptic seizures. In this systematic review, the authors address the issue of the epileptogenic potential of marketed drugs, with the aims of providing criteria for the assessment of the cause-effect relationship between drug exposure and the risk of seizures; and to identify the compounds better fulfilling the requirements of an epileptogenic drug. Finding a correlation between drug exposure and occurrence of seizures does not necessarily establish a causal association. In light of the available evidence, even with these limitations, some conclusive remarks can be made on the epileptogenic potential of some active principles. Drugs with high epileptogenic potential include meperidine, sevoflurane, clozapine, phenothiazines and cyclosporine. Drugs with intermediate epileptogenic potential include propofol, maprotiline, tricyclic antidepressants and chlorambucil. Drugs with low epileptogenic potential include fluorquinolones, carbapenems, bupropion and iodinated contrast media. Drugs with minimal or inconclusive epileptogenic potential include interferon alpha.
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Affiliation(s)
- Claudio Ruffmann
- Centro per l'Epilessia e Clinica Neurologica, Università Bicocca, Monza, Milan, Italy.
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Julliac B, Cotillon P, Guehl D, Richez B, Sztark F. Target-controlled induction with 2.5% sevoflurane does not avoid the risk of electroencephalographic abnormalities. ACTA ACUST UNITED AC 2013; 32:e143-8. [DOI: 10.1016/j.annfar.2013.07.812] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 07/11/2013] [Indexed: 11/30/2022]
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Miao N, Lu X, O’Grady NP, Yanjanin N, Porter FD, Quezado ZMN. Niemann-pick disease type C: implications for sedation and anesthesia for diagnostic procedures. J Child Neurol 2012; 27:1541-6. [PMID: 22378675 PMCID: PMC3508074 DOI: 10.1177/0883073812437243] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Niemann-Pick disease type C, an autosomal recessive lysosomal storage disorder, can present with severe visceral and neurologic involvement and is associated with a significant decrease in life expectancy. As little is known about anesthetic considerations of this disease, we examined the perianesthetic course of patients with Niemann-Pick disease type C. Thirty-two patients with Niemann-Pick disease type C, median age 6.9 years (1.8-33 years), underwent 64 general anesthetics for diagnostic procedures. Perianesthetic morbidity included need for tracheal reintubation, pneumonitis, hypothermia, and seizure. Therefore, Niemann-Pick disease type C-associated neurologic and visceral involvement might have anesthetic implications that neurologists and pediatricians should be aware of and consider discussing with parents, guardians, and the patient's care team when procedures requiring anesthesia are planned. Furthermore, it is important for delivery of safe anesthesia that there is communication among care team members so that all involved understand the disease manifestation spectrum.
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Affiliation(s)
- Ning Miao
- Department of Perioperative Medicine, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Xiaowei Lu
- Department of Perioperative Medicine, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Naomi P. O’Grady
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Nicole Yanjanin
- Section on Molecular Dysmorphology, Program in Developmental Endocrinology and Genetics, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Forbes D. Porter
- Section on Molecular Dysmorphology, Program in Developmental Endocrinology and Genetics, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Zenaide M. N. Quezado
- Department of Perioperative Medicine, National Institutes of Health Clinical Center, Bethesda, MD, USA,The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Medical Center, Washington, DC, USA
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Schultz B, Otto C, Schultz A, Osthaus WA, Krauss T, Dieck T, Sander B, Rahe-Meyer N, Raymondos K. Incidence of epileptiform EEG activity in children during mask induction of anaesthesia with brief administration of 8% sevoflurane. PLoS One 2012; 7:e40903. [PMID: 22829896 PMCID: PMC3400655 DOI: 10.1371/journal.pone.0040903] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 06/14/2012] [Indexed: 11/19/2022] Open
Abstract
Background A high incidence of epileptiform activity in the electroencephalogram (EEG) was reported in children undergoing mask induction of anaesthesia with administration of high doses of sevoflurane for 5 minutes and longer. This study was performed to investigate whether reducing the time of exposure to a high inhaled sevoflurane concentration would affect the incidence of epileptiform EEG activity. It was hypothesized that no epileptiform activity would occur, when the inhaled sevoflurane concentration would be reduced from 8% to 4% immediately after the loss of consciousness. Methodology/Principal Findings 70 children (age 7–96 months, ASA I–II, premedication with midazolam) were anaesthetized with 8% sevoflurane in 100% oxygen via face mask. Immediately after loss of consciousness, the sevoflurane concentration was reduced to 4%. EEGs were recorded continuously and were later analyzed visually with regard to epileptiform EEG patterns. Sevoflurane at a concentration of 8% was given for 1.2±0.4 min (mean ± SD). In 14 children (20%) epileptiform EEG patterns without motor manifestations were observed (delta with spikes (DSP), rhythmic polyspikes (PSR), epileptiform discharges (PED) in 10, 10, 4 children (14%, 14%, 6%)). 38 children (54%) had slow, rhythmic delta waves with high amplitudes (DS) appearing on average before DSP. Conclusions/Significance The hypothesis that no epileptiform potentials would occur during induction of anaesthesia with a reduction of the inspired sevoflurane concentration from 8% to 4% directly after LOC was not proved. Even if 8% sevoflurane is administered only briefly for induction of anaesthesia, epileptiform EEG activity may be observed in children despite premedication with midazolam.
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Affiliation(s)
- Barbara Schultz
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
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PAEDIATRIC ANAESTHESIA. Br J Anaesth 2012. [DOI: 10.1093/bja/aer486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kim SH, Song GS, Sung SK, Son DW. A Case of Seizure in a Patient Following Percutaneous Endoscopic Lumbar Discectomy. KOREAN JOURNAL OF SPINE 2011. [DOI: 10.14245/kjs.2011.8.1.55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Sung Hoon Kim
- Department of Neurosurgery, Pusan National University College of Medicine, Yangsan, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Pusan National University College of Medicine, Yangsan, Korea
| | - Soon Ki Sung
- Department of Neurosurgery, Pusan National University College of Medicine, Yangsan, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Pusan National University College of Medicine, Yangsan, Korea
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Lerman J, Houle TT, Matthews BT, Houck J, Burrows FA. Propofol for tracheal intubation in children anesthetized with sevoflurane: a dose-response study. Paediatr Anaesth 2009; 19:218-24. [PMID: 19236643 DOI: 10.1111/j.1460-9592.2009.02935.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tracheal intubation during sevoflurane induction is frequently facilitated with i.v. propofol. We designed a dose-response study to evaluate the intubating conditions, and the incidence and duration of apnea after i.v. propofol in children. METHODS/MATERIALS Sixty healthy children were randomly assigned to 0, 0.5, 1, 2 or 3 mg x kg(-1) i.v. propofol during sevoflurane/nitrous oxide anesthesia. Tracheal intubation was performed approximately 30 s after propofol by an anesthesiologist who was blind to the treatment. The anesthesiologist assessed the responses to laryngoscopy and intubation using a standardized scale. Incidence and duration of apnea after propofol as well as heart rate, and systolic blood pressure before and after laryngoscopy were recorded. Data were analyzed using one-way and repeated measures ANOVA, the Jonckheere-Terpstra test, and logistic regression, with P < 0.05 accepted. RESULTS The laryngoscopy score after 3 mg x kg(-1) propofol was less than that after 0 mg x kg(-1) (P < 0.01) and 0.5 mg x kg(-1) (P < 0.05). Incidence of apnea after propofol 3 mg x kg(-1), 8/10, was greater than after 0 mg x kg(-1), 3/14 (P < 0.011) and 0.5 mg x kg(-1), 3/12 (P < 0.03). Duration of apnea after 3 mg x kg(-1) was greater than after 0 and 0.5 mg x kg(-1) (P < 0.01). The risk of apnea increased 1.83 fold for each 1 mg x kg(-1) dose increase in propofol (P < 0.01). Mean heart rate and systolic pressure decreased with the main effect, time. CONCLUSION During sevoflurane/nitrous oxide anesthesia, propofol 3 mg x kg(-1) provides superior intubating conditions with an increased incidence of and prolonged apnea compared with 0 and 0.5 mg x kg(-1).
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Affiliation(s)
- Jerrold Lerman
- Department of Anesthesia, Women and Children's Hospital of Buffalo, SUNY @ Buffalo and University of Rochester, Rochester, NY, USA.
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Mohanram A, Kumar V, Iqbal Z, Markan S, Pagel PS. Repetitive generalized seizure-like activity during emergence from sevoflurane anesthesia. Can J Anaesth 2007; 54:657-61. [PMID: 17666720 DOI: 10.1007/bf03022961] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Sevoflurane-induced seizures are most often described during mask induction of anesthesia when high concentrations of the volatile agent are administered concomitant with alveolar hyperventilation. The occurrence of seizure-like activity during emergence from sevoflurane anesthesia has been rarely reported. CLINICAL FEATURES We describe a patient who developed several episodes of generalized tonic-clonic seizure-like activity during and immediately after emergence from sevoflurane anesthesia and discuss the potential factors that contributed to this unusual complication. The patient was treated with intravenous propofol, midazolam, and phenytoin and required intensive care management before his neurologic status stabilized. CONCLUSION The report emphasizes that sevoflurane is capable of producing excitatory central nervous system (CNS) phenomena in spite of causing primarily CNS depressant effects.
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Affiliation(s)
- Arvind Mohanram
- Clement J. Zablocki Veterans Affairs Medical Center, Anesthesia Service, 5000 W. National Avenue, Milwaukee, Wisconsin 53295, USA
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Kretz FJ. The future of paediatric anaesthesia is total intravenous anaesthesia. Curr Opin Anaesthesiol 2007; 15:305-7. [PMID: 17019217 DOI: 10.1097/00001503-200206000-00005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mizuno J, Muroya M, Gauss T, Yamada Y, Arita H, Hanaoka K. Effect of 2.5% sevoflurane, at PaCO2 30 mmHg for epileptic focus resection, on hemodynamics and hepatic and renal functions. J Anesth 2007; 21:108-9. [PMID: 17285429 DOI: 10.1007/s00540-006-0456-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Accepted: 09/20/2006] [Indexed: 10/23/2022]
Affiliation(s)
- Ju Mizuno
- Department of Anesthesiology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 108-8329, Japan
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Fassoulaki A, Sarantopoulos C. Reply to 'Registration of raw data is a must when estimating depth of anaesthesia via EEG indices'. Acta Anaesthesiol Scand 2006. [DOI: 10.1111/j.1399-6576.2006.01127.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Baer GA, Jäntti V, Rorarius MGF. Registration of raw data is a must when estimating depth of anaesthesia via EEG indices. Acta Anaesthesiol Scand 2006; 50:1306; author reply 1306-7. [PMID: 17067332 DOI: 10.1111/j.1399-6576.2006.01160.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Vakkuri AP, Seitsonen ER, Jäntti VH, Särkelä M, Korttila KT, Paloheimo MPJ, Yli-Hankala AM. A Rapid Increase in the Inspired Concentration of Desflurane Is Not Associated with Epileptiform Encephalogram. Anesth Analg 2005; 101:396-400. [PMID: 16037151 DOI: 10.1213/01.ane.0000156562.33415.78] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED The large inspired concentration of sevoflurane (S) during mask induction of anesthesia can induce epileptiform electroencephalogram (EEG) associated with tachycardia. Tachycardia is also seen when the concentration of desflurane (D) is abruptly increased. It is not known whether this is associated with epileptiform EEG similar to S. We studied EEG and heart rate (HR) during rapidly increased concentrations of S or D in 31 females during the postintubation period of anesthesia. Anesthesia was induced with propofol and remifentanil, and the tracheas were intubated. Patients were randomized to receive either S or D in nitrous oxide-oxygen mixture after intubation, at a small dose first. After 10 min, S or D vaporizer was advanced to the highest reading of the vaporizer (7% for S, 18% for D) for 5 min. HR and EEG were recorded. Epileptiform EEG activity was recorded in eight of 15 patients in group S and in none in group D (P < 0.05). HR increased in both groups. In group S, HR increased gradually and the highest HR value was 84 bpm at 5 min after the increase in sevoflurane concentration. In group D, HR increased to 93 bpm 2 min after the increase in desflurane concentration (no significant difference, S versus D). A rapid increase in the concentration of S frequently induces epileptiform EEG during normoventilation. Tachycardia during increasing concentrations of D is not associated with epileptiform EEG. IMPLICATIONS A rapid increase in the concentration of sevoflurane induces epileptiform encephalogram (EEG) with tachycardia. A rapid increase in the concentration of desflurane also induces tachycardia but is not associated with epileptiform EEG.
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Affiliation(s)
- Anne P Vakkuri
- *Department of Anesthesia and Intensive Care, Helsinki University Hospital, Helsinki, Finland; †Department of Clinical Neurophysiology, Tampere University Hospital, Tampere, Finland; ‡GE Healthcare Finland, Helsinki, Finland; and §Department of Anesthesia, Medical School, University of Tampere, and Department of Anesthesia and Intensive Care, Tampere University Hospital, Tampere, Finland
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Chawathe M, Zatman T, Hall JE, Gildersleve C, Jones RM, Wilkes AR, Aguilera IM, Armstrong TS. Sevoflurane (12% and 8%) inhalational induction in children. Paediatr Anaesth 2005; 15:470-5. [PMID: 15910347 DOI: 10.1111/j.1460-9592.2005.01478.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sevoflurane induction of anesthesia is frequently used in children. Rapidly performed inhalational induction may reduce excitation during early anesthesia. Increasing the total anesthetic MAC delivered to patients can be achieved by increasing volatile concentration or adding nitrous oxide. The latter reduces inspired oxygen concentration delivered, which may not be desirable. Even 8% sevoflurane induction is associated with excitation. A system capable of delivering 12% sevoflurane using two tandem vaporizers has been developed. METHODS A randomized double blind study was undertaken to assess whether 12% sevoflurane offered any advantage over 8% in time and quality of induction. Sixty children aged 5-10 years were recruited and received either 12 or 8% sevoflurane. Time to loss of eyelash reflex, central pupils, incidence of adverse events, induction quality, systolic blood pressure and heart rate were recorded. RESULTS Twelve percent sevoflurane reduced time to loss of eyelash reflex compared with 8% [mean (sd): 35 (12) and 46 (14) P<0.05], but the reduction was only 10% higher than the error in the measurement (assessment every 10 s). Twelve percent sevoflurane offered significantly better quality of induction (P<0.05). There was no difference in cardiovascular stability between groups, although heart rate rose significantly in both groups. Maintaining sevoflurane at 12% for 4 min caused significant amounts of apnea (69% with 12% and 38% with 8%, P<0.05). CONCLUSION Twelve percent sevoflurane offers a smoother anesthesia induction than 8% in children of this age with no additional consequences for the cardiovascular system.
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Affiliation(s)
- M Chawathe
- Anaesthetics and Intensive Care Medicine, University of Wales College of Medicine, Cardiff, Wales, UK
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Boutin F, Bonnet A, Cros AM. [Occurrence of epileptiform crisis in child under sevoflurane anaesthesia]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2005; 24:559-60. [PMID: 15904738 DOI: 10.1016/j.annfar.2005.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2004] [Accepted: 02/02/2005] [Indexed: 05/02/2023]
Abstract
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.
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Affiliation(s)
- F Boutin
- Département d'anesthésie-réanimation-IV, hôpital Pellegrin-Enfants, 33076 Bordeaux cedex, France.
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Abstract
Sevoflurane has become the volatile agent of choice for inhalation induction of anesthesia. Hemodynamic stability and lack of respiratory irritation have justified its rapid extension to pediatric inhalation induction. The epileptogenic potential of sevoflurane has been suspected since the first case reports of abnormal movements in children without a history of epilepsy. The objectives of this short review are to: (i) analyze clinical and electroencephalographic (EEG) features supporting epileptogenic activity of sevoflurane, (ii) identify factors which may modulate that activity, and (iii) suggest guidelines of clinical practice to limit expression of this epileptiform phenomenon, which has thus far unknown morbidity. The use of sevoflurane may be associated with cortical epileptiform EEG signs, usually without clinical manifestation. No lasting neurological or EEG sequelae have been described thus far, and the potential morbidity of this epileptogenic effect is unknown. The use of sevoflurane in children, with its remarkable cardiovascular profile, should include a number of precautions. Among them, the limitation of the depth of anesthesia is essential. The wide use of cerebral function monitoring (the most simple being the EEG), may permit optimization of sevoflurane dose and avoidance of burst suppression and major epileptiform signs in fragile subjects, notably the very young and the very old.
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Affiliation(s)
- Isabelle Constant
- Service d'Anesthésie-Réanimation, Hopital d'enfants Armand Trousseau, Assistance-Publique, Hôpitaux de Paris, Paris VI University, Paris, France.
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Schlünzen L, Vafaee MS, Cold GE, Rasmussen M, Nielsen JF, Gjedde A. Effects of subanaesthetic and anaesthetic doses of sevoflurane on regional cerebral blood flow in healthy volunteers. A positron emission tomographic study. Acta Anaesthesiol Scand 2004; 48:1268-76. [PMID: 15504187 DOI: 10.1111/j.1399-6576.2004.00505.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND We tested the hypothesis that escalating drug concentrations of sevoflurane are associated with a significant decline of cerebral blood flow in regions subserving conscious brain activity, including specifically the thalamus. METHODS Nine healthy human volunteers received three escalating doses using 0.4%, 0.7% and 2.0% end-tidal sevoflurane inhalation. During baseline and each of the three levels of anaesthesia one PET scan was performed after injection of . Cardiovascular and respiratory parameters were monitored and electroencephalography and bispectral index (BIS) were registered. RESULTS Sevoflurane decreased the BIS values dose-dependently. No significant change in global cerebral blood flow (CBF) was observed. Increased regional CBF (rCBF) in the anterior cingulate (17-21%) and decreased rCBF in the cerebellum (18-35%) were identified at all three levels of sedation compared to baseline. Comparison between adjacent levels sevoflurane initially (0 vs. 0.2 MAC) decreased rCBF significantly in the inferior temporal cortex and the lingual gyrus. At the next level (0.2 MAC vs. 0.4 MAC) rCBF was increased in the middle temporal cortex and in the lingual gyrus, and decreased in the thalamus. At the last level (0.4 MAC vs. 1 MAC) the rCBF was increased in the insula and decreased in the posterior cingulate, the lingual gyrus, precuneus and in the frontal cortex. CONCLUSION At sevoflurane concentrations at 0.7% and 2.0% a significant decrease in relative rCBF was detected in the thalamus. Interestingly, some of the most profound changes in rCBF were observed in structures related to pain processing (anterior cingulate and insula).
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Affiliation(s)
- L Schlünzen
- Department of Neuroanaesthesiology, Aarhus University Hospital, Aarhus, Denmark.
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Hsieh SW, Lan KM, Luk HN, Jawan B. Postoperative seizures after sevoflurane anesthesia in a neonate. Acta Anaesthesiol Scand 2004; 48:663. [PMID: 15101868 DOI: 10.1111/j.0001-5172.2004.0376b.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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De Deyne C, Joly LM, Ravussin P. Les nouveaux agents volatils halogénés en neuro-anesthésie : quelle place pour le sévoflurane ou le desflurane ? ACTA ACUST UNITED AC 2004; 23:367-74. [PMID: 15120783 DOI: 10.1016/j.annfar.2004.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The effects on cerebral circulation and metabolism of sevoflurane and desflurane are largely comparable to isoflurane. Both induce a direct vasodilation of the cerebral vessels, resulting in a less pronounced decrease in cerebral blood flow compared to the decrease in cerebral metabolism. This direct vasodilation seems to be dose-dependent and more pronounced for desflurane > isoflurane > sevoflurane. Many reports suggest luxury perfusion at high concentrations of desflurane. Sevoflurane maintains intact cerebral autoregulation up to 1.5 MAC. Desflurane induces a significant impairment in autoregulation, with a completely abolished autoregulation at 1.5 MAC. Both sevoflurane and desflurane (up to 1.5 MAC) maintain normal CO(2) regulation. As to their effect on final intracranial pressure (ICP), both sevoflurane and desflurane revealed no increases in ICP. However, compared to intravenous hypnotics, subdural ICP is higher with volatiles because of their tendency to increase cerebral swelling after dura opening (isoflurane > sevoflurane). Several case reports have noted seizure-like movements, as well as EEG recorded seizures during induction of sevoflurane anesthesia. Especially, in children during inhalational induction with hyperventilation at a high sevoflurane concentration, severe epileptiform EEG with a hyperdynamic response were observed, which urges for caution using inhalational sevoflurane induction in children for neurosurgical procedures. Neuroprotective properties (reduced neuronal death either by necrosis or apoptosis) have been attributed to all volatile agents. However, these neuroprotective effects have been described in experimental or animal models, so their possible effect on humans remains to be proven.
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Affiliation(s)
- C De Deyne
- Department of anaesthesia and critical care, Ziekenhuis Oost-Limburg, Genk, Belgique
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Vakkuri A, Yli-Hankala A, Särkelä M, Lindgren L, Mennander S, Korttila K, Saarnivaara L, Jäntti V. Sevoflurane mask induction of anaesthesia is associated with epileptiform EEG in children. Acta Anaesthesiol Scand 2001; 45:805-11. [PMID: 11472278 DOI: 10.1034/j.1399-6576.2001.045007805.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Sevoflurane inhalation induction of anaesthesia is widely used in paediatric anaesthesia. We have found that this method is frequently associated with epileptiform electroencephalogram (EEG) in adults, especially if controlled hyperventilation is used. METHODS We assessed EEG during sevoflurane inhalation induction in 31 children, aged 2-12 yr. Anaesthesia was induced with 8% sevoflurane in O2 in N2O 1:2. The patients were randomized to undergo controlled ventilation (CV group), or to breathe spontaneously (SB group) for 5 min. EEG was recorded as were noninvasive blood pressure and heart rate (HR). EEG recordings were classified by a clinical neurophysiologist. RESULTS Three different types of interictal epileptiform discharge were detected. Suppression with spikes (SSP) was found in 25% and 0% in the CV and SB groups, rhythmic polyspikes (PSR) in 44% and 20%, and periodic epileptiform discharges (PED) in 44% and 0% (P<0.01), respectively. The incidence of all different types of interictal epileptiform discharge (SSP+PSR+PED) was 88% and 20% (P<0.001), respectively. Epileptiform EEG was associated with increased heart rate and blood pressure during anaesthetic induction. CONCLUSION Both ventilation modes produced epileptiform EEG. With controlled ventilation, epileptiform discharges were seen in 88% of children. This warrants further studies of the suitability of this induction type in general, and especially in children with epilepsy.
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Affiliation(s)
- A Vakkuri
- Department of Anaesthesia and Intensive Care, Surgical Hospital, University of Helsinki, Helsinki, Finland.
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Abstract
The advantages of rapid induction of and emergence from sevoflurane anaesthesia may be more than offset by the frequent occurrence of agitation during induction and recovery, and a possible epileptogenic effect. The mechanisms and possible strategies to prevent these drawbacks are reviewed, on the basis of the most recent literature.
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Affiliation(s)
- F Veyckemans
- Anesthesiology, Cliniques Universitaires St. Luc, Brussels, Belgium.
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Lejus C. [Epileptogenic potential of sevoflurane]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2001; 20:435-7. [PMID: 11419237 DOI: 10.1016/s0750-7658(01)00392-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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