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Olejarczyk E, Cukic M, Porcaro C, Zappasodi F, Tecchio F. Clinical Sensitivity of Fractal Neurodynamics. ADVANCES IN NEUROBIOLOGY 2024; 36:285-312. [PMID: 38468039 DOI: 10.1007/978-3-031-47606-8_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Among the significant advances in the understanding of the organization of the neuronal networks that coordinate the body and brain, their complex nature is increasingly important, resulting from the interaction between the very large number of constituents strongly organized hierarchically and at the same time with "self-emerging." This awareness drives us to identify the measures that best quantify the "complexity" that accompanies the continuous evolutionary dynamics of the brain. In this chapter, after an introductory section (Sect. 15.1), we examine how the Higuchi fractal dimension is able to perceive physiological processes (15.2), neurological (15.3) and psychiatric (15.4) disorders, and neuromodulation effects (15.5), giving a mention of other methods of measuring neuronal electrical activity in addition to electroencephalography, such as magnetoencephalography and functional magnetic resonance. Conscious that further progress will support a deeper understanding of the temporal course of neuronal activity because of continuous interaction with the environment, we conclude confident that the fractal dimension has begun to uncover important features of the physiology of brain activity and its alterations.
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Affiliation(s)
- Elzbieta Olejarczyk
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland.
| | - Milena Cukic
- Department of Biomimetic Membranes and Textiles, EMPA Material Science and Technology, St. Gallen, Switzerland
| | - Camillo Porcaro
- Department of Neuroscience and Padova Neuroscience Center (PNC), University of Padova, Padova, Italy
| | - Filippo Zappasodi
- Department of Neuroscienze, Imaging and Clinical Sciences, Gabriele D'annunzio University, Chieti, Italy
| | - Franca Tecchio
- Institute of Cognitive Sciences and Technologies, Consiglio Nazionale delle Ricerche (CNR), Rome, Italy
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Zhao S, Han L, Zhou R, Huang S, Wang Y, Xu F, Shu S, Xia L, Chen X. Electroencephalogram Signatures of Agitation Induced by Sevoflurane and Its Association With Genetic Polymorphisms. Front Med (Lausanne) 2021; 8:678185. [PMID: 34917626 PMCID: PMC8669103 DOI: 10.3389/fmed.2021.678185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Volatile anesthetic-induced agitation, also called paradoxical excitation, is not uncommon during anesthesia induction. Clinically, patients with agitation may lead to self-injury or disrupt the operative position, increasing the incidence of perioperative adverse events. The study was designed to investigate clinical features of sevoflurane-induced agitation and examined whether any gene polymorphisms can potentially be used to predict agitation. Methods: One hundred seventy-six patients underwent anesthesia induction with sevoflurane were included in this study. Frontal electroencephalogram (EEG), electromyography (EMG), and hemodynamics were recorded continuously during anesthesia induction. DNA samples were genotyped using the Illumina Infinium Asian Screening Array and the SNaPshot technology. Genetic association was analyzed by genome-wide association study. Logistic regression analysis was used to determine the role of variables in the prediction of agitation. Results: Twenty-five (14.2%) patients experienced agitation. The depth of anesthesia index (Ai index) (p < 0.001), EMG (p < 0.001), heart rate (HR) (p < 0.001), and mean arterial pressure (MAP) (p < 0.001) rapidly increased during the agitation. EEG exhibited a shift toward high frequencies with spikes during agitation. The fast waves (alpha and beta) were more pronounced and the slow rhythms (delta) were less prominent during the occurrence of agitation. Moreover, three SNPs in the methionine synthase reductase (MTRR) gene were correlated to the susceptibility to agitation (p < 5.0 × 10−6). Carrying rs1801394 A > G (odds ratio 3.50, 95% CI 1.43–9.45) and/or rs2307116 G > A (3.31, 1.36–8.95) predicted a higher risk of agitation. Discussion: This study suggests that the agitation/paradoxical excitation induced by sevoflurane is characterized as increases in Ai index, EMG, HR and MAP, and the high frequency with spikes in EEG. Moreover, our results provide preliminary evidence for MTRR genetic polymorphisms, involving folate metabolism function, may be related to the susceptibility to agitation. Clinical Trial Number and Registry URL: ChiCTR1900026218; http://www.chictr.org.cn/showproj.aspx?proj=40655.
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Affiliation(s)
- Shuai Zhao
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Linlin Han
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruihui Zhou
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiqian Huang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yafeng Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Xu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaofang Shu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Leiming Xia
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangdong Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Chen MH, Fang C, Wu NY, Xia YH, Zeng YJ, Ouyang W. Genetic variation of rs12918566 affects GRIN2A expression and is associated with spontaneous movement response during sevoflurane anesthesia induction. Brain Behav 2021; 11:e02165. [PMID: 34291608 PMCID: PMC8413822 DOI: 10.1002/brb3.2165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/02/2021] [Accepted: 04/11/2021] [Indexed: 11/09/2022] Open
Abstract
N-methyl-D-aspartate (NMDA) receptors mediate excitatory neurotransmission in the nervous system and are preferentially inhibited by general anesthetics such as sevoflurane. Spontaneous movement is a common complication during sevoflurane anesthesia induction and seriously affects operations. In this study, we investigated the relationship between NMDA polymorphisms and spontaneous movement during sevoflurane induction. This prospective clinical study enrolled 393 patients undergoing sevoflurane anesthesia as part of their surgical routine. In the GRIN1, GRIN2A, and GRIN2B genes, 13 polymorphisms that form a heteromeric complex as part of the NMDA receptor were selected using Haploview and genotyped using matrix-assisted laser desorption ionization-time of flight mass spectrometry MassARRAY. Both RNAfold and Genotype-Tissue Expression portals were used to identify gene expression profiles. Our data showed that 35.8% of subjects exhibited spontaneous movement. The GRIN2A rs12918566 polymorphism was associated with spontaneous movement during sevoflurane induction. A logistic regression analysis of additive, dominant, and recessive models indicated a significant association (odds ratio [OR] (95% confidence limit [CI]): 0.58 (0.42-0.80), p = .00086; OR (95% CI): 0.51 (0.31-0.84), p = .0075, and OR (95% CI): 0.47 (0.27-0.81), p = .0060, respectively). After false discovery rate (FDR) correction, the additive model was still significant with a PFDR =0.010. Bioinformatics demonstrated that the rs12918566 genomic variation affected GRIN2A expression in brain tissue. We also revealed that GRIN2A rs12918566 was significantly associated with spontaneous movement during sevoflurane induction. We believe the NMDA receptor plays an important role in regulating the anesthetic effects of sevoflurane.
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Affiliation(s)
- Ming-Hua Chen
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Chao Fang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China.,Postdoctoral Research Station of Clinical Medicine, Third Xiangya Hospital of Central South University, Changsha, China
| | - Na-Yiyuan Wu
- Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yu-Hao Xia
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - You-Jie Zeng
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Wen Ouyang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
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Schultz B, Krauß T, Schmidt M, Schultz M, Schneider A, Wiesner O, Schmidt JJ, Stahl K, David S, Hoeper MM, Busch M. High Incidence of Epileptiform Potentials During Continuous EEG Monitoring in Critically Ill COVID-19 Patients. Front Med (Lausanne) 2021; 8:613951. [PMID: 33842496 PMCID: PMC8032936 DOI: 10.3389/fmed.2021.613951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 02/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To analyze continuous 1- or 2-channel electroencephalograms (EEGs) of mechanically ventilated patients with coronavirus disease 2019 (COVID-19) with regard to occurrence of epileptiform potentials. Design: Single-center retrospective analysis. Setting: Intensive care unit of Hannover Medical School, Hannover, Germany. Patients: Critically ill COVID-19 patients who underwent continuous routine EEG monitoring (EEG monitor: Narcotrend-Compact M) during sedation. Measurements and Main Results: Data from 15 COVID-19 patients (11 men, four women; age: 19-75 years) were evaluated. Epileptiform potentials occurred in 10 of 15 patients (66.7%). Conclusions: The results of the evaluation regarding the occurrence of epileptiform potentials show that there is an unusually high percentage of cerebral involvement in patients with severe COVID-19. EEG monitoring can be used in COVID-19 patients to detect epileptiform potentials.
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Affiliation(s)
- Barbara Schultz
- Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Terence Krauß
- Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Maren Schmidt
- Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | | | - Andrea Schneider
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Olaf Wiesner
- Department of Respiratory Medicine and German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - Julius J Schmidt
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Klaus Stahl
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Sascha David
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.,Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Marius M Hoeper
- Department of Respiratory Medicine and German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - Markus Busch
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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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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Yamagata K, Hirose Y, Tanaka K, Yoshida M, Ohnuki T, Sendo R, Niwa H, Sugimura M. Anesthetic Management of a Patient With a Vagal Nerve Stimulator. Anesth Prog 2020; 67:16-22. [PMID: 32191509 DOI: 10.2344/anpr-66-03-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Vagal nerve stimulation (VNS) is an established adjunctive treatment for patients with refractory epilepsy. VNS is effective in many cases, but few patients achieve complete elimination of seizures. Furthermore, VNS can cause respiratory complications, such as obstructive sleep apnea. This report describes the successful anesthetic management of a 28-year-old woman with a VNS device who underwent dental treatment under general anesthesia. She was morbidly obese and had undergone placement of a VNS device secondary to drug-resistant epilepsy 2 years prior but continued to experience daily epileptic seizures. Because of concerns about the risk of perioperative epileptic seizures and apneic events, use of the dedicated VNS device magnet was planned if such complications occurred. Total intravenous anesthesia was induced with propofol and remifentanil and a bispectral index sensor was used to help monitor brain wave activity for evidence of seizures along with the depth of anesthesia. Postoperatively, the patient received positional therapy and supplemental oxygen while being closely monitored in recovery. The anesthetic course was completed uneventfully without need of the VNS magnet. A thorough understanding of the mechanics of a VNS device, including proper use of the VNS magnet, is critical for an anesthesiologist during the perioperative period.
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Affiliation(s)
- Kazuaki Yamagata
- Sakai Special Needs Dental Clinic, Sakai, Japan.,Department of Dental Anesthesiology, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | | | | | | | - Tomotaka Ohnuki
- Department of Dental Anesthesiology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Ryozo Sendo
- Department of Dental Anesthesiology, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hitoshi Niwa
- Department of Dental Anesthesiology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Mitsutaka Sugimura
- Department of Dental Anesthesiology, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Ng KT, Sarode D, Lai YS, Teoh WY, Wang CY. The effect of ketamine on emergence agitation in children: A systematic review and meta-analysis. Paediatr Anaesth 2019; 29:1163-1172. [PMID: 31587414 DOI: 10.1111/pan.13752] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/20/2019] [Accepted: 09/30/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Ketamine is believed to reduce the incidence of emergence agitation in children undergoing surgery or procedure. However, recent randomized controlled trials reported conflicting findings. AIMS To investigate the effect of ketamine on emergence agitation in children. METHODS Databases of MEDLINE, EMBASE, and CENTRAL were systematically searched from their start date until February 2019. Randomized controlled trials comparing intravenous ketamine and placebo in children were sought. The primary outcome was the incidence of emergence agitation. Secondary outcomes included postoperative pain score, duration of discharge time, and the adverse effects associated with the use of ketamine, namely postoperative nausea and vomiting, desaturation, and laryngospasm. RESULTS Thirteen studies (1125 patients) were included in the quantitative meta-analysis. The incidence of emergence agitation was 14.7% in the ketamine group and 33.3% in the placebo group. Children receiving ketamine had a lower incidence of emergence agitation, with an odds ratio being 0.23 (95% confidence interval: 0.11 to 0.46), certainty of evidence: low. In comparison with the placebo, ketamine group achieved a lower postoperative pain score (odds ratio: -2.42, 95% confidence interval: -4.23 to -0.62, certainty of evidence: very low) and lower pediatric anesthesia emergence delirium scale at 5 minutes after operation (odds ratio: -3.99, 95% confidence interval: -5.03 to -2.95; certainty of evidence: moderate). However, no evidence was observed in terms of incidence of postoperative nausea and vomiting, desaturation, and laryngospasm. CONCLUSION In this meta-analysis of 13 randomized controlled trials, high degree of heterogeneity and low certainty of evidence limit the recommendations of ketamine for the prevention of emergence agitation in children undergoing surgery or imaging procedures. However, the use of ketamine is well-tolerated without any notable adverse effects across all the included trials. PROSPERO REGISTRATION CRD42019131865.
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Affiliation(s)
- Ka Ting Ng
- Department of Anaesthesiology, University of Malaya, Kuala Lumpur, Malaysia
| | - Deep Sarode
- Department of Anaesthesiology, University of Glasgow, Glasgow, Scotland
| | - Yuen Sin Lai
- Department of Anaesthesiology, University of Malaya, Kuala Lumpur, Malaysia
| | - Wan Yi Teoh
- Department of Anaesthesiology, University of Liverpool, Liverpool, UK
| | - Chew Yin Wang
- Department of Anaesthesiology, University of Malaya, Kuala Lumpur, Malaysia
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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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9
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Ton HT, Yang L, Xie Z. Sevoflurane increases locomotion activity in mice. PLoS One 2019; 14:e0206649. [PMID: 31112538 PMCID: PMC6528997 DOI: 10.1371/journal.pone.0206649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 05/07/2019] [Indexed: 12/13/2022] Open
Abstract
Clinical observations show emergence of agitation and hyperactivity during the anesthesia induction and/or recovery period post-anesthesia. However, an animal model to illustrate this clinical phenomenon has not yet been established. We therefore set out to investigate whether sevoflurane, a commonly used anesthetic, could alter locomotion in mice during the anesthesia induction and recovery period post-anesthesia. The activity of the mice was recorded 5 minutes before, during (for 30 minutes), and 40 minutes after the administration of the anesthetic sevoflurane [1-, 1.5- and 2-fold minimum alveolar concentration] at 370 C. The total walking distance and velocity of movement were measured and quantified as the indexes of locomotion. We found that the anesthetic sevoflurane increased the locomotion of the mice during the induction period of the anesthesia. During the recovery phase after anesthesia, the mice exhibited increased locomotion for a short period of time (about 5 minutes) and then displayed a sharp decrease in mobility for up to 60 minutes following the end of anesthesia administration. The anesthetic sevoflurane did not significantly alter the food intake and body weight of the mice. Furthermore, we found that Alzheimer’s disease transgenic mice exhibited a greater degree of sevoflurane-induced hyperactivity than the wild-type mice did. Our results showed that inhalation of the anesthetic sevoflurane induced an acute hyperactivity in mice, particularly among Alzheimer’s disease transgenic mice. These findings from the pilot studies have established an animal model to promote further studies into postoperative emergence agitation, hyperactivity and the underlying mechanisms into these conditions.
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Affiliation(s)
- Hoai T. Ton
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States of America
- Department of Biology, Vinh University, Vinh City, Nghe An, Vietnam
| | - Lei Yang
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States of America
- Department of Anesthesia, Ruijing Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Zhongcong Xie
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States of America
- * E-mail:
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Rigouzzo A, Khoy-Ear L, Laude D, Louvet N, Moutard ML, Sabourdin N, Constant I. EEG profiles during general anesthesia in children: A comparative study between sevoflurane and propofol. Paediatr Anaesth 2019; 29:250-257. [PMID: 30614153 DOI: 10.1111/pan.13579] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 11/25/2018] [Accepted: 12/10/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND In this prospective study, we describe the electroencephalographic (EEG) profiles in children anesthetized with sevoflurane or propofol. METHODS Seventy-three subjects (11 years, range 5-18) were included and randomly assigned to two groups according to the anesthetic agent. Anesthesia was performed by target-controlled infusion of propofol (group P) or by sevoflurane inhalation (group S). Steady-state periods were performed at a fixed randomized concentration between 2, 3, 4, 5, and 6 μg.ml-1 of propofol in group P and between 1, 2, 3, 4, and 5% of sevoflurane in group S. Remifentanil was continuously administered throughout the study. Clinical data, Bispectral Index (BIS), and raw EEG were continuously recorded. The relationship between BIS and anesthetic concentrations was studied using nonlinear regression. For all steady-state periods, EEG traces were reviewed to assess the presence of epileptoid signs, and spectral analysis of raw EEG was performed. RESULTS Under propofol, BIS decreased monotonically and EEG slowed down as concentrations increased from 2 to 6 μg.ml-1 . Under sevoflurane, BIS decreased from 0% to 4% and paradoxically rose from 4% to 5% of expired concentration: this increase in BIS was associated with the occurrence of fast oscillations and epileptoid signs on the EEG trace. Propofol was associated with more delta waves and burst suppression periods compared to sevoflurane. CONCLUSION Under deep anesthesia, the BIS and electroencephalographic profiles differ between propofol and sevoflurane. For high concentrations of sevoflurane, an elevated BIS value may be interpreted as a sign of epileptoid patterns or EEG fast oscillations rather than an insufficient depth of hypnosis.
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Affiliation(s)
- Agnes Rigouzzo
- Anesthesiology Department, Hôpital Armand Trousseau, Paris, France
| | - Linda Khoy-Ear
- Anesthesiology Department, Hôpital Armand Trousseau, Paris, France
| | - Dominique Laude
- Inserm U1138, Université Pierre & Marie Curie Paris 6, Paris, France
| | - Nicolas Louvet
- Anesthesiology Department, Hôpital Armand Trousseau, Paris, France
| | | | - Nada Sabourdin
- Anesthesiology Department, Hôpital Armand Trousseau, Paris, France
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11
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Loughnan T, McKenzie G, Leong S. Sevoflurane versus Propofol for Induction of Anaesthesia for Electroconvulsive Therapy: A Randomized Crossover Trial. Anaesth Intensive Care 2019; 32:236-40. [PMID: 15957722 DOI: 10.1177/0310057x0403200212] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Propofol is often used to induce anaesthesia for electroconvulsive therapy. Some patients who receive propofol have fits of poor quality or inadequate duration despite increasing electroconvulsive therapy doses. Sevoflurane has been reported to exhibit pro-convulsant properties in some “at-risk” patients during anaesthesia for other procedures. The purpose of this study was to perform a randomized crossover trial in patients undergoing electroconvulsive therapy, comparing the effects on seizure parameters of propofol versus sevoflurane induction. Patients were randomly allocated to receive either sevoflurane or propofol for their first treatment. In the subsequent treatment the alternative agent was used. Patients in both treatment groups exhibited equally good fits, with those in the sevoflurane group having slightly better morphology, which is the most subjective of the parameters measured. The sevoflurane administrations were associated with slightly higher pulse rates and blood pressures. Sevoflurane provides a suitable alternative to propofol for anaesthesia in patients undergoing electroconvulsive therapy, although the slightly greater pulse rate rise and blood pressure rise should be considered in patients with ischaemic heart disease.
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Affiliation(s)
- T Loughnan
- Department of Anaesthesia, Frankston Hospital, Melbourne, Victoria
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12
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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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13
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Pipanmekaporn T, Punjasawadwong Y, Raksakietisak M, Sriraj W, Lekprasert V, Werawatganon T. A study into perioperative anaesthetic adverse events in Thailand (PAAd THAI): An analysis of suspected emergence delirium. J Perioper Pract 2018; 28:1750458918780117. [PMID: 29901431 DOI: 10.1177/1750458918780117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study is to demonstrate the characteristics, contributing factors and recommended policy changes associated with emergence delirium. Relevant data were extracted from the PAAd Thai database of 2,006 incident reports which were conducted from 1 January to 31 December 2015. Details pertinent to the patient, surgery, anaesthetic and systematic factors were reviewed independently. Seventeen incidents of emergence delirium were recorded. Emergence delirium was common in the following categories: male (70.6%), over 65 years of age (53%), elective surgery (76%) and orthopedic surgery (35%). Physical restraint was required in 53% (9 of 17) of cases and 14 patients (82%) required medical treatment. One patient developed postoperative delirium and required medical treatment. The study led to the following recommendations: Development of a classification of practice guidelines and a screening tool, and training for restraint use.
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Affiliation(s)
- Tanyong Pipanmekaporn
- 1 Department of Anaesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Yodying Punjasawadwong
- 1 Department of Anaesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Manee Raksakietisak
- 2 Department of Anaesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Wimonrat Sriraj
- 3 Department of Anaesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40000, Thailand
| | - Varinee Lekprasert
- 4 Department of Anaesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Thewarug Werawatganon
- 5 Department of Anaesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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14
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Liang P, Li F, Liu J, Liao D, Huang H, Zhou C. Sevoflurane activates hippocampal CA3 kainate receptors (Gluk2) to induce hyperactivity during induction and recovery in a mouse model. Br J Anaesth 2017; 119:1047-1054. [PMID: 28981700 DOI: 10.1093/bja/aex043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2017] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND In addition to general anaesthetic effects, sevoflurane can also induce hyperactive behaviours during induction and recovery, which may contribute to neurotoxicity; however, the mechanism of such effects is unclear. Volatile anaesthetics including isoflurane have been found to activate the kainate (GluK2) receptor. We developed a novel mouse model and further explored the involvement of kainate (GluK2) receptors in sevoflurane-induced hyperactivity. METHODS Maximal speed, mean speed, total movement distance and resting percentage of C57BL/6 mice were quantitatively measured using behavioural tracking software before and after sevoflurane anaesthesia. Age dependence of this model was also analysed and sevoflurane-induced hyperactivity was evaluated after intracerebral injection of the GluK2 receptor blocker NS-102. Neurones from the hippocampal CA3 region were used to undertake in vitro electrophysiological measurement of kainate currents and miniature excitatory postsynaptic potential (mEPSP). RESULTS Sevoflurane induced significant hyperactivities in mice under sevoflurane 1% anaesthesia and during the recovery period, characterized as increased movement speed and total distance. The hyperactivity was significantly increased in young mice compared with adults (P<0.01) and pre-injection of NS-102 significantly prevented this sevoflurane-induced hyperactivity. In electrophysiological experiments, sevoflurane significantly increased the frequency of mEPSP at low concentrations and evoked kainate currents at high concentrations. CONCLUSIONS We developed a behavioural model in mice that enabled characterization of sevoflurane-induced hyperactivity. The kainate (GluK2) receptor antagonist attenuated these sevoflurane-induced hyperactivities in vivo, suggesting that kainate receptors might be the underlying therapeutic targets for sevoflurane-induced hyperactivities in general anaesthesia.
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Affiliation(s)
- P Liang
- Laboratory of Anaesthesia & Critical Care Medicine, Translational Neuroscience Center, West China Hospital of Sichuan University, China
- Department of Anaesthesiology, West China Hospital of Sichuan University, China
| | - F Li
- Laboratory of Anaesthesia & Critical Care Medicine, Translational Neuroscience Center, West China Hospital of Sichuan University, China
| | - J Liu
- Laboratory of Anaesthesia & Critical Care Medicine, Translational Neuroscience Center, West China Hospital of Sichuan University, China
- Department of Anaesthesiology, West China Hospital of Sichuan University, China
| | - D Liao
- Laboratory of Anaesthesia & Critical Care Medicine, Translational Neuroscience Center, West China Hospital of Sichuan University, China
| | - H Huang
- Laboratory of Anaesthesia & Critical Care Medicine, Translational Neuroscience Center, West China Hospital of Sichuan University, China
- Department of Anaesthesiology, West China Second Hospital of Sichuan University, Sichuan, China
| | - C Zhou
- Laboratory of Anaesthesia & Critical Care Medicine, Translational Neuroscience Center, West China Hospital of Sichuan University, China
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15
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A clinical review of inhalation anesthesia with sevoflurane: from early research to emerging topics. J Anesth 2017; 31:764-778. [PMID: 28585095 PMCID: PMC5640726 DOI: 10.1007/s00540-017-2375-6] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/20/2017] [Indexed: 12/20/2022]
Abstract
A large number of studies during the past two decades have demonstrated the efficacy and safety of sevoflurane across patient populations. Clinical researchers have also investigated the effects of sevoflurane, its hemodynamic characteristics, its potential protective effects on several organ systems, and the incidence of delirium and cognitive deficiency. This review examines the clinical profiles of sevoflurane and other anesthetic agents, and focuses upon emerging topics such as organ protection, postoperative cognitive deficiency and delirium, and novel ways to improve postanesthesia outcomes.
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16
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Network Meta-Analysis on the Efficacy of Dexmedetomidine, Midazolam, Ketamine, Propofol, and Fentanyl for the Prevention of Sevoflurane-Related Emergence Agitation in Children. Am J Ther 2016; 23:e1032-42. [DOI: 10.1097/mjt.0000000000000321] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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17
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Iturri Clavero F, Tamayo Medel G, de Orte Sancho K, González Uriarte A, Iglesias Martínez A, Martínez Ruíz A. Use of BIS VISTA bilateral monitor for diagnosis of intraoperative seizures, a case report. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2015; 62:590-595. [PMID: 25944463 DOI: 10.1016/j.redar.2015.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 02/28/2015] [Accepted: 03/02/2015] [Indexed: 06/04/2023]
Abstract
Changes in BIS (bispectral index) VISTA bilateral monitoring system associated with intraoperative episodes of generalized and focal seizures, during total intravenous anesthesia for resection of a left frontal parasagittal meningioma, are herein described.
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Affiliation(s)
- F Iturri Clavero
- Servicio de Anestesiología y Reanimación del Hospital Universitario de Cruces, Plaza de Cruces s/n, 48903 Barakaldo, Bizkaia, Spain.
| | - G Tamayo Medel
- Servicio de Anestesiología y Reanimación del Hospital Universitario de Cruces, Plaza de Cruces s/n, 48903 Barakaldo, Bizkaia, Spain; Departamento de Farmacología de la Universidad del País Vasco, Campus de Bizkaia, Barrio Sarriena, s/n, 48940 Leioa, Bizkaia, Spain
| | - K de Orte Sancho
- Servicio de Anestesiología y Reanimación del Hospital Universitario de Cruces, Plaza de Cruces s/n, 48903 Barakaldo, Bizkaia, Spain
| | - A González Uriarte
- Servicio de Anestesiología y Reanimación del Hospital Universitario de Cruces, Plaza de Cruces s/n, 48903 Barakaldo, Bizkaia, Spain
| | - A Iglesias Martínez
- Servicio de Neurofisiología clínica del Hospital Universitario de Cruces, Plaza de Cruces s/n Cruces, 48903 Barakaldo, Bizkaia, Spain
| | - A Martínez Ruíz
- Servicio de Anestesiología y Reanimación del Hospital Universitario de Cruces, Plaza de Cruces s/n, 48903 Barakaldo, Bizkaia, Spain; Departamento de Departamento: Cirugía, Radiología y Medicina Física, Área de Cirugía, Universidad del País Vasco, Campus de Bizkaia, Barrio Sarriena, s/n, 48940 Leioa, Bizkaia, Spain
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18
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Aho A, Kamata K, Jäntti V, Kulkas A, Hagihira S, Huhtala H, Yli-Hankala A. Comparison of Bispectral Index and Entropy values with electroencephalogram during surgical anaesthesia with sevoflurane †. Br J Anaesth 2015; 115:258-66. [DOI: 10.1093/bja/aev206] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2015] [Indexed: 11/13/2022] Open
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19
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Affiliation(s)
- D.D.L. Wong
- Department of Anaesthetics; Evelina London Children's Hospital; Guys and St. Thomas' NHS Foundation Trust; London UK
| | - C.R. Bailey
- Department of Anaesthetics; Evelina London Children's Hospital; Guys and St. Thomas' NHS Foundation Trust; London UK
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20
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Smith DAB, Bath J. Epileptiform activity during induction of anesthesia with sevoflurane prior to elective carotid endarterectomy. Vascular 2015; 24:96-9. [DOI: 10.1177/1708538115571405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The optimal anesthetic technique for carotid endarterectomy is still controversial. For general anesthesia, various induction agents have been used. We present two patients with asymptomatic high-grade carotid stenosis where induction with sevoflurane resulted in epileptiform discharges seen on perioperative electroencephalogram monitoring without adverse clinical sequelae. The occurrence of epileptogenic electroencephalogram during sevoflurane anesthesia has been widely described despite its popular use in pediatric anesthesia. This phenomenon, however, has not been previously described during electroencephalogram monitoring in carotid surgery. The authors suggest that induction anesthesia with sevoflurane should be avoided in this patient population especially where routine electroencephalogram monitoring is not performed.
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Affiliation(s)
- Denise AB Smith
- Department of Surgery, Division of Vascular Surgery, University of Cincinnati College of Medicine, Cincinnati, USA
- Department of Surgery, Cincinnati Veterans Affairs Medical Center, Cincinnati, USA
| | - Jonathan Bath
- Department of Surgery, Division of Vascular Surgery, University of Cincinnati College of Medicine, Cincinnati, USA
- Department of Surgery, Cincinnati Veterans Affairs Medical Center, Cincinnati, USA
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21
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Ayeko M, Mohamed AA. Prevention and treatment of sevoflurane emergence agitation and delirium in children with dexmedetomidine. Saudi J Anaesth 2015; 9:103. [PMID: 25558213 PMCID: PMC4279335 DOI: 10.4103/1658-354x.146333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Michael Ayeko
- Department of Anesthesiology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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22
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Abstract
Preoperative anxiolysis is important for children scheduled for surgery. The nature of the anxiety depends on several factors, including age, temperament, past hospitalizations, and socioeconomic and ethnic backgrounds. A panoply of interventions effect anxiolysis, including parental presence, distraction, and premedication, although no single strategy is effective for all ages. Emergence delirium (ED) occurs after the use of sevoflurane and desflurane in preschool-aged children in the recovery room. Symptoms usually last approximately 15 minutes and resolve spontaneously. The Pediatric Anesthesia Emergence Delirium scale is used to diagnose ED and evaluate therapeutic interventions for ED such as propofol and opioids.
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Affiliation(s)
- Richard J Banchs
- Department of Anesthesiology (MC515), University of Illinois Medical Center, Children's Hospital University of Illinois, 1740 West Taylor Street, Suite 3200 West, Chicago, IL 60612-7239, USA
| | - Jerrold Lerman
- Department of Anesthesia, Women and Children's Hospital of Buffalo, SUNY at Buffalo, 219 Bryant Street, Buffalo, NY 14222, USA; Department of Anesthesia, Strong Medical Center, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, USA.
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23
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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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25
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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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26
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Sevoflurane-induced epileptiform electroencephalographic activity and generalized tonic-clonic seizures in a volunteer study. Anesthesiology 2013; 119:447. [PMID: 23221897 DOI: 10.1097/aln.0b013e31827335b9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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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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28
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Abstract
In tumoral surgery, the risk factors for perioperative epilepsy can be roughly grouped into two categories: those related to the preoperative patient's conditions (type and location of the tumors, their impact on the surrounding brain…) and those specifically related to surgery (cerebral edema, parenchymal hematoma, surgical approach, complete or incomplete resection...). The first category is supposed to be responsible for preoperative and late postoperative epilepsy, while the second would be more related to the risk of epilepsy in the first postoperative week (or may be even in the first 48hours). It is well accepted (but not always respected) by the neuro-oncologists that there is no indication for preventive antiepileptic drugs (AED) in a patient with a brain tumor that has never presented seizure. However, every seizure crisis must be treated medically. Neurosurgical procedure (which is also a key factor for controlling epilepsy when it occurs. The AED should then be maintained as appropriate. In the absence of preoperative treatment, it has never been shown that prophylactic AED significantly decreases the incidence of postoperative seizures, early or late. Yet, the opposite has not been shown neither, and many groups use AED despite the risk of side effects and an uncertain risk-benefit ratio. Currently, postoperative epilepsy is much less frequent than it was 20 or 30years ago, and the risk of AED side effects also decreases with the latest generation of molecules (such as levetiracetam). So, AED risks and benefits tend to diminish in parallel, but their relationship is still to be assessed. In practice, a modern attitude would restrict prophylactic AED use to the higher risk patients (preoperative epilepsy, temporal astrocytoma, the extent of edema and mass effect...). A drug of last generation should be used, starting one week before surgery. The duration of the treatment should be limited to one week postoperatively in the absence of seizure.
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Affiliation(s)
- N Engrand
- Département d'anesthésie réanimation, fondation ophtalmologique Rothschild, 25-29, rue Manin, 75019 Paris, France.
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29
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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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Abstract
The accurate assessment of the depth of anesthesia, allowing a more accurate adaptation of the doses of hypnotics, is an important end point for the anesthesiologist. It is a particularly crucial issue in pediatric anesthesia, in the context of the recent controversies about the potential neurological consequences of the main anesthetic drugs on the developing brain. The electroencephalogram signal reflects the electrical activity of the neurons in the cerebral cortex. It is thus the key to assessment of the level of hypnosis. Beyond visual analysis, several monitoring devices allow an automated treatment of the electroencephalographic (EEG) signal, combining time and frequency domain analysis. Each of these monitors focuses on a specific combination of characteristics of the signal and provides the clinician with useful information that remains, however, partial. For a comprehensive approach of the EEG-derived indices, the main features of the normal EEG, in adults and children, will be presented in the awake state and during sleep. Age-related modifications accompanying cerebral maturation during infancy and childhood will be detailed. Then, this review will provide an update on how anesthetic drugs, particularly hypnotics, influence the EEG signal, and how the main available monitors analyze these drug-induced modifications. The relationships between pain, memory, and the EEG will be discussed. Finally, this review will focus on some specific EEG features such as the electrical epileptoid activity observed under sevoflurane anesthesia. The EEG signal is the best window we have on cortical brain activity and provides a fair pharmacodynamic feedback of the effects of hypnotics. However, the cortex is only one of several targets of anesthesia. Hypnotics and opiates, have also subcortical primary targets, and the EEG performances in the evaluation or prediction of nociception are poor. Monitoring subcortical structures in combination with the EEG might in the future allow a better evaluation and a more precise adaptation of balanced anesthesia.
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Affiliation(s)
- Isabelle Constant
- Department of Anesthesiology, Armand Trousseau Hospital, AP-HP, UPMC, Paris, France.
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Oose Y, Miura M, Inoue R, Andou N, Aosaki T, Nishimura K. Imbalanced suppression of excitatory and inhibitory synaptic transmission onto mouse striatal projection neurons during induction of anesthesia with sevoflurane in vitro. Eur J Neurosci 2012; 35:1396-405. [DOI: 10.1111/j.1460-9568.2012.08065.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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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Olejarczyk E, Jozwik A, Zmyslowski W, Sobieszek A, Marciniak R, Byrczek T, Jalowiecki P, Bem T. Automatic detection and analysis of the EEG sharp wave-slow wave patterns evoked by fluorinated inhalation anesthetics. Clin Neurophysiol 2012; 123:1512-22. [PMID: 22300687 DOI: 10.1016/j.clinph.2011.12.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 12/20/2011] [Accepted: 12/23/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to develop a method for the automatic detection of sharp wave-slow wave (SWSW) patterns evoked in EEG by volatile anesthetics and to identify the patterns' characteristics. METHODS The proposed method consisted in the k-NN classification with a reference set obtained using expert knowledge, the morphology of the EEG patterns and the condition for their synchronization. The decision rules were constructed and evaluated using 24h EEG records in ten patients. RESULTS The sensitivity, specificity and selectivity of the method were 0.88 ± 0.10, 0.81 ± 0.13 and 0.42 ± 0.16, respectively. SWSW patterns' recruitment was strictly dependent on anesthetic concentration. SWSW patterns evoked by different types of anesthetics expressed different characteristics. CONCLUSIONS Synchronization criterion and adequately selected morphological features of "slow wave" were sufficient to achieve the high sensitivity and specificity of the method. SIGNIFICANCE The monitoring of SWSW patterns is important in view of possible side effects of volatile anesthetics. The analysis of SWSW patterns' recruitment and morphology could be helpful in the diagnosis of the anesthesia effects on the CNS.
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Affiliation(s)
- Elzbieta Olejarczyk
- Nałęcz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Trojdena 4 Str., 02-109 Warszawa, Poland.
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Khattab AM, El-Seify ZA. Sevoflurane-emergence agitation: Effect of supplementary low-dose oral ketamine premedication in preschool children undergoing dental surgery. Saudi J Anaesth 2011; 3:61-6. [PMID: 20532105 PMCID: PMC2876942 DOI: 10.4103/1658-354x.57878] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The use of sevoflurane in pediatric anesthesia, which could enable a more rapid emergence and recovery, is complicated by the frequent occurrence of post-anesthesia agitation. This study aims to test the efficacy of adding a low dose of ketamine orally, as a supplement to the midazolam-based oral premedication for reducing sevoflurane-related emergence agitation. MATERIALS AND METHODS Ninety-two preschool children, aged between two and six years, with an American Society of Anesthesiologists physical status I or II, scheduled for elective dental filling and extractions under general anesthesia were included. The patients were allocated into two groups: Group M (46 patients) received oral midazolam 0.5 mg/kg, mixed with ibuprofen 10 mg/kg, while group KM (46 patients) received a similar premedication mixture, in addition to ketamine 2 mg/kg. The acceptance of the drug mixture, the onset of action, and the occurrence of vomiting were monitored over the next 30 minutes. Induction of anesthesia was carried out using sevoflurane 8 Vol% in 100% oxygen via face mask. Anesthesia was maintained with sevoflurane 1.5-2 Vol% in an oxygen-nitrous oxide mixture. After extubation, the standard scoring scale was used for assessing the quality of emergence. Agitation parameters were measured using a five-point scale. Agitated children were managed by giving intravenous increments of fentanyl 1 mug/ kg. The time of hospital discharge allowance was recorded. RESULTS Drug palatability, vomiting, and onset of action of premedication; showed no significant differences between both groups. Time of eye opening after discontinuation of sevoflurane showed no significant differences between both groups. Postoperative agitation score and rescue fentanyl consumption were higher in group M than in group KM on admission to the PACU (P < 0.01). The time of hospital discharge allowance in group M was longer than in group KM (P < 0.05). CONCLUSION Adding a low dose of oral ketamine to midazolam-based oral premedication in preschool children undergoing dental surgery reduced sevoflurane-related emergence agitation without delaying discharge.
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Affiliation(s)
- Ahmed Metwally Khattab
- Ain Shams University, Cairo, Egypt, Doha Clinic Hospital, Department of Anesthesia, Doha, Qatar
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Holzki J. Recent advances in pediatric anesthesia. Korean J Anesthesiol 2011; 60:313-22. [PMID: 21716960 PMCID: PMC3110288 DOI: 10.4097/kjae.2011.60.5.313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 10/26/2010] [Indexed: 12/02/2022] Open
Abstract
Writing about advances in a field of medicine normally includes some pride about progress which one was witness to or even a participant in. The younger one is, the more enthusiastically every advance is lauded and welcomed. This is human nature and nothing to be complained about. However, when anesthesiologists, having worked and struggled in the field of pediatric anesthesia for about 40 years, look back to past advances, a more realistic, even painful picture comes to mind. There was a price which a considerable number of patients had to pay for progress, ruined health or even death. This experience of decades of practice is rarely presented in the literature but should not be forgotten when we proudly remember advances in pediatric anesthesia.
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Affiliation(s)
- Josef Holzki
- Emeritus, Department of Paediatric Anaesthesia, Children's Hospital Cologne, Germany
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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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Iturri Clavero F, González Uriarte A, Tamayo Medel G, Pomposo Gaztelu IC, Cano Dorronsoro M, Martínez Ruiz A. [Perioperative considerations in vagal nerve stimulator implantation]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2010; 57:431-438. [PMID: 20857639 DOI: 10.1016/s0034-9356(10)70270-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Vagal nerve stimulation has become an a important tool in the treatment of refractory epilepsy, which continues to be the main indication for this technique. Other therapeutic indications are emerging, however, and vagal nerve stimulation has now been approved for major depression. Additional possible uses under study include morbid obesity, Alzheimer disease, chronic pain syndromes, and certain neuropsychologic disorders. This review considers perioperative aspects relevant to using this therapeutic procedure with a view to facilitating better and more integrated management of its application.
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Affiliation(s)
- F Iturri Clavero
- Servicio de Anestesiología y Reanimación, Hospital de Cruces, Baracaldo,. Bizkaia.
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Sevoflurane-emergence agitation: effect of supplementary low-dose oral ketamine premedication in preschool children undergoing dental surgery. Eur J Anaesthesiol 2010; 27:353-8. [DOI: 10.1097/eja.0b013e328335b2ec] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sleigh JW, Vizuete JA, Voss L, Steyn-Ross A, Steyn-Ross M, Marcuccilli CJ, Hudetz AG. The electrocortical effects of enflurane: experiment and theory. Anesth Analg 2009; 109:1253-62. [PMID: 19762755 DOI: 10.1213/ane.0b013e3181add06b] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND High concentrations of enflurane will induce a characteristic electroencephalogram pattern consisting of periods of suppression alternating with large short paroxysmal epileptiform discharges (PEDs). In this study, we compared a theoretical computer model of this activity with real local field potential (LFP) data obtained from anesthetized rats. METHODS After implantation of a high-density 8 x 8 electrode array in the visual cortex, the patterns of LFP and multiunit spike activity were recorded in rats during 0.5, 1.0, 1.5, and 2.0 minimum alveolar anesthetic concentration (MAC) enflurane anesthesia. These recordings were compared with computer simulations from a mean field model of neocortical dynamics. The neuronal effect of increasing enflurane concentration was simulated by prolonging the decay time constant of the inhibitory postsynaptic potential (IPSP). The amplitude of the excitatory postsynaptic potential (EPSP) was modulated, inverse to the neocortical firing rate. RESULTS In the anesthetized rats, increasing enflurane concentrations consistently caused the appearance of suppression pattern (>1.5 MAC) in the LFP recordings. The mean rate of multiunit spike activity decreased from 2.54/s (0.5 MAC) to 0.19/s (2.0 MAC). At high MAC, the majority of the multiunit action potential events became synchronous with the PED. In the theoretical model, prolongation of the IPSP decay time and activity-dependent EPSP modulation resulted in output that was similar in morphology to that obtained from the experimental data. The propensity for rhythmic seizure-like activity in the model could be determined by analysis of the eigenvalues of the equations. CONCLUSION It is possible to use a mean field theory of neocortical dynamics to replicate the PED pattern observed in LFPs in rats under enflurane anesthesia. This pattern requires a combination of a moderately increased total area under the IPSP, prolonged IPSP decay time, and also activity-dependent modulation of EPSP amplitude.
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Affiliation(s)
- James W Sleigh
- Department of Anaesthesiology, Waikato Clinical School, University of Auckland, Auckland, New Zealand.
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Pedroviejo V, Ayuso M, Jiménez A. [Anesthesia for procedures other than neurosurgery in the adult with epilepsy]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2009; 56:425-435. [PMID: 19856689 DOI: 10.1016/s0034-9356(09)70423-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Epilepsy is a common disease affecting between 1% and 2% of the general population. The incidence increases with age. Given the complicated etiology and pathogenesis of this disease, epileptic patients of all ages may require anesthesia. The perioperative care of these patients involves a number of special considerations, although the main issues to deal with are pharmacologic. This review gives an overview of the etiopathogenesis and pathophysiology of epilepsy and describes the general characteristics of antiepileptic drug therapy. The anesthetic implications of chronic treatment with antiepileptic agents and the interactions between these drugs and common anesthetics are discussed in more detail.
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Affiliation(s)
- V Pedroviejo
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid.
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Sonkajärvi E, Alahuhta S, Suominen K, Hakalax N, Vakkuri A, Löppönen H, Ohtonen P, Jäntti V. Topographic electroencephalogram in children during mask induction of anaesthesia with sevoflurane. Acta Anaesthesiol Scand 2009; 53:77-84. [PMID: 19032567 DOI: 10.1111/j.1399-6576.2008.01725.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Epileptiform patterns, spikes, polyspikes and periodic epileptiform discharges (PED) have been reported in electroencephalograms (EEGs) during anaesthesia induction with sevoflurane in healthy adults and children. Published recordings have been performed with a limited number of channels, and therefore the topographic distributions of these patterns are not known. METHODS Twenty ASA I children aged 4-10 years undergoing routine operations were anaesthetized with 8% sevoflurane in 50%/50% oxygen and nitrous oxide using mask induction with controlled normoventilation. An EEG was recorded with a full 10-20 electrode system including orbitofrontal and ear electrodes, and a recording band of 0.016-70 Hz. Beat-to-beat heart rate (HR) was calculated off-line. RESULTS Nineteen out of 20 children developed multifocal spikes and polyspikes with a maximum over the frontal lobes. Four patients developed suppression, which was almost continuous and lasted several minutes, and thereafter a continuous EEG resumed, a few spikes were seen and then a nonepileptiform pattern. In three children a couple of PED waves were seen at the onset of a continuous EEG. HR increased maximally before the onset of spikes. No motor phenomena were seen. CONCLUSION These recordings confirm the epileptogenic property of sevoflurane in mask induction. The spikes and polyspikes had frontal multifocal maxima and may be missed in recordings from frontopolar electrodes used by depth-of-anaesthesia monitors. PED and burst suppression were synchronous over the whole cortex. Epileptiform activity was indiscernible from epileptiform waveforms without anaesthesia, such as the patterns seen in status epilepticus.
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Affiliation(s)
- E Sonkajärvi
- Departmetn of Anaesthesiology, Oulu University Hospital, Oulu, Finland.
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Voss LJ, Sleigh JW, Barnard JPM, Kirsch HE. The Howling Cortex: Seizures and General Anesthetic Drugs. Anesth Analg 2008; 107:1689-703. [PMID: 18931234 DOI: 10.1213/ane.0b013e3181852595] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sandin M, Thörn SE, Dahlqvist A, Wattwil L, Axelsson K, Wattwil M. Effects of pain stimulation on bispectral index, heart rate and blood pressure at different minimal alveolar concentration values of sevoflurane. Acta Anaesthesiol Scand 2008; 52:420-6. [PMID: 18269392 DOI: 10.1111/j.1399-6576.2007.01569.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of the present study was to examine the level of unconsciousness measured with bispectral index (BIS) at different minimal alveolar concentration (MAC) levels of sevoflurane, and to study the hemodynamic and BIS reactions during noxious stimulation with transcutaneous electrical nerve stimulation (TENS) and an ice water pain test (IWP). METHODS This study was approved by the Ethics Committee and was performed on 10 healthy, young volunteers (six males and four females), ASA physical status I. Anesthesia was induced and maintained with sevoflurane in an oxygen/air mixture. The volunteers were spontaneously breathing, but if necessary, ventilation was mechanically supported. TENS and IWP were performed at 1.0, 1.5 and 2.0 MAC of sevoflurane. RESULTS At 1.0 MAC, there was a significant increase in BIS during pain stimulation both with IWP (P<0.03) and with TENS (P<0.005), but at 1.5 MAC there were no changes. A marked variation in BIS was seen at 2.0 MAC, with periods of burst suppression and periods of high BIS values despite clinical signs of deep anesthesia. These marked variations in BIS were seen before, during and after pain stimulation. One volunteer (# 8) had a short episode of convulsions at 2.0 MAC. CONCLUSION BIS, heart rate and blood pressure increased during pain stimulation at 1.0 MAC but not at 1.5 MAC of sevoflurane. There was a remarkable variation in BIS at 2.0 MAC of sevoflurane, with BIS values indicating wakefulness despite clinical signs of deep anesthesia. This BIS variation is probably caused by epileptogenic activity due to sevoflurane.
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Affiliation(s)
- M Sandin
- Department of Clinical Medicine, University of Orebro, Orebro, Sweden.
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Jäntti V, Sloan TB. EEG and anesthetic effects. INTRAOPERATIVE MONITORING OF NEURAL FUNCTION 2008. [DOI: 10.1016/s1567-4231(07)08004-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Rewari V, Sethi D. Recurrence of focal seizure activity in an infant during induction of anaesthesia with sevoflurane. Anaesth Intensive Care 2007; 35:788-91. [PMID: 17933171 DOI: 10.1177/0310057x0703500523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A three-month-old male infant, previously diagnosed with seizures with a focal origin induced by hypocalcaemia secondary to hypoparathyroidism, presented for right cataract surgery. The hypocalcaemia and seizure activity had resolved with medical therapy, with normal calcium levels and no seizures for a month. Anaesthesia with halothane and isoflurane for left cataract surgery two days previously had been uneventful. During induction of anaesthesia with sevoflurane for the right cataract surgery, the patient had a focal seizure similar to those previously occurring when the patient was hypocalcaemic. The patient had normal calcium levels at the time of surgery. It appears likely that sevoflurane had triggered seizure activity in the apparently controlled focus. The potential for sevoflurane to induce epileptogenic activity in patients with reduced seizure threshold is discussed.
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Affiliation(s)
- V Rewari
- Department of Anaesthesiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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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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