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Influence of the sevoflurane concentration on the occurrence of epileptiform EEG patterns.

Kreuzer I, Osthaus WA, Schultz A, Schultz B - PLoS ONE (2014)

Bottom Line: 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).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).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.

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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Time from start of sevoflurane administration to the first second with the patterns delta with spikes (DSP), rhythmic polyspikes (PSR), and periodic epileptiform discharges (PED) in the first 10 minutes of anaesthesia induction.
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pone-0089191-g002: Time from start of sevoflurane administration to the first second with the patterns delta with spikes (DSP), rhythmic polyspikes (PSR), and periodic epileptiform discharges (PED) in the first 10 minutes of anaesthesia induction.

Mentions: In section A, the median values for the time between the start of sevoflurane administration and the first second with the patterns DSP or PSR were smaller in patients with 8% compared to 6% sevoflurane. For the pattern PSR, the difference was statistically significant (p = 0.0051) (Table 6, Figure 2, Table 7). The times until PED and SSP started were not compared statistically between the groups, because the numbers of patients with these patterns were small.


Influence of the sevoflurane concentration on the occurrence of epileptiform EEG patterns.

Kreuzer I, Osthaus WA, Schultz A, Schultz B - PLoS ONE (2014)

Time from start of sevoflurane administration to the first second with the patterns delta with spikes (DSP), rhythmic polyspikes (PSR), and periodic epileptiform discharges (PED) in the first 10 minutes of anaesthesia induction.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3935848&req=5

pone-0089191-g002: Time from start of sevoflurane administration to the first second with the patterns delta with spikes (DSP), rhythmic polyspikes (PSR), and periodic epileptiform discharges (PED) in the first 10 minutes of anaesthesia induction.
Mentions: In section A, the median values for the time between the start of sevoflurane administration and the first second with the patterns DSP or PSR were smaller in patients with 8% compared to 6% sevoflurane. For the pattern PSR, the difference was statistically significant (p = 0.0051) (Table 6, Figure 2, Table 7). The times until PED and SSP started were not compared statistically between the groups, because the numbers of patients with these patterns were small.

Bottom Line: 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).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).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.

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.

Show MeSH
Related in: MedlinePlus