Incidence of epileptiform EEG activity in children during mask induction of anaesthesia with brief administration of 8% sevoflurane

• Published in: PloS one Vol. 7; no. 7; p. e40903
• Main Authors: Schultz, Barbara, Otto, Christian, Schultz, Arthur, Osthaus, Wilhelm Alexander, Krauss, Terence, Dieck, Thorben, Sander, Björn, Rahe-Meyer, Niels, Raymondos, Konstantinos
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 19.07.2012; Public Library of Science (PLoS)
• Subjects: Anesthesia; Anesthesiology; Anesthetic gases; Anesthetics, Inhalation - administration & dosage; Anesthetics, Inhalation - therapeutic use; Blood pressure; Child; Child, Preschool; Children; Children & youth; Consciousness; Digital signal processors; EEG; Electrocardiography; Electroencephalography; Epilepsy; Ethics; Female; Firing pattern; Humans; Incidence; Infant; Intensive care; Intubation; Male; Medical schools; Medicine; Methyl Ethers - administration & dosage; Methyl Ethers - therapeutic use; Midazolam; Midazolam - pharmacology; Nitrous oxide; Oxygen; Prospective Studies; Protective equipment; Rhythms; Sevoflurane; Germany
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0040903

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. 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. 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.