Incidence of epileptiform discharges in children during induction of anaesthesia using Propofol versus Sevoflurane

被引：17

作者：

Koch, Susanne ^{[1
,2
,3
]}

Rupp, Leopold ^{[1
,2
,3
]}

Prager, Christine ^{[2
,3
,4
]}

Moergeli, Rudolf ^{[1
,2
,3
]}

Kramer, Sylvia ^{[1
,2
,3
]}

Wernecke, Klaus Dieter ^{[5
]}

Fahlenkamp, Astrid ^{[1
,2
,3
]}

Spies, Claudia ^{[1
,2
,3
]}

机构：

[1] Charite Univ Med Berlin, Dept Anaesthesiol & Operat Intens Care Med CCM, CVK, Augustenburger Pl 1, D-13353 Berlin, Germany

[2] Humboldt Univ, Freie Univ Berlin, Berlin, Germany

[3] Berlin Inst Hlth, Campus Virchow Klinikum, Augustenburger Pl 1, D-13353 Berlin, Germany

[4] Charite Univ Med Berlin, Dept Paediat & Neurol CVK, Berlin, Germany

[5] Charite Univ Med Berlin, Inst Med Biometry, Sostana GmbH, Berlin, Germany

来源：

CLINICAL NEUROPHYSIOLOGY | 2018年 / 129卷 / 08期

关键词：

General anaesthesia; Epileptiform discharges; Propofol; Infant; Preschool children; School children; EPILEPSY; EEG; SEIZURES; MULTICENTER;

D O I：

10.1016/j.clinph.2018.05.013

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Objective: In pediatric patients, anaesthesia induction is often performed with intravenous Propofol or Sevoflurane inhalation. Although epileptiform discharges have been observed during inductions with Sevoflurane, their occurrence has not been investigated for i.v. Propofol inductions. The aim of this study is to compare the incidence of epileptiform discharges in children during anaesthesia induction using Propofol versus Sevoflurane. Methods: Prospective, observational cohort study in children aged 0.5-8 years undergoing elective surgery. Children were anaesthetized with either Propofol or Sevoflurane. Bi-frontal electroencephalograms electrodes were placed before start of anaesthesia. Visual electroencephalogram analysis was performed from start of anesthetic agent administration until Intubation with regard to identify epileptiform patterns, i.e. delta with spikes; rhythmic polyspikes; periodic, epileptiform discharges; or suppression with spikes. Results: 39 children were anaesthetized with Propofol, and 18 children with Sevoflurane. Epileptiform discharges were seen in 36% of the children in the Propofol group, versus 67% in the Sevoflurane group (p = 0.03). Incidence of the distinct types of epileptiform discharge differed for periodic, epileptiform discharges (Sevoflurane group 39% vs. Propofol group 3%; p < 0.001). Higher concentration of Remifentanil (>= 0.15 mg/kg/min) was associated with less frequent epileptiform discharges (Exp 5.8; CI 95% 1.6/21.2; p = 0.008). Conclusions: Propofol i.v. induction of anaesthesia in children triggers epileptiform discharges, whereas to a lesser extent than Sevoflurane does. Significance: Presuming that epileptiform discharges have an impact on postoperative brain function, it is advisable to use Propofol rather than Sevoflurane and higher level of Remifentanil for anaesthesia induction in children. (C) 2018 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

引用

页码：1642 / 1648

页数：7