Author(s): Schultz B, Otto C, Schultz A, Osthaus WA, Krauss T,
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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.
This article was published in PLoS One
and referenced in Journal of Microbial & Biochemical Technology