Induction with high sevoflurane concentrations may trigger epileptiform electroencephalographic activity without motor or cardiovascular manifestations in healthy patients. No other symptoms were associated in this series, and only electroencephalographic monitoring allowed the diagnosis. Midazolam and dexmedetomidine are sedatives commonly used in children before surgery. Although the mechanisms are different, both have been reported in antiepileptic effects. This study was designed to compare the effects between intranasal midazolam or dexmedetomidine on epileptiform EEG during sevoflurane mask induction in children. Anaesthesia was induced with 8% sevoflurane. The patients were randomly assigned to Group A (n=15, preoperative intranasal normal saline), Group B (n=15, preoperative intranasal 0.25mg/kg midazolam), and Group C (n=15, preoperative intranasal 1μg/kg dexmedetomidine). An electroencephalogram was recorded before and during induction up to 10 min after the start of induction.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
45
Patients in Group A receive intranasal normal saline before anesthesia. Anaesthesia was induced with 8% sevoflurane initially. Sevoflurane concentration decreased to 2% after intubation. An electroencephalogram was recorded before and during induction up to 10 min after the start of induction.
Patients in Group B receive intranasal 0.25mg/kg midazolam before anesthesia. Anaesthesia was induced with 8% sevoflurane initially. Sevoflurane concentration decreased to 2% after intubation. An electroencephalogram was recorded before and during induction up to 10 min after the start of induction.
Patients in Group C receive intranasal 1μg/kg dexmedetomidine before anesthesia. Anaesthesia was induced with 8% sevoflurane initially. Sevoflurane concentration decreased to 2% after intubation. An electroencephalogram was recorded before and during induction up to 10 min after the start of induction.
Shanghai Ninth People's Hospital,Affililated to Shanghai Jiaotong University School of Medicine
Shanghai, China
incidence of epileptiform EEG
EEG were visually analyzed off-line by a neurophysiologist familiar with anesthesia EEG and blinded to the randomization. EEG abnormalities related to epileptic features were classified according to the description of Vakkuri and Jaaskelainen, and the recommendations of Constant: spikes and spikes with slow wave complexes (SW), rhythmic polyspikes corresponding to waveforms appearing at regular intervals (RPS) and periodic epileptiform discharge (PED), which refers to periodic hypersynchronized complexes occurring bilaterally. These entire electroencephalographic phenomena were considered as epileptiform EEG if their duration was longer than three seconds.
Time frame: 0 min after induction, up to 10 min
electroencephalographic changes
the delay between the start of induction and the first changes in electroencephalographic activity (appearance of β, θ, or δ rhythms)
Time frame: 0 min after induction, up to 10 min
electroencephalographic changes
the occurrence of burst suppressions
Time frame: 0 min after induction, up to 10 min
electroencephalographic changes
duration of suppression period, i.e. the sum of the EEG silences.
Time frame: 0 min after induction, up to 10 min
hemodynamic changes
blood pressure
Time frame: 1 min before induction
hemodynamic changes
heart rate
Time frame: 1 min before induction
hemodynamic changes
blood pressure
Time frame: during induction procedure
hemodynamic changes
heart rate
Time frame: during induction procedure
hemodynamic changes
blood pressure
Time frame: 2 min after induciton
hemodynamic changes
heart rate
Time frame: 2 min after induciton
hemodynamic changes
blood pressure
Time frame: 4 min after induciton
hemodynamic changes
heart rate
Time frame: 4 min after induciton
hemodynamic changes
blood pressure
Time frame: 6 min after induciton
hemodynamic changes
heart rate
Time frame: 6 min after induciton
hemodynamic changes
blood pressure
Time frame: 8 min after induciton
hemodynamic changes
heart rate
Time frame: 8 min after induciton
hemodynamic changes
blood pressure
Time frame: 10 min after induciton
hemodynamic changes
heart rate
Time frame: 10 min after induciton
intubation time
from taking of the intubation device to successful intubation
Time frame: 0 min after intubation
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