Electrical Seizures during Sevoflurane Anesthesia in Two Pediatric Patients with Epilepsy

Komatsu, Hisao; Taie, Satoshi; Endo, Syoiti; Fukuda, Kuniaki; Ueki, Masaaki; Nogaya, Junko; Ogli, Kenji

doi:10.1097/00000542-199412000-00030

Cited by 118 publications

(46 citation statements)

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“…Although the reason for frequent EA following sevoflurane is not clear, sevoflurane may exert an irritating effect on the central nervous system. 31,32) Thus, the decreased frequency of EA may be related to the decrease in sevoflurane concentration and the sedative effect of caudal DEX. 5,33) Sedation score was relatively high in the DEX group at arrival and at 30 min of PACU, but comparable afterwards and the discharge time was similar in both groups.…”

Section: Discussionmentioning

confidence: 99%

The Effect of 1 µg/kg Dexmedetomidine Combined with High-Volume/Low-Concentration Caudal Ropivacaine in Children Undergoing Ambulatory Orchiopexy

Cho

Kim

Park

et al. 2015

Biological & Pharmaceutical Bulletin

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When local anesthetics are used, the administration of dexmedetomidine (DEX) can prolong analgesic duration. However, the effect of caudal DEX on high volume/low concentration (HVLC) local anesthetics has not been studied. We investigated the analgesic effect of DEX added to a HVLC of ropivacaine for caudal block in children. Eighty children (the American Society of Anesthesiologists (ASA) status I; age, 1-6 years) undergoing ambulatory orchiopexy were enrolled in the study. Children were randomly assigned to undergo a caudal block with 1.5 mL/kg of 0.15% ropivacaine and either 1 µg/kg of DEX (DEX group, n 40) or the same amount of saline (Control group, n 40) under general anesthesia. The results showed that the time to first analgesic request was significantly longer in the DEX group than in the control group. The sevoflurane requirement for anesthesia and frequency of emergence agitation (EA) were also significantly lower in the DEX group. There was no difference in adverse events between the two groups. In conclusion, a dose of 1 µg/ kg of caudal DEX prolonged the first analgesic request time, although the immediate postoperative pain scores were comparable in both groups. Furthermore, caudal DEX significantly reduced the sevoflurane requirement and the frequency of EA.Key words dexmedetomidine; caudal block; child; orchiopexy Caudal block is common method for postoperative analgesia in children undergoing infra-umbilical surgery. One major limitation of caudal block is a relatively short analgesic duration owing to the single-injection. Thus, adjuvants such as ketamine, clonidine, or opioids are frequently added to the local anesthetics in order to improve analgesic efficacy and duration.1,2) The effectiveness of local anesthetics using in caudal block is dependent upon the dose, volume, and concentration of the local anesthetic solution, but high-concentration local anesthetics can increase the incidence of motor weakness, delayed micturition, or urinary retention. In children undergoing ambulatory surgery, such adverse effects can prolong the discharge time and may result in inadvertent admission. Recently, high-volume/low-concentration (HVLC) regimens for caudal blocks in children (1.5 mL/kg of 0.1-0.2% local anesthetics) have gained popularity following a report by Silvani et al. that demonstrated that a HVLC regimen provides a longer analgesic duration with less adverse effects than conventional dose/concentration. [3][4][5][6][7][8] However, the analgesic duration is still limited in caudal block with single-injection.Dexmedetomidine (DEX) is a highly selective α 2 adrenoceptor agonist with an α2/α1 selectivity ratio of 1600 : 1, and is eight times more potent than clonidine. 9) DEX is successfully used as an adjuvant in caudal blocks for children in order to reduce pain without inducing any significant respiratory and hemodynamic effects. Several studies have reported that in children, caudal DEX (1-2 µg/kg) with 0.25% bupivacaine (1 mL/kg) prolongs postoperative analgesic duration by 2.5-3 fold comp...

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Section: Discussionmentioning

confidence: 99%

The Effect of 1 µg/kg Dexmedetomidine Combined with High-Volume/Low-Concentration Caudal Ropivacaine in Children Undergoing Ambulatory Orchiopexy

Cho

Kim

Park

et al. 2015

Biological & Pharmaceutical Bulletin

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“…Clinical proconvulsant effects have occurred with nitrous oxide, enflurane, etomidate, ketamine, propofol, morphine, meperidine, fentanyl, sufentanil, alfentanil, and local anesthetics; EEG seizures have occurred with enflurane, sevoflurane, etomidate, meperidine, and local anesthetics (Modica et al, 1990a, b;Woodforth et al, 1997;Yasukawa and Yasukawa, 1999). In epileptic patients, spike activation or seizure activity has occurred with enflurane, sevoflurane, methohexital, etomidate, benzodiazepines, ketamine, propofol, alfentanil, and remifentanil Komatsu et al, 1994;Modica et al, 1990a, b;Wass et al, 2001). Therefore, some seizurelike events could be coincidental unless EEG demonstrates TES-induced seizure patterns.…”

Section: Safety Of Tes Mep Monitoringmentioning

confidence: 99%

Safety of Intraoperative Transcranial Electrical Stimulation Motor Evoked Potential Monitoring

MacDonald¹

2002

Journal of Clinical Neurophysiology

310

130

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“…The haemodynamic responses to > 1 MAC sevoflurane in infants and children have not been quantified, although blood pressure and heart rate responses during inhalational induction with inspired concentrations up to 7% sevoflurane have been unremarkable [20,21]. While a vaporiser delivering 7% sevoflurane is widely used, high concentrations (> 5%) of sevoflurane were reported to possibly induce electroencephalographic evidence of seizure activity [12]. We can recommend 5% sevoflurane as a safe inspired concentration.…”

Section: Figurementioning

confidence: 99%

Anaesthetic induction time for tracheal intubation using sevoflurane or halothane in children

et al. 1998

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SummaryThe current study was designed to determine the anaesthetic induction time required for tracheal intubation (Time EI ) with equipotent inspired concentrations of 5% sevoflurane and 2.5% halothane in oxygen. Time EI that prevents 50% and 95% of patients from coughing and gross purposeful muscular movements after intubation was defined as Time EI 50 and Time EI 95, respectively. Thirtysix patients aged 1-7 years were enrolled in the study. Anaesthesia was induced via mask and when Time EI attained a predetermined value, intubation was performed using an uncuffed tube. Each Time EI at which tracheal intubation was attempted was predetermined according to the up-anddown method. When intubation was accomplished without gross purposeful muscular movements, it was considered a smooth intubation. Determination with this method revealed that Time EI 50 and Time EI 95 for the sevoflurane/halothane groups were 147/214 s and 194/255 s, respectively. In conclusion, it is possible to determine Time EI using an inspired sevoflurane concentration of 5% and halothane 2.5% in oxygen. The technique with 5% sevoflurane seems more practical for paediatric anaesthesia induction in busy clinical situations. Although halothane has been used as the main drug for inhalational induction of anaesthesia in children, sevoflurane has several theoretical advantages over halothane. Sevoflurane has fewer myocardial depressant effects than halothane [1], and it is less extensively metabolised [2]. Additionally, sevoflurane has a lower solubility in blood [3] and a pleasant smell [2, 4-6] permitting smooth induction and tracheal intubation without neuromuscular blockade [7,8]. Moveover, sevoflurane would be expected to produce a more rapid anaesthetic induction for tracheal intubation than halothane. End-tidal concentrations of sevoflurane and halothane at which a smooth intubation is possible in 50% of patients have been designated as minimum alveolar concentration required for (endo)tracheal intubation (MAC EI ) [7,9]. In the conventional method to determine MAC EI , a predetermined end-tidal concentration of inhaled anaesthetic needs to be maintained at a constant level for at least 15 min to establish equilibration among cerebral, arterial blood and alveolar gas tensions before tracheal intubation is attempted [7][8][9][10][11]. This conventional method may not be practical for tracheal intubation in children. To our knowledge, there has been no detailed study of minimum anaesthetic induction time required for tracheal intubation using inhalational anaesthetics without neuromuscular relaxants. Moreover, the use of an overpressure technique to achieve MAC EI within a clinically acceptable time is limited by reports that high concentrations (> 5%) of sevoflurane may induce electroencephalographic evidence of seizure activity [12]. The aim of the current study, therefore, was to determine the anaesthetic induction time required for tracheal intubation (Time EI ) with equipotent inspired concentrations (Ϸ 2 MAC EI ) [7,9] of 5% sevoflurane ...

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Electrical Seizures during Sevoflurane Anesthesia in Two Pediatric Patients with Epilepsy

Cited by 118 publications

References 0 publications

The Effect of 1 µg/kg Dexmedetomidine Combined with High-Volume/Low-Concentration Caudal Ropivacaine in Children Undergoing Ambulatory Orchiopexy

The Effect of 1 µg/kg Dexmedetomidine Combined with High-Volume/Low-Concentration Caudal Ropivacaine in Children Undergoing Ambulatory Orchiopexy

Safety of Intraoperative Transcranial Electrical Stimulation Motor Evoked Potential Monitoring

Anaesthetic induction time for tracheal intubation using sevoflurane or halothane in children

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