Emergence delirium in children is related to epileptiform discharges during anaesthesia induction

Koch, Susanne; Rupp, Leopold; Prager, Christine; Wernecke, Klaus D.; Krämer, Sarah; Fahlenkamp, Astrid; Spies, Claudia

doi:10.1097/eja.0000000000000867

Cited by 29 publications

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“…The occurrence of Burst Suppression during general anaesthesia in elderly patients is positively correlated to the incidence of postoperative delirium, hence one might propose that elderly patients struggle to restore the preoperative brain metabolism level. In contrast, in children neuronal hyperexcitability – as seen by occurrence of interictal, epileptiform discharges during anaesthesia induction or increased frontal connectivity during emergence of general anaesthesia – has been related to ED [7, 8]. These striking differences in EEG activity related to delirium in children compared with elderly patients extends into its clinical presentation, where delirious children present with crying, agitation, disorientation and altered response to their surroundings, whereas elderly patients present primarily with a hypoactive form of delirium.…”

Section: Discussionmentioning

confidence: 99%

“…Elevated concentrations of the anaesthetic agent sevoflurane cause an increase of epileptiform discharges during anaesthesia induction in children [6]. In a former EEG analysis - focusing on the period of anaesthesia induction in the same patient cohort that is presented here - we have shown that the occurrence of interictal, epileptiform discharges is positively related to the development of ED [7]. In a study from Martin and colleagues analysing multichannel EEG characteristics in 12 children, from whom 5 developed ED, ED was associated with arousal from an indeterminate state (low voltage / fast frequency EEG activity) and an increased frontal cortical functional connectivity [8].…”

Section: Introductionmentioning

confidence: 99%

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Emergence delirium in children is not related to intraoperative burst suppression – prospective, observational electrography study

et al. 2019

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Background Emergence-delirium is the most frequent brain dysfunction in children recovering from general anaesthesia, though the pathophysiological background remains unclear. The presented study analysed an association between emergence delirium and intraoperative Burst Suppression activity in the electroencephalogram, a period of very deep hypnosis during general anaesthesia. Methods In this prospective, observational cohort study at the Charité - university hospital in Berlin / Germany children aged 0.5 to 8 years, undergoing planned surgery, were included between September 2015 and February 2017. Intraoperative bi-frontal electroencephalograms were recorded. Occurrence and duration of Burst Suppression periods were visually analysed. Emergence delirium was assessed using the Pediatric Assessment of Emergence Delirium Score. Results From 97 children being analysed within this study, 40 children developed emergence delirium, and 57 children did not. Overall 52% of the children displayed intraoperative Burst Suppression periods; however, occurrence and duration of Burst Suppression (Emergence delirium group 55% / 261 + 462 s vs. Non-emergence delirium group 49% / 318 + 531 s) did not differ significantly between both groups. Conclusions Our data reveal no correlation between the occurrence and duration of intraoperative Burst Suppression activity and the incidence of emergence delirium. Burst Suppression occurrence is frequent; however, it does not seem to have an unfavourable impact on cerebral function at emergence from general anaesthesia in children. Trail registration NCT02481999, June 25, 2015. Electronic supplementary material The online version of this article (10.1186/s12871-019-0819-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Emergence delirium in children is not related to intraoperative burst suppression – prospective, observational electrography study

et al. 2019

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show abstract

“…In children elevated concentrations of the anaesthetic agent Sevoflurane cause an increase of epileptiform discharges during anaesthesia induction (6). In a former EEG analysis -focusing on the period of anaesthesia induction in the same patients group presented here -we had shown that the occurrence of interictal, epileptiform discharges, is positively related to the development of ED (7). In a study from Martin and colleagues, analyzing multichannel EEG characteristics in 12 children, from whom 5 developed ED, ED was associated with arousal from an indeterminate state (low voltage / fast frequency EEG activity) and an increased frontal cortical functional connectivity (8).…”

Section: Introductionmentioning

confidence: 58%

“…The occurrence of Burst Suppression during general anaesthesia in elderly patients is positively correlated to the incidence of postoperative delirium, hence one might propose, that elderly patients struggle to restore preoperative brain metabolism level. In contrast, in children neuronal hyperexcitability -as seen by occurrence of interictal, epileptiform discharges during anaesthesia induction or increased frontal connectivity during emergence of general anaesthesia -has been related to ED (7,8). These striking differences in EEG activity related to delirium in children compared with elderly patients extends into its clinical presentation, where delirious children present with crying, agitation, disorientation and altered response to their surroundings, whereas elderly patients present primarily with a hypoactive form of delirium.…”

Section: Discussionmentioning

confidence: 99%

Emergence Delirium in children and intraoperative Electroencephalogram Burst Suppression – findings from a prospective, observational study

Koch

Stegherr

Rupp

et al. 2019

Preprint

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Background Emergence-delirium is the most frequent brain dysfunction in children recovering from general anaesthesia, though the pathophysiological background remains unclear. The presented study analysed an association between emergence delirium and intraoperative burst suppression activity in the electroencephalogram, a period of very deep hypnosis during general anaesthesia. Methods In this prospective, observational cohort study at the Charité - university hospital in Berlin / Germany children aged 0.5 to 8 years old, undergoing planned surgery, were included between September 2015 and February 2017. Intraoperative bi-frontal electroencephalogram monitoring were recorded. Occurrence and duration of burst suppression periods were visually analysed. Emergence delirium was assessed with the Pediatric Assessment of Emergence Delirium Score. Results From 97 children being analysed within this study, 40 children developed emergence delirium, and 57 children did not. Overall 52% of the children displayed intraoperative burst suppression periods; however, occurrence and duration of burst suppression (Emergence delirium group 55% / 261+462sec vs. Non-emergence delirium group 49% / 318+531sec) did not differ in between both groups. Conclusions Our data reveal no correlation between the occurrence and duration of intraoperative burst suppression activity and the incidence of emergence delirium. Burst suppression occurrence is frequent; however, it does not seem to have an unfavourable impact on cerebral function at emergence from general anaesthesia in children.

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“…Many studies have shown that these paradoxical discharges found in children with or without epilepsy are related to poorer cognitive performance [8] and emergency delirium. [9] However, the incidence, prevention and risk factors of these epileptiform patterns during sevoflurane anesthesia in children are still under debate. Based on the above facts and the existing studies, it is urgent to conduct this systematic review and meta-analysis to evaluate the epileptic potential of sevoflurane in EEG during general anesthesia in children.…”

Section: Introductionmentioning

confidence: 99%

Epileptiform EEG discharges and sevoflurane in children

Miao

et al. 2019

Medicine

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Background:Epileptiform discharges in electroencephalogram (EEG) have been frequently reported in children undergoing sevoflurane mask induction. However, the incidence, characteristics and risk factors of these epileptiform patterns during sevoflurane anesthesia in children are poorly understood. The aim of this study is to systematically review the epileptic potential of sevoflurane in children with the EEG monitoring.Methods:PubMed, EMBASE, Cochrane library (Central) will be systematically searched from inception to December 2018. The effect of sevoflurane on epileptic EEG patters in children will be studied. The primary outcome will be the incidence of epileptic discharges, the characteristics and risk factors of these epileptic discharges. Meta-analysis will be calculated using R software 3.5.1.Results:This study will offer new evidence of the incidence, characteristics and risk factors of EEG epileptic discharges during sevoflurane anesthesia.Conclusion:The conclusion drawn from this systematic review will benefit the children with or without epilepsy undergoing sevoflurane anesthesia.Ethics and dissemination:Ethics approval is unnecessary because data of individual patients will not be included and no privacy will be involved. The results of this review will be published in a peer-reviewed journal or a conference report. Amendments of the basic protocol will be documented in the comprehensive review.PROSPERO registration number:PROSPERO CRD 42019122008.

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Emergence delirium in children is related to epileptiform discharges during anaesthesia induction

Abstract: NCT02481999.

Cited by 29 publications

References 25 publications

Emergence delirium in children is not related to intraoperative burst suppression – prospective, observational electrography study

Emergence delirium in children is not related to intraoperative burst suppression – prospective, observational electrography study

Emergence Delirium in children and intraoperative Electroencephalogram Burst Suppression – findings from a prospective, observational study

Epileptiform EEG discharges and sevoflurane in children

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