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

Abstract

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.

A retrospective study of electroencephalography burst suppression in children undergoing general anesthesia

“…In this pilot study, burst suppression events occurred in 56% of children 1–36 months of age undergoing surgery using sevoflurane or propofol and remifentanil infusion maintenance anesthesia. The prevalence was similar to data reported by Koch et al, 15 who observed that 52% of children had burst suppression during general anesthesia. We demonstrated a significant difference in the prevalence of burst suppression between sevoflurane and propofol anesthesia (72% vs .…”

Desflurane is risk factor for postoperative delirium in older patients’ independent from intraoperative burst suppression duration

“…These distinct receptor affinities of the different anesthetic agents are most likely the underlying causes for their different EEG signatures ( Purdon et al, 2015b ) and their different ability to induce burst suppression activity ( Purdon et al, 2015a ). Since in preschool children, elevated neuronal excitability is related to the occurrence of emergence delirium ( Martin et al, 2014 ; Koch et al, 2018 ), but not the presence of burst suppression activity ( Faulk et al, 2010 ; Frederick et al, 2016 ; Koch et al, 2019 ), it is obvious, that there are different pathophysiological neuronal states being related to delirious symptoms. Moreover, it has been shown in molecular studies that volatile anesthetics can mediate inflammatory responses or may show neurotoxic effects ( Jiang and Jiang, 2015 ; Yuki and Eckenhoff, 2016 ).…”

Impact of Propofol Bolus Administration on the Nociceptive Flexion Reflex Threshold and Bispectral Index in Children—A Case Series

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