Epilepsietypische EEG-Aktivität: Auftreten bei Sevoflurananflutung und nicht unter Propofolapplikation

Schultz, Barbara; Schultz, A.; Grouven, Ulrich; Korsch, G

doi:10.1007/s001010050962

Cited by 19 publications

(5 citation statements)

References 8 publications

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“…Although no EEG was recorded in either case, we cannot exclude that the convulsive movements observed were actually associated with electrocortical seizure activity, particularly in the second child. Based on our observations and previous reports (3,4,6,(8)(9)(10)(11)(12) we conclude that sevoflurane should be avoided, or at least used cautiously, in those patients where epilepsy has been verified or is strongly suspected.…”

Section: Discussionsupporting

confidence: 74%

“…Epileptiform EEG activity in nonepileptic patients has been found to be associated with the use of sevoflurane for induction of anaesthesia in children (12) and adults (10,11,13) as well as for maintenance of anaesthesia in adults (3,6). In contrast, no EEG seizure activity was found in patients also given midazolam (14), thiopental (15) or fentanyl (16), and nitrous oxide has accordingly been reported to attenuate (9) or to have no effect on (4) the EEG response to sevoflurane.…”

Section: Discussionmentioning

confidence: 99%

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Convulsions on anaesthetic induction with sevoflurane in young children

Åkeson

Didriksson

2004

Acta Anaesthesiol Scand

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Increased worldwide use for paediatric anaesthesia of the volatile anaesthetic agent sevoflurane has mainly resulted from its low blood‐gas partition coefficient and low airway irritability, providing smooth conditions for rapid induction of anaesthesia. Nevertheless, there are several clinical and experimental reports suggesting a correlation between exposure to sevoflurane and generalized clonic or tonic seizure activity. We report two clinical episodes of convulsions associated with the induction of sevoflurane anaesthesia in young children.Case 1: during induction of anaesthesia with sevoflurane by facemask in a 3‐year‐old healthy boy, there were symmetrical clonic seizure‐like movements of the upper extremities for 60 s. Case 2: on re‐induction of anaesthesia with sevoflurane because of profuse bleeding following nasal adenoidectomy in a 4‐year‐old healthy girl with a family history of epilepsy, there were symmetrical tonic and clonic seizure‐like movements for 30–40 s in the upper and lower extremities. Both episodes ceased spontaneously.Although no EEG was recorded, it cannot be excluded that both episodes resulted from seizure activity within the CNS. Based on our observations and reports by others we suggest that, until further notice, sevoflurane should be avoided or at least used cautiously in patients where clinical epileptic activity has been verified or is strongly suspected.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Convulsions on anaesthetic induction with sevoflurane in young children

Åkeson

Didriksson

2004

Acta Anaesthesiol Scand

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“…Propofolanwendung reduziert die Häufigkeit von Laryngospasmen [13,19,36]. Epilepsietypische EEG-Verände-rungen, die während inhalativer Einleitung mit Sevofluran auftreten können, wurden unter Propofolapplikation nicht gefunden [26,31,42].…”

Section: Tab 3 Postoperative Unruhezustände Erbrechen Und Dipidolorunclassified

Propofoleinsatz für Hals-Nasen-Ohren-Eingriffe im Kindesalter

et al. 2006

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“…Die Arbeitsgruppe um Schultz beobachtete, dass es unter Maskeneinleitung von Kindern zu anfallsartigen, krampfähnlichen Veränderungen im EEG kam und zitieren weitere Berichte anderer Autoren,die ebenfalls pathologische Veränderungen im EEG unter Sevofluran beobachtet haben [106]. Die Autoren berichten ferner über eine älte-re Patientin, die zweimal eine Narkose erhalten hat.Während es unter Propofol zu keinen pathologischen Veränderungen im EEG kam, kam es bei der zweiten Narkose, die mit Sevofluran durchgeführt wurde, epilepsietypische Veränderungen im EEG [107].…”

Section: Postoperative Agitationunclassified

“…Bislang ist keine einfache Lösung in Sicht, mit der die kontinuierliche Infusion am Austritt der Veneverweilkanüle kontrolliert werden kann. Schultz u. Schultz [107] berichten aber, dass durch eine kontinuierliche EEGÜberwachung die unterbrochene Propofolinfusion durch ein Wacherwerden im EEG sicher erkannt wurde. An der eigenen Klinik erfolgt die Überwachung der Narkosen immer mit EEG (Narcotrend ® ), damit Fälle von Wachheit infolge unterbrochener Infusionen verhindert werden können.Eine kontinuierliche Messung der Serumspiegel (durch Biosensoren?)…”

Section: Kontrolle Der Infusionunclassified

Total intraven�se An�sthesie

Strauß

Giest

2003

Der Anaesthesist

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Since venous cannulation in children has become easier and extensive experience has been gained with total intravenous anaesthesia (TIVA) in adults, the interest in TIVA for children has recently increased. An intensified sensitivity of the operating room atmosphere to contamination with volatile anaesthetic agents is another important reason to choose intravenous techniques for paediatric anaesthesia. One of the most interesting agents for TIVA in paediatric anaesthesia is propofol. The pharmacokinetic and pharmacodynamic data for modern intravenous drugs is poor. Because the interpatient variability is relatively large, pharmacokinetic data can only provide guidelines for the dosage of propofol. Propofol has a rapid and smooth onset of action and is as easy to titrate in children as in adults. Propofol can be excellently controlled. Severe haemodynamic side-effects are missing in healthy children and plasma is cleared rapidly of propofol by redistribution and metabolism. There is no evidence of significant accumulation, not even after prolonged infusion times. Because propofol has no analgetic properties it must be combined with analgetics or a regional block for all painful procedures. The combination with the ultra-short acting remifentanil is a major advantage, but requires effective analgetic concepts for painful procedures. In comparison the combination of propofol with long acting opioids abolishes some of the favourable properties of propofol. Further studies of the kinetics and dynamics of propofol and other intravenous agents are needed in paediatrics which should focus on age, maturity and severity of illness. The whole importance of the propofol-infusion syndrome has to be cleared up urgently. TIVA has an important significance in paediatric anaesthesia for diagnostic and therapeutic procedures, especially where these have to be repeated. In day-case anaesthesia TIVA has advantages for all short procedures and for ENT and ophthalmic surgery: even after prolonged infusion children have an short recovery time. There is no evidence of agitation or other behavioural disorders after TIVA with propofol in paediatric anaesthesia. Propofol has anti-emetic properties. TIVA with propofol can be combined with regional anaesthesia advantageously to provide long-lasting analgesia after surgery. TIVA with propofol has been used successfully for sedation of spontaneously breathing children for MRI and CT and other procedures with open airways like bronchoscopy or endoscopy. Propofol facilitates endotracheal intubation without the use of muscle relaxants. Of course, in malignant hyperthermia TIVA will continue to be the technique of choice. Nothing is known about awareness under TIVA in paediatric patients. TIVA must be considered by comparison with the volatile agents. The use of ultra-short acting agents may cause problems such as awareness, vagal response, involuntary movements and in some cases slow recovery after prolonged infusion of propofol. But it is not known exactly how often this happens during paediatri...

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Epilepsietypische EEG-Aktivität: Auftreten bei Sevoflurananflutung und nicht unter Propofolapplikation

Cited by 19 publications

References 8 publications

Convulsions on anaesthetic induction with sevoflurane in young children

Convulsions on anaesthetic induction with sevoflurane in young children

Propofoleinsatz für Hals-Nasen-Ohren-Eingriffe im Kindesalter

Total intraven�se An�sthesie

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