Tonic-Clonic Activity after Sufentanil

Seizures in a 77‐year‐old‐woman after a bolus dose of remifentanil

“…Seizure-like events have been reported for all opioids of the fentanyl group (3)(4)(5). The effect of these opioids to induce activity in epileptogenic areas of the brain has been used to localize these during epilepsy surgery (6).…”

“…We have experienced seizures in a patient with no previous history of epilepsy after a 50-mg bolus dose of remifentanil. The ability to induce seizure-like events has previously been described for other opioids of the fentanyl group (3)(4)(5).…”

Mechanism of Action of Opioids and Clinical Effects

“…Pethidine (meperidine), morphine, alfentanil, fentanyl and sufentanil when administered in doses above 20, 180, 5, 4 and 4 mg/kg body weight respectively, induced epileptogenic discharges [103]. Because such massive dosages are never used in anesthesia or for analgesia in acute or chronic pain, epileptogenic effects, although being cited in the literature after fentanyl [104,105] and sufentanil [106] are of insignificant nature. This is because the clinical picture resembles tonicclonic seizures, however, in the EEG no such discharges could be derived [107].…”

Electrocorticography

“…The anaesthetic agents used for the operative procedure can have significant effects on the ECOG. Sufentanil, fentanyl, alfentanil, propofil methohexital have been reported to produce epileptiform changes on ECOG, whereas halothane, barbituates and benzodiazepines may suppress the epileptic activity [3][4][5][6][7]. Both nitrous oxide and isoflurane have been reported to affect the ECOG, but more recent reports have suggested that this is not the case when low concentrations are used [8,9).…”