EEGs during High-Dose Fentanyl-, Sufentanil-, or Morphine-Oxygen Anesthesia

Smith, N. Ty; Dec-Silver, H.; Sanford, Ted J.; Westover, Charles J.; Quinn, Michael J.; Klein, F.; Davis, Dirk A

doi:10.1213/00000539-198404000-00002

Cited by 35 publications

(14 citation statements)

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“…High-dose morphine (1-2 mg/kg, IV) during open-heart surgery was associated with progressive slowing of EEG activity and an increase in low-frequency amplitude. No epileptiform activity was noted (114). Electroencephalographic investigations have not been performed in epileptic patients during high-dose morphine administration.…”

Section: Morphinementioning

confidence: 99%

Pro-and Anticonvulsant Effects of Anesthetics (Part I)

Modica

Tempelhoff

White

1990

Anesthesia & Analgesia

148

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Many inhaled anesthetics and intravenous analgesics have been alleged to produce both proconvulsant and anticonvulsant activity in humans. The reasons for these contrasting actions on the CNS are poorly understood at the present time. However, biologic variability plays an important role in determining individual patient's responses to anesthetic and analgesic drugs. In addition, variations in the responsiveness of inhibitory and excitatory neurons to the central depressant effects of these drugs could also explain these apparently conflicting data. Depending on the brain concentration, centrally active drugs may produce differing effects on the CNS inhibitory and excitatory neurotransmitter systems. The availability of increasingly powerful magnetic resonance imaging techniques to provide noninvasive information about tissue chemistry (e.g., neurotransmitters and citric acid cycle metabolites) and positron emission tomography to noninvasively evaluate CNS drug-receptor interactions should lead to a more in-depth understanding of the in vivo effects of anesthetics and analgesics on the CNS. In the second part of this review article, we discuss the pro- and anticonvulsant effects of the sedative-hypnotics, local anesthetics, and other anesthetic adjuvant drugs.

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Section: Morphinementioning

confidence: 99%

Pro-and Anticonvulsant Effects of Anesthetics (Part I)

Modica

Tempelhoff

White

1990

Anesthesia & Analgesia

148

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“…In surgical patients, the inject able opioid anesthetics, fentanyl, sufentanil, and alfen tanil, increased abundance of EEG delta power and de creased abundance of alpha and/or beta power (Sebel et al 1981;Bovill et al 1983;Smith et al 1984;Wau quier et al 1984;Bromm et al 1989;Scott et al 1991). In contrast, in normal, pain-free human subjects, a small decrease in delta, an increase in slow alpha with a de crease in relative fast alpha, and an increase in beta power occurred 1 to 2 hours after subcutaneous administra tion of morphine (4 and 8 mg) (Matejcek et al 1988).…”

mentioning

confidence: 99%

Morphine Effects on the Spontaneous Electroencephalogram in Polydrug Abusers: Correlations with Subjective Self-Reports

Phillips

Herning

London

1994

Neuropsychopharmacol

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The spontaneous electroencephalogram (EEG) was recorded after the intramuscular (IM) injection of morphine sulfate (15, 30 mg) or saline (0.9% NaCl). Correlations between changes in EEG spectral power and subjective self-reports, as measured on subscales of the Addiction Research Center Inventory (ARC!), were evaluated. Morphine increased alphaJ and alpha2 power and theta power, and attenuated the increase in delta power observed after placebo. Positive correlations were found between the change in alpha1, alpha2, beta1, and beta2 power in response to 30 mg of morphine and scores

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“…Benzodiazepines and opioids increase delta activity at high doses (33)(34)(35). Dosing in our patients was within the recommended range, and at the time of EEG slowing dosing was usually lower than during surgery and during the first postoperative hours.…”

Section: Discussionmentioning

confidence: 59%

“…No or only a minimal increase of ␦P (102-227%) was observed in five children (2,7,8,16, and 29), and ␦P always below the preoperative values (Ͻ100%) occurred in four of five neonates (33)(34)(35)(36) and in three of 31 older children (15, 26, and 27).…”

Section: Resultsmentioning

confidence: 83%

Electroencephalographic Changes after Pediatric Cardiac Surgery with Cardiopulmonary Bypass: Is Slow Wave Activity Unfavorable?

et al. 2005

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Pediatric cardiac surgery with cardiopulmonary bypass (CPB) is frequently associated with neurologic deficits. We describe the postoperative EEG changes, assess their possible causes, and evaluate their relevance to neurologic outcome. Thirty-one children and five neonates with congenital heart disease were included. EEG recording started after intubation and continued until 22-96 h after CPB. In addition to conventional analysis, spectral analysis was performed for occipital and frontal electrodes, and differences between pre-and postoperative delta power (delta-␦P) were calculated. Maximum values of occipital delta-␦P that occurred within 48 h after CPB were correlated with clinical variables and with perioperative markers of oxidative stress and inflammation. Occipital delta-␦P correlated with frontal delta-␦P, and maximum delta-␦P correlated with conventional rating. Distinct rise of ␦P was detected in 18 of 21 children without any acute or long-term neurologic deficits but only in five of 10 children with temporary or permanent neurologic deficits. Furthermore, maximally registered delta-␦P was inversely associated with duration of CPB and postoperative ventilation. Maximal delta-␦P was also inversely associated with the loss of plasma ascorbate (as an index of oxidative stress) and plasma levels of IL-6 and IL-8. Slow wave activity frequently occurs within 48 h after CPB. However, our data do not support the notion that EEG slowing is associated with adverse neurologic outcome. This is supported by the fact that EEG slowing was associated with less oxido-inflammatory stress. Abbreviations AC, aortic cross-clamping CPB, cardiopulmonary bypass FFT, fast Fourier transformation max delta-␦P, maximum difference between pre-and postoperative delta power MDA, malondialdehyde MDA-TNL, malondialdehyde corrected for total neutral lipids ␦P, delta power delta-␦P, difference between pre-and postoperative delta power Cardiac surgery with cardiopulmonary bypass (CPB) in children and neonates is frequently associated with acute neurologic symptoms and long-term neurologic deficits (1-4). Neuropsychological deficits persist in a substantial number of patients. During the intraoperative period, a global decrease in perfusion and oxygen delivery and focal ischemia related to embolic insults or diffuse microvascular changes are the principal mechanisms of brain damage (5). Systemic inflammation and reactive oxygen species generated by CPB might contribute to postoperative neurologic dysfunction (6,7). Impaired cerebral vasoregulation and ischemia/reperfusion injury continues in the early postoperative period (8,9). Postoperative cardiopulmonary dysfunction may additionally threaten cerebral perfusion pressure and oxygen delivery. However, there is an increased energy demand to restore neuronal membrane function and ionic gradients that are compromised by CPB.Events that affect the brain are usually followed by neuronal dysfunction, which can often be detected by EEG changes.

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EEGs during High-Dose Fentanyl-, Sufentanil-, or Morphine-Oxygen Anesthesia

Cited by 35 publications

References 0 publications

Pro-and Anticonvulsant Effects of Anesthetics (Part I)

Pro-and Anticonvulsant Effects of Anesthetics (Part I)

Morphine Effects on the Spontaneous Electroencephalogram in Polydrug Abusers: Correlations with Subjective Self-Reports

Electroencephalographic Changes after Pediatric Cardiac Surgery with Cardiopulmonary Bypass: Is Slow Wave Activity Unfavorable?

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