Effect of Sedation and Analgesia on Postoperative Amplitude-Integrated EEG in Newborn Cardiac Patients

Abstract

ABSTRACT:The aim of this study is to describe the effect of sedation and analgesia on postoperative amplitude-integrated EEG (aEEG) in newborns with congenital heart disease (CHD) undergoing heart surgery. This is a consecutive series of 26 newborns with CHD of which 16 patients underwent cardiopulmonary bypass (CPB) surgery and 10 patients did not. aEEG was monitored for at least 12 h preoperatively and started within the first 6 h postoperatively for 48 h. Outcome was assessed at 1 year of age. All 26 patients showed a normal preoperative continuous cerebral activity with sleep-wake cycles (SWC). The postoperative duration to return to normal background activity with SWC was similar for both groups. Independent of group assignment, patients requiring midazolam had a significantly later onset of a normal SWC than those without midazolam (p ϭ 0.03). Three patients in the CPB group and two in the non-CPB group showed continuous low voltage or flat trace after administration of fentanyl. These changes did not correlate with neurodevelopmental outcome. Sedation with midazolam has a transient effect on the background activity, whereas fentanyl can induce a severe pathologic background pattern. The significance of these changes on outcome is not yet clear. Thus, more attention should be paid to these effects when interpreting aEEG in this population. (Pediatr Res 67: 650-655, 2010)

Premedication for intubation with morphine causes prolonged depression of electrocortical background activity in preterm infants

“…The study was not randomized, and the aEEG depression may have been attributed to greater illness severity in the group who needed intubation or to a more rapid turnover of naloxone, with morphine effects persisting after naloxone reversal. Bolus doses of other opioids, sufentanil or fentanyl, can also induce profound and prolonged EEG depression in both preterm and term infants (2,6). Sleep pattern is altered with reduced rapid eye movement sleep after oxycodone administration (26), which is consistent with our results on depressed SWC after morphine administration.…”

“…Many of these drugs are known to cause cerebral depression (1)(2)(3)(4)(5)(6) and also arterial hypotension with potentially compromising cerebral side effects, especially in preterm infants (7)(8)(9). Only a few prospective studies have systematically evaluated drug effects on the electroencephalogram (EEG) in newborn infants (2,5,6,10,11). Because amplitude-integrated EEG (aEEG) and EEG monitoring are increasingly used in neonatal intensive care units (NICUs) (12), drug effects on neonatal aEEG/EEG should be characterized in relation to gestational age.…”

Impact of perinatal factors on continuous early monitoring of brain electrocortical activity in very preterm newborns by amplitude-integrated EEG

“…This has not been reported in term cardiac infants (23), but it has already been demonstrated for preterms after morphine bolus application (24). According to multivariate analyses, the suppressive effect of morphine was only seen for the qualitative aEEG but not for the quantitative measures.…”

Bispectral Index and Lower Margin Amplitude of the Amplitude-Integrated Electroencephalogram in Neonates

“…Both aEEG and BIS are prone to change when midazolam and/or opiates are administered [8,9,10,26]. We did not observe any statistically significant difference regarding the correlation index between infants with and without midazolam and/or opiates.…”

“…Several aEEG reports indicate that opiates and benzodiazepines, routinely used drugs in the neonatal intensive care setting, can suppress the lower margin amplitude (LMA) of the aEEG, a parameter that describes the EEG discontinuity [8,9,10,11]. …”