Electroencephalographic (EEG) density spectral array monitoring in children during sevoflurane anaesthesia: a prospective observational study

Abstract

Summary Electroencephalographic density spectral array monitoring has been developed to facilitate the interpretation of unprocessed electroencephalogram signals. The primary aim of this prospective observational study, performed in a tertiary children's hospital, was to identify the clinical applicability and validity of density spectral array monitoring in infants and children during sevoflurane anaesthesia. We included 104 children, aged < 6 years, undergoing elective surgery during sevoflurane anaesthesia. We investigated the correlation between non‐steady state end‐tidal sevoflurane and the expression of the four electroencephalogram frequency bands β, α, θ and δ, representing density spectral array. Patients were divided into three age groups (< 6 months, 6–12 months, > 12 months). There was a significant correlation between end‐tidal sevoflurane and density spectral array in the age groups 6–12 months (p < 0.05) and 1–6 years (p < 0.0001). In infants < 6 months of age, the relative percentages of density spectral array did not correlate with end‐tidal sevoflurane. The main finding was that different end‐tidal concentrations of sevoflurane produce age‐dependent changes in the density spectral array power spectrum. In infants younger than 6 months‐old, α and β coherence are absent, whereas θ and δ oscillations have already emerged. In cases where anaesthesia was too deep, this presented as burst suppression on the electroencephalogram, θ disappeared, leaving the electroencephalographic activity in the δ range. Future research should address this issue, aiming to clarify whether the emergence of θ oscillations in infants helps to prevent sevoflurane overdosing.

Intranasal dexmedetomidine is an effective sedative agent for electroencephalography in children

“…A small dose of propofol can increase beta waves, and a high dose of propofol increases the delta wave frequency due to the double action of propofol at different dosages [17]. Sevoflurane affects the number of slow delta and alpha waves [18]. The sedative drugs midazolam and chloral hydrate were used in the past; while they exhibited little interference with EEG, they had a long half-life, many side effects, high sedation failure rates and other undesirable characteristics [19,20].…”

Seizure-like movements caused by residual sevoflurane inside the anesthesia machine

“…Despite the frequent use of sevoflurane in anesthesia without adverse reactions, there have been several reports of sevoflurane-induced seizures in patients anesthetized with sevoflurane. [ 8 , 9 ] In these cases, the end-tidal concentration of sevoflurane ranged from 0.75% to 2.5%. Similar to our case, most previous reports of seizure-like activity during sevoflurane were characterized by symmetrical tonic-clonic motor activity, and no serious neurological adverse effects were found in the postoperative period.…”

Why do We Use the Concepts of Adult Anesthesia Pharmacology in Developing Brains? Will It Have an Impact on Outcomes? Challenges in Neuromonitoring and Pharmacology in Pediatric Anesthesia

“…For example, the full significance of electroencephalographic and functional imaging data obtained in children exposed to anesthetic is not yet fully understood. In a recent study on infants <6 months of age, the relative percentages of density spectral array did not correlate with end-tidal sevoflurane, there being an absence of coherence in alpha and beta frequencies [ 7 ]. This also applies to pharmacologic data.…”