Epileptogenic Effect of Sevoflurane

Gibert, Stéphanie; Sabourdin, Nada; Louvet, Nicolas; Moutard, Marie‐Laure; Piat, V.; Guye, Marie-Laurence; Rigouzzo, A.; Constant, Isabelle

doi:10.1097/aln.0b013e318273e272

Cited by 79 publications

(21 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The concentrations reported by Gibert et al [14] are higher. Reasons for the difference may be that in the own analysis the endtidal concentrations were already noted shortly before the epileptiform patterns appeared, and that the first epileptiform patterns, not only major epileptiform patterns, were included.…”

Section: Discussionmentioning

confidence: 69%

“…In children receiving sevoflurane in 100% O 2 under steady-state conditions, the lowest endtidal concentration causing major epileptiform signs, which were characterized by rhythmicity, was 4.3% in a study by Gibert et al [14]. The concentration was 4.5% when sevoflurane was given together with a mixture of N 2 O/O 2 (50∶50) or when 20 µg/kg alfentanil had been given before the study period [14].…”

Section: Discussionmentioning

confidence: 97%

“…The concentration was 4.5% when sevoflurane was given together with a mixture of N 2 O/O 2 (50∶50) or when 20 µg/kg alfentanil had been given before the study period [14].…”

Section: Discussionmentioning

confidence: 99%

“…Constant et al [5] and Gibert et al [14] recommend to use sevoflurane with a maximum of 1.5 MAC for maintenance of anaesthesia to reduce the possibility that major epileptiform signs, which are characterized by rhythmicity, occur in the EEG. The authors argue that it is reasonable to avoid circumstances favouring the emergence of these signs, particularly, because there are concerns about the safety of anaesthetic agents in the brain of young children.…”

Section: Discussionmentioning

confidence: 99%

“…Hyperventilation [4], speed of induction [7], high alveolar concentrations of sevoflurane [4], [8], [12], and female gender [2] are discussed in the literature as factors which may activate seizure-like motor activity as well as EEG abnormalities [13] during sevoflurane administration. As it is still not clear whether these EEG changes are of clinical relevance, some authors recommend to avoid them [14]. Holzki and Kretz [12] considered the use of sevoflurane in concentrations not higher than 5.0–5.5% in N 2 O during the induction period in order to prevent the occurrence of epileptiform EEG activity.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Influence of the Sevoflurane Concentration on the Occurrence of Epileptiform EEG Patterns

et al. 2014

View full text Add to dashboard Cite

Objectives and AimThis study was performed to analyse the effects of different sevoflurane concentrations on the incidence of epileptiform EEG activity during induction of anaesthesia in children in the clinical routine.BackgroundIt was suggested in the literature to use sevoflurane concentrations lower than 8% to avoid epileptiform activity during induction of anaesthesia in children.Methods100 children (age: 4.6±3.0 years, ASA I–III, premedication with midazolam) were anaesthetized with 8% sevoflurane for 3 min or 6% sevoflurane for 5 min in 100% O2 via face mask followed by 4% sevoflurane until propofol and remifentanil were given for intubation. EEGs were recorded continuously and were analysed visually with regard to epileptiform EEG patterns.ResultsFrom start of sevoflurane until propofol/remifentanil administration, 38 patients (76%) with 8% sevoflurane had epileptiform EEG patterns compared to 26 patients (52%) with 6% (p = 0.0106). Epileptiform potentials tended to appear later in the course of the induction with 6% than with 8%. Up to an endtidal concentration of 6% sevoflurane, the number of children with epileptiform potentials was similar in both groups (p = 0.3708). The cumulative number of children with epileptiform activity increased with increasing endtidal sevoflurane concentrations. The time from start of sevoflurane until loss of consciousness was similar in patients with 8% and 6% sevoflurane (42.2±17.5 s vs. 44.9 s ±14.0 s; p = 0.4073). An EEG stage of deep anaesthesia with continuous delta waves <2.0 Hz appeared significantly earlier in the 8% than in the 6% group (64.0±22.2 s vs. 77.9±20.0 s, p = 0.0022).ConclusionThe own analysis and data from the literature show that lower endtidal concentrations of sevoflurane and shorter administration times can be used to reduce epileptiform activity during induction of sevoflurane anaesthesia in children.

show abstract

Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 97%

“…The concentration was 4.5% when sevoflurane was given together with a mixture of N 2 O/O 2 (50∶50) or when 20 µg/kg alfentanil had been given before the study period [14].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%