Sevoflurane requirements during electroencephalogram (EEG)-guided vs standard anesthesia Care in Children: A randomized controlled trial

Long, Melody H Y; Lim, Eileen C.P.; Balanza, Gustavo A; Allen, John C.; Purdon, Patrick L.; Bong, Choon Looi

doi:10.1016/j.jclinane.2022.110913

Cited by 11 publications

(22 citation statements)

References 27 publications

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“…9,10 A recent randomized controlled trial demonstrated that EEG monitoring reduces sevoflurane requirements and incidence of burst suppression during anesthesia in young children. 11 However, the use of EEG-guided anesthesia in children is not routine, possibly due in part to a lack of practical knowledge on how to use the EEG clinically.…”

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confidence: 99%

“…A total of 304 unique articles were screened, 73 underwent full-text review and 59 were included. 11–68 (Supplemental Digital Content 1, Search Strategy, http://links.lww.com/AA/E81.) There were 13 review articles, 12–24 10 of which discussed the role and limitations of EEG monitoring during pediatric anesthesia, 12–21 including 4 relating to cardiac anesthesia.…”

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confidence: 99%

“…There were 13 review articles, [12][13][14][15][16][17][18][19][20][21][22][23][24] 10 of which discussed the role and limitations of EEG monitoring during pediatric anesthesia, [12][13][14][15][16][17][18][19][20][21] including 4 relating to cardiac anesthesia. [18][19][20][21] Seven randomized controlled trials investigated EEG-guidance during anesthesia, 11,25,30 several of which demonstrated benefit. 11,[27][28][29] Eight observational studies 9,10,[31][32][33][34][35] demonstrated usefulness of EEG-guided anesthesia in children, and 32 observational studies described anesthesia-induced changes in children's brains.…”

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confidence: 99%

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A Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children

Bong

Balanza

Khoo

et al. 2022

Anesthesia &Amp; Analgesia

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The major therapeutic end points of general anesthesia include hypnosis, amnesia, and immobility. There is a complex relationship between general anesthesia, responsiveness, hemodynamic stability, and reaction to noxious stimuli. This complexity is compounded in pediatric anesthesia, where clinicians manage children from a wide range of ages, developmental stages, and body sizes, with their concomitant differences in physiology and pharmacology. This renders anesthetic requirements difficult to predict based solely on a child’s age, body weight, and vital signs. Electroencephalogram (EEG) monitoring provides a window into children’s brain states and may be useful in guiding clinical anesthesia management. However, many clinicians are unfamiliar with EEG monitoring in children. Young children’s EEGs differ substantially from those of older children and adults, and there is a lack of evidence-based guidance on how and when to use the EEG for anesthesia care in children. This narrative review begins by summarizing what is known about EEG monitoring in pediatric anesthesia care. A key knowledge gap in the literature relates to a lack of practical information illustrating the utility of the EEG in clinical management. To address this gap, this narrative review illustrates how the EEG spectrogram can be used to visualize, in real time, brain responses to anesthetic drugs in relation to hemodynamic stability, surgical stimulation, and other interventions such as cardiopulmonary bypass. This review discusses anesthetic management principles in a variety of clinical scenarios, including infants, children with altered conscious levels, children with atypical neurodevelopment, children with hemodynamic instability, children undergoing total intravenous anesthesia, and those undergoing cardiopulmonary bypass. Each scenario is accompanied by practical illustrations of how the EEG can be visualized to help titrate anesthetic dosage to avoid undersedation or oversedation when patients experience hypotension or other physiological challenges, when surgical stimulation increases, and when a child’s anesthetic requirements are otherwise less predictable. Overall, this review illustrates how well-established clinical management principles in children can be significantly complemented by the addition of EEG monitoring, thus enabling personalized anesthesia care to enhance patient safety and experience.

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A Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children

Bong

Balanza

Khoo

et al. 2022

Anesthesia &Amp; Analgesia

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“…In line with this, several human studies used surface brain electrical activity method, called EEG under anesthesia, and have demonstrated that anesthetic agents reduce EEG amplitude through incidence of burst suppression by reducing the amount of synaptic neuronal acticvity 60,61 . However, the pattern depends on the type and dosage of the agent 62,63 .…”

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“…6 In line with this, several human studies used surface brain electrical activity method, called EEG under anesthesia, and have demonstrated that anesthetic agents reduce EEG amplitude through incidence of burst suppression by reducing the amount of synaptic neuronal acticvity. 60,61 However, the pattern depends on the type and dosage of the agent. 62,63 For instance, Cornelissen et al have reported that the slow and delta oscillation measured by EEG under anesthesia is due to anesthetic-induced reduction in major excitatory brainstem inputs to the cortex.…”

Section: Effect Of Anesthesia On Neuronal Activitymentioning

confidence: 99%

Vascular and neuronal effects of general anesthesia on the brain: An fMRI study

Vedaei

Alizadeh

Tantawi

et al. 2022

Journal of Neuroimaging

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Background and Purpose A number of functional magnetic resonance imaging (fMRI) studies rely on application of anesthetic agents during scanning that can modulate and complicate interpretation of the measured hemodynamic blood oxygenation level‐dependent (BOLD) response. The purpose of the present study was to investigate the effect of general anesthesia on two main components of BOLD signal including neuronal activity and vascular response. Methods Breath‐holding (BH) fMRI was conducted in wakefulness and under anesthesia states in 9 patients with drug‐resistant epilepsy who needed to get scanned under anesthesia during laser interstitial thermal therapy. BOLD and BOLD cerebrovascular reactivity (BOLD‐CVR) maps were compared using t‐test between two states to assess the effect of anesthesia on neuronal activity and vascular factors (p < .05). Results Overall, our findings revealed an increase in BOLD‐CVR and decrease in BOLD response under anesthesia in several brain regions. The results proposed that the modulatory mechanism of anesthetics on neuronal and vascular components of BOLD signal may work in different ways. Conclusion This experiment for the first human study showed that anesthesia may play an important role in dissociation between neuronal and vascular responses contributed to hemodynamic BOLD signal using BH fMRI imaging that may assist the implication of general anesthesia and interpretation of outcomes in clinical setting.

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