Electroencephalographic changes and their regional differences during pediatric cardiovascular surgery with hypothermia.
Monitoring brain function by EEG is an important means of preventing cerebral insults in pediatric cardiovascular surgery. We studied intraoperative EEG changes and their regional differences associated with hypothermia and brain ischemia. The subjects of this study consisted of 13 children ranging in age from 4 months to 4 years and 6 months. Multi-channel EEGs were recorded using a portable digital EEG system, and the EEG changes were examined by visual inspection and computerized analyses. The results were as follows. (1) During cooling, a discontinuous EEG pattern was transiently observed in four patients, and this phenomenon indicated rapid suppression of cerebral function and subsequent adaptation. (2) Regarding the patterns of change in equivalent potentials induced by hypothermia, there were two different patterns depending on the degree of hypothermia, and the borderline rectal temperature was found to be around 32 degrees C. (3) During cooling, regional differences in the changes in equivalent potentials were observed in nine patients. A decrease in slow waves was marked in the occipital head area, and a decrease in fast waves was prominent in the anterior head area. (4) Arterial hypotension caused transient EEG abnormalities. Of them, bilaterally synchronous rhythmic high voltage slow waves were remarkable and exhibited bifrontal or bicentral dominance. (5) The EEG changes induced by hypothermia were influenced not only by the rectal temperature itself, but also by the rate of change in rectal temperature, and we speculated that this phenomenon was a result of adaptation. In intraoperative EEG monitoring, these findings constitute the basis for early detection of a cerebral hypoxic-ischemic state during pediatric cardiovascular surgery.
Akiyama
T
T
Department of Child Neurology, Okayama University Medical School, 2-5-1 Shikata-cho, Okayama 700-8558, Japan. takiyama@md.okayama-u.ac.jp
Kobayashi
K
K
Nakahori
T
T
Yoshinaga
H
H
Ogino
T
T
Ohtsuka
Y
Y
Takeuchi
M
M
Morita
K
K
Sano
S
S
Oka
E
E
D001831:Body Temperature / Q000502:physiology; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D002540:Cerebral Cortex / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology; D002675:Child, Preschool; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects*; D020925:Hypoxia-Ischemia, Brain / Q000503:physiopathology* / Q000517:prevention & control; D007223:Infant; D007431:Intraoperative Complications / Q000503:physiopathology* / Q000517:prevention & control*; D008297:Male; D016343:Monitoring, Intraoperative