title: Sevoflurane mask induction of anaesthesia is associated with epileptiform EEG in children.
abstract: BACKGROUND
  Sevoflurane inhalation induction of anaesthesia is widely used in paediatric anaesthesia. We have found that this method is frequently associated with epileptiform electroencephalogram (EEG) in adults, especially if controlled hyperventilation is used.
  
  
  METHODS
  We assessed EEG during sevoflurane inhalation induction in 31 children, aged 2-12 yr. Anaesthesia was induced with 8% sevoflurane in O2 in N2O 1:2. The patients were randomized to undergo controlled ventilation (CV group), or to breathe spontaneously (SB group) for 5 min. EEG was recorded as were noninvasive blood pressure and heart rate (HR). EEG recordings were classified by a clinical neurophysiologist.
  
  
  RESULTS
  Three different types of interictal epileptiform discharge were detected. Suppression with spikes (SSP) was found in 25% and 0% in the CV and SB groups, rhythmic polyspikes (PSR) in 44% and 20%, and periodic epileptiform discharges (PED) in 44% and 0% (P<0.01), respectively. The incidence of all different types of interictal epileptiform discharge (SSP+PSR+PED) was 88% and 20% (P<0.001), respectively. Epileptiform EEG was associated with increased heart rate and blood pressure during anaesthetic induction.
  
  
  CONCLUSIONS
  Both ventilation modes produced epileptiform EEG. With controlled ventilation, epileptiform discharges were seen in 88% of children. This warrants further studies of the suitability of this induction type in general, and especially in children with epilepsy.
authors.affiliation: Department of Anaesthesia and Intensive Care, Surgical Hospital, University of Helsinki, Helsinki, Finland. anne.vakkuri@hus.fi
authors.forename: A
authors.initials: A
authors.lastname: Vakkuri
authors.forename: A
authors.initials: A
authors.lastname: Yli-Hankala
authors.forename: M
authors.initials: M
authors.lastname: Särkelä
authors.forename: L
authors.initials: L
authors.lastname: Lindgren
authors.forename: S
authors.initials: S
authors.lastname: Mennander
authors.forename: K
authors.initials: K
authors.lastname: Korttila
authors.forename: L
authors.initials: L
authors.lastname: Saarnivaara
authors.forename: V
authors.initials: V
authors.lastname: Jäntti
mesh_terms: D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D002245:Carbon Dioxide / Q000097:blood; D002648:Child; D004569:Electroencephalography / Q000187:drug effects*; D004827:Epilepsy / Q000139:chemically induced* / Q000503:physiopathology; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006985:Hyperventilation; D017214:Laryngeal Masks / Q000009:adverse effects*; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects*; D012121:Respiration, Artificial; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D002245:Carbon Dioxide; D000077149:Sevoflurane