title: Sedative doses of remifentanil have minimal effect on ECoG spike activity during awake epilepsy surgery.
abstract: The use of remifentanil for sedation during awake epilepsy surgery has been described in a case report. However, little information is available regarding the effect of remifentanil on the quality of intraoperative electrocorticography (ECoG). This study was designed to investigate the effect of sedative doses of remifentanil on ECoG interictal spike activity among patients undergoing awake anterior temporal lobectomy for refractory epilepsy. Ten adult patients were studied prospectively. After baseline EcoG recordings were obtained, remifentanil was administered as a continuous infusion at 0.1 microg/kg/min and the ECoG recorded continuously for 15 minutes. Recordings obtained before and during the administration of remifentanil were compared with respect to spike frequency and location. A trend toward a small decrease in spike frequency was observed as patients became increasingly somnolescent and background ECoG activity slowed. The difference was not statistically significant. Blood pressure and heart rate were not adversely affected by the administration of remifentanil. Respiratory rates decreased in all patients (mean decrease, 8 breaths/min) and one patient transiently developed a respiratory rate of 4 breaths per minute that elicited a decrease in the rate of remifentanil administration. Remifentanil administered at sedation doses does not adversely affect intraoperatively recorded interictal spike activity. Further investigation of the use of this drug during awake epilepsy surgery is warranted.
authors.affiliation: Department of Anesthesia, London Health Sciences Center-University of Western Ontario, London, Ontario, Canada.
authors.forename: Ian A
authors.initials: IA
authors.lastname: Herrick
authors.forename: Rosemary A
authors.initials: RA
authors.lastname: Craen
authors.forename: Warren T
authors.initials: WT
authors.lastname: Blume
authors.forename: Teresa
authors.initials: T
authors.lastname: Novick
authors.forename: Adrian W
authors.initials: AW
authors.lastname: Gelb
mesh_terms: D000328:Adult; D002540:Cerebral Cortex / Q000187:drug effects / Q000502:physiology; D016292:Procedural Sedation; D003243:Consciousness; D004569:Electroencephalography / Q000187:drug effects*; D004833:Epilepsy, Temporal Lobe / Q000601:surgery*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007262:Infusions, Intravenous; D008297:Male; D016343:Monitoring, Intraoperative; D010880:Piperidines / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D000077208:Remifentanil
chemical_list: D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil