title: A rapid increase in the inspired concentration of desflurane is not associated with epileptiform encephalogram.
abstract: The large inspired concentration of sevoflurane (S) during mask induction of anesthesia can induce epileptiform electroencephalogram (EEG) associated with tachycardia. Tachycardia is also seen when the concentration of desflurane (D) is abruptly increased. It is not known whether this is associated with epileptiform EEG similar to S. We studied EEG and heart rate (HR) during rapidly increased concentrations of S or D in 31 females during the postintubation period of anesthesia. Anesthesia was induced with propofol and remifentanil, and the tracheas were intubated. Patients were randomized to receive either S or D in nitrous oxide-oxygen mixture after intubation, at a small dose first. After 10 min, S or D vaporizer was advanced to the highest reading of the vaporizer (7% for S, 18% for D) for 5 min. HR and EEG were recorded. Epileptiform EEG activity was recorded in eight of 15 patients in group S and in none in group D (P < 0.05). HR increased in both groups. In group S, HR increased gradually and the highest HR value was 84 bpm at 5 min after the increase in sevoflurane concentration. In group D, HR increased to 93 bpm 2 min after the increase in desflurane concentration (no significant difference, S versus D). A rapid increase in the concentration of S frequently induces epileptiform EEG during normoventilation. Tachycardia during increasing concentrations of D is not associated with epileptiform EEG.
  
  
  CONCLUSIONS
  A rapid increase in the concentration of sevoflurane induces epileptiform encephalogram (EEG) with tachycardia. A rapid increase in the concentration of desflurane also induces tachycardia but is not associated with epileptiform EEG.
authors.affiliation: *Department of Anesthesia and Intensive Care, Helsinki University Hospital, Helsinki, Finland; †Department of Clinical Neurophysiology, Tampere University Hospital, Tampere, Finland; ‡GE Healthcare Finland, Helsinki, Finland; and §Department of Anesthesia, Medical School, University of Tampere, and Department of Anesthesia and Intensive Care, Tampere University Hospital, Tampere, Finland.
authors.forename: Anne P
authors.initials: AP
authors.lastname: Vakkuri
authors.forename: Elina R
authors.initials: ER
authors.lastname: Seitsonen
authors.forename: Ville H
authors.initials: VH
authors.lastname: Jäntti
authors.forename: Mika
authors.initials: M
authors.lastname: Särkelä
authors.forename: Kari T
authors.initials: KT
authors.lastname: Korttila
authors.forename: Markku P J
authors.initials: MPJ
authors.lastname: Paloheimo
authors.forename: Arvi M
authors.initials: AM
authors.lastname: Yli-Hankala
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000009:adverse effects*; D000077335:Desflurane; D004311:Double-Blind Method; D004562:Electrocardiography / Q000187:drug effects; D004569:Electroencephalography / Q000187:drug effects*; D004809:Ephedrine / Q000008:administration & dosage / Q000627:therapeutic use; D004827:Epilepsy / Q000139:chemically induced* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007022:Hypotension / Q000188:drug therapy; D007431:Intraoperative Complications / Q000188:drug therapy; D007530:Isoflurane / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives*; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D016343:Monitoring, Intraoperative; D000077149:Sevoflurane; D013610:Tachycardia / Q000503:physiopathology; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D014662:Vasoconstrictor Agents; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane; D004809:Ephedrine