title: The electroencephalograph during anesthesia and emergence in infants and children.
abstract: BACKGROUND
  The characteristics of the electroencephalogram (EEG) during anesthesia in children are poorly described. An understanding of the EEG during anesthesia may help explain and predict the performance of EEG-derived depth of anesthesia monitors in children. This study aims to describe the association between age and some basic characteristics of the EEG during nonstandardized anesthesia in children and infants.
  
  
  METHODS
  Sixty-four children aged 9 days to 12 years were enrolled in this observational physiological study. Anesthesia was given at the discretion of the anesthetist. EEG was recorded from after induction to emergence using a BRM2 brain monitor ''BrainZ Instruments, Auckland, New Zealand'' in parietal and frontal montages. For comparison, 90% spectral edge frequency (SEF-90) and power were determined at three points (equilibrium during anesthesia, when the volatile agent was discontinued and at emergence), and children were divided into three age groups (0-6 months, 6-24 months and 2-12 years).
  
  
  RESULTS
  Fifty-seven children had artifact-free EEG data. From equilibrium to emergence the mean forehead power decreased substantially in children aged 2-12 years (3171-153 microV(2), P < 0.001) and 6-24 months (756-140 microV(2), P < 0.001) but no difference was found in infants aged 0-6 months (93-63 microV(2), P = 0.4). From equilibrium to emergence mean forehead spectral edge frequency increased in children aged 2-12 years (10.8-13.7 Hz, P = 0.01) but no change was found in children aged 6-24 months (12.7-12.7 Hz, P = 0.9) or 0-6 months (9.45-7.26 Hz, P = 0.08). Throughout emergence, infants demonstrated a discontinuous EEG pattern with intermittent bursts separated with low amplitude.
  
  
  CONCLUSIONS
  During anesthesia, the EEG in infants is fundamentally different from the EEG in older children. This study supports the need for specific infant-derived algorithms if EEG-derived anesthesia depth monitors are to be used in infants.
authors: Department of Anaesthesia & Pain Management, Royal Children's Hospital, Melbourne, Australia. andrew.davidson@rch.org.au
authors: Andrew J
authors: AJ
authors: Davidson
authors: Steven M
authors: SM
authors: Sale
authors: Connie
authors: C
authors: Wong
authors: Stephen
authors: S
authors: McKeever
authors: Suzette
authors: S
authors: Sheppard
authors: Zeke
authors: Z
authors: Chan
authors: Chris
authors: C
authors: Williams
mesh_terms: D000375:Aging / Q000502:physiology*; D000758:Anesthesia; D000762:Anesthesia Recovery Period; D002648:Child; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D004569:Electroencephalography / Q000187:drug effects*; D005260:Female; D005546:Forehead / Q000502:physiology; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016343:Monitoring, Intraoperative; D011292:Premedication; D011446:Prospective Studies