Anesthetic-specific electroencephalographic patterns during emergence from sevoflurane and isoflurane in infants and children.
BACKGROUND
Devices that monitor the depth of anesthesia are increasingly used to titrate sedation and avoid awareness during anesthesia. Many of these monitors are based upon electroencephalography (EEG) collected from large adult reference populations and not pediatric populations (Anesthesiology, 86, 1997, 836; Journal of Anaesthesia, 92, 2004, 393; Anesthesiology, 99, 2003, 34). We hypothesized that EEG patterns in children would be different from those previously reported in adults and that they would show anesthetic-specific characteristics.


METHODS
This prospective observational study was approved by the Institutional Review Board, and informed written consent was obtained. Patients were randomized to receive maintenance anesthesia with isoflurane or sevoflurane. EEG data collection included at least 10 min at steady-state maintenance anesthesia. The EEG was recorded continuously through emergence until after extubation. A mixed model procedure was performed on global and regional power by pooled data analysis and by analyzing each anesthetic group separately. Statistical significance was defined as P < 0.05.


RESULTS
Thirty-seven children completed the study (ages 22 days-3.6 years). Isoflurane and sevoflurane had different effects on global and regional EEG power during emergence from anesthesia, and frontal predominance patterns were significantly different between these two anesthetic agents.


CONCLUSIONS
The principal finding of the present study was that there are anesthetic-specific and concentration-dependent EEG effects in children. Depth-of-anesthesia monitors that utilize algorithms based on the EEGs of adult reference populations therefore may not be appropriate for use in children.
Lo
Sansan S
SS
Department of Anesthesiology, Columbia University, New York, NY 10032, USA.
Sobol
Julia B
JB
Mallavaram
Navin
N
Carson
Margaret
M
Chang
Chung
C
Grieve
Philip G
PG
Emerson
Ronald G
RG
Stark
Raymond I
RI
Sun
Lena S
LS
D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000494:pharmacology*; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004569:Electroencephalography / Q000187:drug effects*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007530:Isoflurane / Q000008:administration & dosage / Q000494:pharmacology*; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage / Q000494:pharmacology*; D011446:Prospective Studies; D000077149:Sevoflurane; D016037:Single-Blind Method; D016896:Treatment Outcome
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D007530:Isoflurane