title: Effect of sedation and analgesia on postoperative amplitude-integrated EEG in newborn cardiac patients.
abstract: The aim of this study is to describe the effect of sedation and analgesia on postoperative amplitude-integrated EEG (aEEG) in newborns with congenital heart disease (CHD) undergoing heart surgery. This is a consecutive series of 26 newborns with CHD of which 16 patients underwent cardiopulmonary bypass (CPB) surgery and 10 patients did not. aEEG was monitored for at least 12 h preoperatively and started within the first 6 h postoperatively for 48 h. Outcome was assessed at 1 year of age. All 26 patients showed a normal preoperative continuous cerebral activity with sleep-wake cycles (SWC). The postoperative duration to return to normal background activity with SWC was similar for both groups. Independent of group assignment, patients requiring midazolam had a significantly later onset of a normal SWC than those without midazolam (p=0.03). Three patients in the CPB group and two in the non-CPB group showed continuous low voltage or flat trace after administration of fentanyl. These changes did not correlate with neurodevelopmental outcome. Sedation with midazolam has a transient effect on the background activity, whereas fentanyl can induce a severe pathologic background pattern. The significance of these changes on outcome is not yet clear. Thus, more attention should be paid to these effects when interpreting aEEG in this population.
authors.affiliation: Department of Pediatric Intensive Care and Neonatology, Child Development Center, University Children's Hospital, Zurich, Switzerland. vera.bernet@kispi.uzh.ch
authors.forename: Vera
authors.initials: V
authors.lastname: Bernet
authors.forename: Beatrice
authors.initials: B
authors.lastname: Latal
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Natalucci
authors.forename: Carsten
authors.initials: C
authors.lastname: Doell
authors.forename: Anna
authors.initials: A
authors.lastname: Ziegler
authors.forename: Gabriele
authors.initials: G
authors.lastname: Wohlrab
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001921:Brain / Q000187:drug effects* / Q000254:growth & development / Q000503:physiopathology; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002657:Child Development; D056805:Consciousness Monitors; D004569:Electroencephalography; D005283:Fentanyl / Q000627:therapeutic use*; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D008874:Midazolam / Q000627:therapeutic use*; D009020:Morphine / Q000627:therapeutic use*; D009460:Neurologic Examination; D012890:Sleep / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome; D014851:Wakefulness / Q000187:drug effects
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D009020:Morphine; D008874:Midazolam; D005283:Fentanyl