title: Effect of isolated anticonvulsant drug use and associated to midazolam as pre-anesthetic medication on the Bispectral Index (BIS) in patients with cerebral palsy.
abstract: OBJECTIVE
  Patients with cerebral palsy (CP) frequently receive drugs for the treatment of concomitant diseases, such as seizures. Midazolam is a benzodiazepine with hypnotic action most often used as pre-anesthetic medication and its drug interactions in patients with CP are unknown. The objective of the present study was to evaluate the effect of midazolam as pre-anesthetic drug on the BIS of patients with CP undergoing chronic treatment with anticonvulsant agents.
  
  
  METHODS
  Three groups of patients were assessed: CP without anticonvulsant treatment, CP undergoing treatment with anticonvulsant and a group with no disease and no medication use (control group). On the day before the surgery, with the patients conscious and in dorsal decubitus, the BIS monitor was placed and the basal BIS values were recorded. On the following day, 40 minutes before the surgery, the patients received 0.6 mg*kg(-1) of midazolam orally. Before the start of the anesthetic procedure, the same procedure for BIS recording was carried out after midazolam administration.
  
  
  RESULTS
  A total of 107 patients were studied - 39 patients from the Control Group (CG) and 68 with a diagnosis of CP. Among these, 17 used anticonvulsant drugs. Regarding the mean BIS value after the midazolam administration, there was no difference between patients from the CG and those in the CP group that did not take anticonvulsant drugs, whereas the ones who took anticonvulsants exhibited a difference (p = 0.003). The possibility of decrease in the BIS after midazolam use increases according to the number of anticonvulsant drugs used by the patient.
  
  
  CONCLUSIONS
  The chronic use of anticonvulsants associated to oral midazolam as pre-anesthetic medication can lead to the decrease in the BIS values, which configures deep level of hypnosis.
authors.affiliation: Hospital Sarah, Brasília, DF. veve@sarah.br
authors.forename: Verônica Vieira
authors.initials: VV
authors.lastname: da Costa
authors.forename: Renato Angelo
authors.initials: RA
authors.lastname: Saraiva
authors.forename: Rafael Villela Derré
authors.initials: RV
authors.lastname: Torres
authors.forename: Sandro Barbosa
authors.initials: SB
authors.lastname: de Oliveira
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003243:Consciousness / Q000187:drug effects*; D056805:Consciousness Monitors; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008874:Midazolam / Q000627:therapeutic use*; D016343:Monitoring, Intraoperative; D011229:Preanesthetic Medication; D011446:Prospective Studies
chemical_list: D000927:Anticonvulsants; D006993:Hypnotics and Sedatives; D008874:Midazolam