title: Ingestion of stimulant medications does not alter bispectral index or clinical depth of anesthesia at 1 MAC sevoflurane in children.
abstract: OBJECTIVE
  Children treated with stimulant medications for the behavioral management of attention deficit hyperactivity disorder (ADHD) may present for elective surgery. Stimulant medication is often continued until the morning of surgery to optimize perioperative behavior. It is unknown whether such stimulant drug ingestion can affect cerebral arousal and alter depth of anesthesia. A clinically relevant alteration in measured depth of anesthesia could form the basis for an evidence-based recommendation that children taking stimulant medications require a change in the amount of anesthetic delivered or that they require routine monitoring of depth of anesthesia.
  
  
  METHODS
  Thirty-four ASA 1 and 2 children aged between 5 and 16, presenting for elective day case surgery, were recruited. Seventeen had a diagnosis of ADHD and had taken stimulant medication on the day of surgery, and 17 were controls. A standard inhalational induction of anesthesia using air, oxygen, and sevoflurane by facemask was performed and maintained for 10 min at 1 MAC endtidal sevoflurane. During this time, no other stimulus was applied to the patient. Bispectral index (BIS) and other markers of depth of anesthesia were recorded after 10 min.
  
  
  RESULTS
  Children in both groups were of similar ages and weights. There were a higher percentage of boys in the stimulants group. Baseline physiological parameters were similar in both groups. After induction and equilibration for 10 min of anesthesia at 1 MAC endtidal sevoflurane, there was no significant difference in BIS or clinical markers of depth of anesthesia.
  
  
  CONCLUSIONS
  Children taking stimulant medication for ADHD, and who ingest medication on the day of surgery, do not appear to have altered BIS or depth of anesthesia at 1 MAC of sevoflurane. These results do not support a recommendation for a change in anesthetic practice for children having ingested stimulants up to the day of surgery, either in terms of increasing the amount of anesthetic given or monitoring of depth.
authors: Princess Margaret Hospital for Children, Subiaco, WA, Australia. neil.chambers@health.wa.gov.au
authors: Neil A
authors: NA
authors: Chambers
authors: Elaine
authors: E
authors: Pascoe
authors: Serge
authors: S
authors: Kaplanian
authors: Ian
authors: I
authors: Forsyth
mesh_terms: D000293:Adolescent; D000556:Ambulatory Surgical Procedures; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications* / Q000188:drug therapy; D000697:Central Nervous System Stimulants / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D056805:Consciousness Monitors; D003913:Dextroamphetamine / Q000009:adverse effects; D004347:Drug Interactions; D004569:Electroencephalography / Q000187:drug effects; D023381:Endpoint Determination; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008738:Methyl Ethers; D008774:Methylphenidate / Q000009:adverse effects; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D000697:Central Nervous System Stimulants; D008738:Methyl Ethers; D008774:Methylphenidate; D000077149:Sevoflurane; D003913:Dextroamphetamine