title: The effect of sevoflurane on electrocorticographic spike activity in pediatric patients with epilepsy.
abstract: BACKGROUND
  Electrocorticogram (ECoG) spike activity is enhanced under general anesthesia with 1.5 minimum alveolar concentration (MAC) sevoflurane compared with lower concentrations in adult patients with epilepsy. However, the effect of concentration of sevoflurane on ECoG in children with epilepsy is less known.
  
  
  OBJECTIVE
  The primary endpoint was to investigate the effects of sevoflurane on ECoG spike activity in pediatric patients undergoing epilepsy surgery. The secondary endpoint was to examine its effects on baseline ECoG including burst suppression.
  
  
  METHODS
  Children of age 3-18 years with medically intractable epilepsy undergoing corpus callosotomy or resection of the epileptic foci (n = 11) were enrolled. Electrodes were placed on the brain surface and ECoG was recorded under anesthesia with endtidal carbon dioxide tension at 30 mmHg and sevoflurane at 2.5%, followed by age-adjusted 1.5 MAC (3.1-3.4%) for 10 min. The number of leads with spikes, the average number of spikes per lead per minute, median frequency of ECoG, and duration of suppression of ECoG ≥ 1 s were compared between 2.5% and 1.5 MAC sevoflurane.
  
  
  RESULTS
  The number of leads with spikes increased [11 vs 14, P = 0.003, difference in mean (95% CI) is 3 (2-5)], and the average number of spikes increased [9 vs 14·lead-1·min-1, P = 0.003, difference in mean (95% CI) is 5 (2-8) lead-1·min-1] under anesthesia with 1.5 MAC compared with 2.5% sevoflurane. Median frequency was decreased [2.8 Hz vs 2.0 Hz, P = 0.003, difference in mean (95% CI) is 0.8 (0.4-1.2) Hz], and the duration of suppression was increased [105 s vs 262 s, P < 0.001, difference in mean (95% CI) is 156 (90-223) s] with 1.5 MAC compared with 2.5% sevoflurane.
  
  
  CONCLUSIONS
  Sevoflurane at 1.5 MAC significantly increased the extent and the number of spikes, prolonged the duration of suppression, and decreased median frequency of ECoG compared with those at 2.5% sevoflurane.
authors.affiliation: Department of Anesthesiology, Osaka City General Hospital, Osaka, Japan.
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Anesthesiology, Osaka City General Hospital, Osaka, Japan.
authors.forename: Yutaka
authors.identifier: http://orcid.org/0000-0002-1111-7162
authors.initials: Y
authors.lastname: Oda
authors.affiliation: Department of Anesthesiology, Osaka City General Hospital, Osaka, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Ryokai
authors.affiliation: Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Uda
authors.affiliation: Department of Pediatric Neurosurgery, Osaka City General Hospital, Osaka, Japan.
authors.forename: Noritsugu
authors.initials: N
authors.lastname: Kunihiro
authors.affiliation: Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kuki
authors.affiliation: Department of Anesthesiology, Osaka City General Hospital, Osaka, Japan.
authors.forename: Ryu
authors.initials: R
authors.lastname: Okutani
mesh_terms: D000293:Adolescent; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D001921:Brain / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography / Q000187:drug effects*; D004827:Epilepsy / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology*; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane
keywords: child; electroencephalogram; epilepsy; sevoflurane