Inhalation Anesthesia
Conditions
Keywords
sevoflurane, epileptiform EEG, midazolam, dexmedetomidine
Brief summary
Induction with high sevoflurane concentrations may trigger epileptiform electroencephalographic activity without motor or cardiovascular manifestations in healthy patients. No other symptoms were associated in this series, and only electroencephalographic monitoring allowed the diagnosis. Midazolam and dexmedetomidine are sedatives commonly used in children before surgery. Although the mechanisms are different, both have been reported in antiepileptic effects. This study was designed to compare the effects between intranasal midazolam or dexmedetomidine on epileptiform EEG during sevoflurane mask induction in children. Anaesthesia was induced with 8% sevoflurane. The patients were randomly assigned to Group A (n=15, preoperative intranasal normal saline), Group B (n=15, preoperative intranasal 0.25mg/kg midazolam), and Group C (n=15, preoperative intranasal 1μg/kg dexmedetomidine). An electroencephalogram was recorded before and during induction up to 10 min after the start of induction.
Interventions
DRUGPlacebos
Patients in Group A receive intranasal normal saline before anesthesia. Anaesthesia was induced with 8% sevoflurane initially. Sevoflurane concentration decreased to 2% after intubation. An electroencephalogram was recorded before and during induction up to 10 min after the start of induction.
DRUGMidazolam
Patients in Group B receive intranasal 0.25mg/kg midazolam before anesthesia. Anaesthesia was induced with 8% sevoflurane initially. Sevoflurane concentration decreased to 2% after intubation. An electroencephalogram was recorded before and during induction up to 10 min after the start of induction.
DRUGDexmedetomidine
Patients in Group C receive intranasal 1μg/kg dexmedetomidine before anesthesia. Anaesthesia was induced with 8% sevoflurane initially. Sevoflurane concentration decreased to 2% after intubation. An electroencephalogram was recorded before and during induction up to 10 min after the start of induction.
Sponsors
Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
1 Years to 12 Years
Healthy volunteers
No
Inclusion criteria
* ASA physical status 1-2 * Scheduled for general anesthesia
Exclusion criteria
* Patients with a history of neurological, mental illnes * Patients with a history of congenital heart disease * Patients with a history of allergies to related drugs
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| incidence of epileptiform EEG | 0 min after induction, up to 10 min | EEG were visually analyzed off-line by a neurophysiologist familiar with anesthesia EEG and blinded to the randomization. EEG abnormalities related to epileptic features were classified according to the description of Vakkuri and Jaaskelainen, and the recommendations of Constant: spikes and spikes with slow wave complexes (SW), rhythmic polyspikes corresponding to waveforms appearing at regular intervals (RPS) and periodic epileptiform discharge (PED), which refers to periodic hypersynchronized complexes occurring bilaterally. These entire electroencephalographic phenomena were considered as epileptiform EEG if their duration was longer than three seconds. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| electroencephalographic changes | 0 min after induction, up to 10 min | the delay between the start of induction and the first changes in electroencephalographic activity (appearance of β, θ, or δ rhythms) |
| hemodynamic changes | 1 min before induction | blood pressure |
| intubation time | 0 min after intubation | from taking of the intubation device to successful intubation |
Countries
China
Contacts
Primary ContactYu Sun, MD,PhD
Backup ContactChenyu Jin
Outcome results
None listed