From the Departments of Anesthesiology and Critical Care Medicine.
Neurology and Pediatrics, The Children's Hospital of Philadelphia. University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
Anesth Analg. 2020 Feb;130(2):462-471. doi: 10.1213/ANE.0000000000004221.
In infants and young children, anesthetic dosing is based on population pharmacokinetics and patient hemodynamics not on patient-specific brain activity. Electroencephalography (EEG) provides insight into brain activity during anesthesia. The primary goal of this prospective observational pilot study was to assess the prevalence of isoelectric EEG events-a sign of deep anesthesia-in infants and young children undergoing general anesthesia using sevoflurane or propofol infusion for maintenance.
Children 0-37 months of age requiring general anesthesia for surgery excluding cardiac, intracranial, and emergency cases were enrolled by age: 0-3, 4-6, 7-12, 13-18, and 19-37 months. Anesthesia was maintained with sevoflurane or propofol infusion. EEG was recorded from induction to extubation. Isoelectric EEG events (amplitude <20 µV, lasting ≥2 seconds) were characterized by occurrence, number, duration, and percent of isoelectric EEG time over anesthetic time. Associations with patient demographics, anesthetic, and surgical factors were determined.
Isoelectric events were observed in 63% (32/51) (95% confidence interval [CI], 49-76) of patients. The median (interquartile range [IQR]) number of isoelectric events per patient was 3 (0-31), cumulative isoelectric time per patient was 12 seconds (0-142 seconds), isoelectric time per event was 3 seconds (0-4 seconds), and percent of total isoelectric over anesthetic time was 0.1% (0%-2.2%). The greatest proportion of isoelectric events occurred between induction and incision. Isoelectric events were associated with higher American Society of Anesthesiologists (ASA) physical status, propofol bolus, endotracheal tube use, and lower arterial pressure during surgical phase.
Isoelectric EEG events were common in infants and young children undergoing sevoflurane or propofol anesthesia. Although the clinical significance of these events remains uncertain, they suggest that dosing based on population pharmacokinetics and patient hemodynamics is often associated with unnecessary deep anesthesia during surgical procedures.
在婴儿和幼儿中，麻醉剂量是基于群体药代动力学和患者血液动力学而不是基于患者特定的大脑活动来确定的。脑电图 (EEG) 可提供麻醉期间大脑活动的信息。本前瞻性观察性初步研究的主要目标是评估在使用七氟醚或异丙酚输注维持麻醉的情况下，接受全身麻醉的婴儿和幼儿中常见的等电 EEG 事件（深度麻醉的标志）的发生率。
纳入年龄在 0-37 个月、需要全身麻醉行手术但不包括心脏、颅内和急诊手术的患儿。按年龄分组：0-3 个月、4-6 个月、7-12 个月、13-18 个月和 19-37 个月。麻醉采用七氟醚或异丙酚输注维持。从诱导到拔管期间记录脑电图。通过出现、数量、持续时间和麻醉时间内等电 EEG 时间的百分比来描述等电 EEG 事件（幅度 <20 µV，持续时间≥2 秒）。确定与患者人口统计学、麻醉和手术因素的关联。
63%（32/51）（95%置信区间 [CI]，49-76）的患者出现等电事件。每位患者的等电事件中位数（四分位距 [IQR]）为 3（0-31），每位患者的累计等电时间为 12 秒（0-142 秒），每次事件的等电时间为 3 秒（0-4 秒），麻醉时间内等电时间的百分比为 0.1%（0%-2.2%）。最大比例的等电事件发生在诱导和切开之间。等电事件与较高的美国麻醉医师协会（ASA）身体状况、异丙酚推注、气管内导管使用以及手术期间较低的动脉压相关。
在接受七氟醚或异丙酚麻醉的婴儿和幼儿中，等电 EEG 事件很常见。尽管这些事件的临床意义尚不确定，但它们表明，基于群体药代动力学和患者血液动力学的剂量通常与手术过程中不必要的深度麻醉相关。
