Robert Seeman | PubMed Health

PubMed2005

Inhalational anesthetics in pediatric anesthesia.

PURPOSE OF REVIEW: The purpose of this review is to discuss interesting recent developments concerning the use of halogenated agents. Now we are in a new stage of halogen use; we have become alerted to the secondary effects which although not life-threatening are potentially deleterious. RECENT FINDINGS: The recent literature highlighted some unexpected effects with the use of new halogens such as emergence agitation associated with rapid elimination of new anesthetics, or epileptogenic effect of sevoflurane. In addition, recent advances in monitoring of depth of anesthesia may contribute to a more-precise dosing of halogens and concomitant decrease of the deleterious side effects. SUMMARY: Based on this new approach, the therapeutic range of the new halogenated agents may be revisited and possibly narrowed.

Journal Article↗

PubMed2005

Sevoflurane and epileptiform EEG changes.

Sevoflurane has become the volatile agent of choice for inhalation induction of anesthesia. Hemodynamic stability and lack of respiratory irritation have justified its rapid extension to pediatric inhalation induction. The epileptogenic potential of sevoflurane has been suspected since the first case reports of abnormal movements in children without a history of epilepsy. The objectives of this short review are to: (i) analyze clinical and electroencephalographic (EEG) features supporting epileptogenic activity of sevoflurane, (ii) identify factors which may modulate that activity, and (iii) suggest guidelines of clinical practice to limit expression of this epileptiform phenomenon, which has thus far unknown morbidity. The use of sevoflurane may be associated with cortical epileptiform EEG signs, usually without clinical manifestation. No lasting neurological or EEG sequelae have been described thus far, and the potential morbidity of this epileptogenic effect is unknown. The use of sevoflurane in children, with its remarkable cardiovascular profile, should include a number of precautions. Among them, the limitation of the depth of anesthesia is essential. The wide use of cerebral function monitoring (the most simple being the EEG), may permit optimization of sevoflurane dose and avoidance of burst suppression and major epileptiform signs in fragile subjects, notably the very young and the very old.

Adult↗