Seizures Clinical Trial
Official title:
Influence of Volatile Induction of General Anaesthesia With Sevoflurane Using Two Different Techniques and Intravenous Induction Using Propofol on the Epileptiform Electroencephalograph Patterns:
The aim of the study was to assess the influence of volatile induction of general anaesthesia with sevoflurane using two different techniques and intravenous anaesthesia with propofol on the possible presence of epileptiform electroencephalograph patterns during the induction of general anaesthesia. We aimed to verify whether presence of epileptiform patterns (EPs) defined as polispikes (PS), rhytmic polispikes (RPS), periodic epileptiform discharges (PED) on Electroencephalographs (EEGs) influence the behaviour of values of the Bispectral Index (BIS), State (SE) and Response (RE), A-line Auto Regressive Index (AAI) derived from middle latency auditory evoked potentials (MLAEP) during the induction of general anaesthesia using abovementioned techniques and such variations may be useful in detection of presence of EPs.
Both sevoflurane and propofol are considered safe and potent anaesthetics and are used for
induction or coinduction of general anaesthesia. During all stages of general anaesthesia,
both agents may induce seizure-like movements or seizures (clinically manifested events and
confirming electroencephalographic pattern) accompanied by haemodynamic instability. Their
proconvulsant activity should be verified and assessed.
The aim of the additional analysis was to identify whether observance of the variations of
values displayed on different depth of anaesthesia monitors (DOA monitors) reliably reflect
the actual depth of general anaesthesia during presence of epileptiform patterns (EPs) in
EEGs during VIGA with sevoflurane using two different techniques and intravenous induction of
general anaesthesia with single dose of propofol.
We performed standard 30-minute initial EEG recordings for all patients participating in the
study to exclude any pre-existing epileptic EEG patterns. We took the initial EEG recordings
in a dark quiet room for 5 minutes as a baseline, followed by three eye opening and closing
sequences of 10 seconds each and photostimulation lasting 10 minutes (flash stimuli at
frequencies of 3/6/9/12 Hz- alpha; 15/18/21/24 Hz- beta). Then we obtained another baseline
reading and we asked the patients to achieve a state of hyperventilation by taking 20
forceful breathes per minute for five minutes. Finally, we obtained another baseline reading.
Throughout the induction of anaesthesia and the surgery, standard monitoring procedures were
utilised to pay close attention to the vital parameters such as non-invasive arterial
pressure (BP), heart rate (HR), standard electrocardiography (ECG) II, arterial oxygen
saturation (SaO2), fraction of inspired oxygen in the gas mixture (FiO2), facial
electromyography (fEMG), fraction of inspired sevoflurane (FiAA), fraction of expired
sevoflurane (FeAA), exhaled carbon dioxide concentration (etCO2), minimal alveolar
concentration of sevoflurane (MAC).
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