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Propofol and spontaneous movements: an EEG study
A Borgeat1, C Dessibourg, V Popovic
1Service d'Anesthésiologie-Réanimation, Hôpital Cantonal Fribourg, Switzerland.
Insights
Propofol anesthesia in children can cause spontaneous movements, particularly at lower doses. These movements, characterized as dystonic and choreiform, correlate with specific electroencephalogram (EEG) patterns during induction.
Area of Science:
- Anesthesiology
- Pediatric Neurology
- Neurophysiology
Background:
- Spontaneous movements during anesthesia induction are common in children.
- The underlying mechanisms and electroencephalogram (EEG) correlates are not fully understood.
Purpose of the Study:
- To investigate spontaneous movements during propofol or thiopental anesthesia induction in children.
- To analyze the relationship between these movements and EEG changes.
Main Methods:
- 21 children (6-12 yr) were randomized to propofol (3 or 5 mg/kg) or thiopental (5-7 mg/kg).
- EEG was recorded during induction and post-intubation.
- Spontaneous movements were videotaped and analyzed by a neurologist.
Main Results:
- Spontaneous movements occurred in all children receiving 3 mg/kg propofol, versus 14% in the higher dose propofol and thiopental groups.
- EEG showed a consistent pattern of alpha to beta wave transition, followed by delta waves, then reappearing beta waves.
- All observed movements were dystonic and choreiform, coinciding with delta wave activity on EEG.
Conclusions:
- Lower dose propofol (3 mg/kg) is associated with a higher incidence of spontaneous movements during induction in children.
- These movements appear to originate from subcortical structures, as indicated by their dystonic nature and the absence of cortical epileptic activity on EEG.
Abstract:
Spontaneous movements during induction of anesthesia with propofol were studied in 21 children aged 6-12 yr. The children were randomly assigned to group A (propofol 3 mg.kg-1), B (propofol 5 mg.kg-1), or C (thiopental 5-7 mg.kg-1). A baseline electroencephalogram (EEG) was recorded during 10 min in children awake, supine with eyes closed and opened, and then from the beginning of induction until 5 min after tracheal intubation. Spontaneous movements were observed in all children in group A but only in 14% in groups B and C. The induction EEG sequences were similar for the three groups: after a mean latency of 12 s, the tracing showed an increase in frequency from 9 to 10 Hz (alpha waves) to more than 14 Hz (beta waves). This transition lasted approximately 2 s, followed by delta waves (2-3 Hz) that continued for 1-2 min. Finally, beta waves reappeared and progressively but incompletely replaced delta waves during the next 5 min. Neither spikes, spike-wave patterns, rhythmic theta waves, nor burst suppressions were observed. Spontaneous movements were recorded on videotape and analyzed after the completion of the study by a neurologist unaware of patient treatment. Videotape analysis of the periinduction period showed spontaneous movements to be dystonic and choreiform with flexion, twisting, or extension movements of all extremities. All movements occurred coincident with the appearance of delta waves on the EEG. Their dystonic nature and the absence of EEG abnormalities suggest a subcortical origin and argue against associated cortical epileptic activity.