Alterations in the functional connectivity of frontal lobe networks preceding emergence delirium in children
Jessica C Martin1, David T J Liley, A Simon Harvey
1From the Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, Victoria, Australia, and Murdoch Children's Research Institute, and Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Melbourne, Victoria, Australia (J.C.M.); Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Melbourne, Victoria, Australia (D.T.J.L.); Murdoch Children's Research Institute, Melbourne, Victoria, Australia, and Department of Neurology, The Royal Children's Hospital, and Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia (A.S.H.); Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Melbourne, Victoria, Australia, and Centre for Neural Engineering, The University of Melbourne, Melbourne, Victoria, Australia (L.K.); Waikato Clinical School, University of Auckland, Auckland, New Zealand (J.W.S.); and Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, Victoria, Australia, and Murdoch Children's Research Institute, and Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia (A.J.D.).
Insights
Emergence delirium (ED) in children is linked to altered brain activity, specifically increased frontal lobe functional connectivity during the indeterminate state after anesthesia. This finding may help predict and prevent ED.
Area of Science:
- Neuroscience
- Anesthesiology
- Pediatric Medicine
Background:
- Emergence delirium (ED) is a common post-anesthetic complication in children.
- Understanding the electroencephalogram (EEG) patterns associated with ED is crucial for developing preventative strategies.
Purpose of the Study:
- To characterize EEG patterns and cortical functional connectivity in children experiencing ED compared to those without ED.
- To investigate the role of frontal lobe functional connectivity in the pathophysiology of ED.
Main Methods:
- Multichannel EEG recordings were obtained from children aged 5-15 years during anesthesia induction and emergence.
- Cortical functional connectivity measures were compared between children with ED and age-, sex-, and anesthetic-matched controls.
- Sevoflurane anesthesia was used for minor surgical procedures.
Main Results:
- Both groups showed EEG changes including delta slowing and frontal alpha activity, followed by an indeterminate state.
- Children with ED exhibited delirious behavior and varied EEG patterns during the indeterminate state before normal wake/sleep patterns.
- Statistically significant differences in frontal lobe functional connectivity were found between ED and non-ED groups.
Conclusions:
- ED is associated with arousal from an indeterminate EEG state preceding sleep-like patterns.
- Increased frontal lobe cortical functional connectivity immediately post-anesthesia is a key finding in ED.
- This research has implications for predicting, preventing, and understanding ED's pathophysiology.
Background:
This study aimed to characterize the electroencephalogram in children who emerged with emergence delirium (ED) compared with children without ED using methods that involved the assessment of cortical functional connectivity.
Methods:
Children aged 5 to 15 yr had multichannel electroencephalographic recordings during induction and emergence from anesthesia during minor surgical procedures. Of these, five children displayed ED after sevoflurane anesthesia. Measures of cortical functional connectivity previously used to evaluate anesthetic action in adults were compared between ED and age-, sex-, and anesthetic-matched non-ED children during emergence from anesthesia.
Results:
At the termination of sevoflurane anesthesia, the electroencephalogram in both ED and control patients showed delta frequency slowing and frontally dominant alpha activity, followed by a prolonged state with low-voltage, fast frequency activity (referred to as an indeterminate state). In children with ED, arousal with delirious behavior and a variety of electroencephalogram patterns occurred during the indeterminate state, before the appearance of normal wake or sleep patterns. The electroencephalogram in children without ED progressed from the indeterminate state to classifiable sleep or drowsy states, before peaceful awakening. Statistically significant differences in frontal lobe functional connectivity were identified between children with ED and non-ED.
Conclusions:
ED is associated with arousal from an indeterminate state before the onset of sleep-like electroencephalogram patterns. Increased frontal lobe cortical functional connectivity observed in ED, immediately after the termination of sevoflurane anesthesia, will have important implications for the development of methods to predict ED, the design of preventative strategies, and efforts to better understand its pathophysiology.
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