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Emergence delirium in children is related to epileptiform discharges during anaesthesia induction: An observational
Susanne Koch1, Leopold Rupp, Christine Prager
1From the Department of Anaesthesiology and Operative Intensive Care Medicine (SK, LR, SK, AF, CDS), Department of Paediatrics and Neurology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte (CP), Institute of Medical Biometry, Charité - Universitätsmedizin Berlin (KDW) and CRO Sostana GmbH, Berlin, Germany (KDW).
Insights
Emergence delirium in children undergoing anesthesia is linked to specific brain activity. Interictal spike events during anesthesia induction significantly predict the occurrence of emergence delirium in pediatric patients.
Area of Science:
- Anesthesiology
- Pediatric Neurology
- Neurophysiology
Background:
- Epileptiform discharges are common during pediatric anesthesia induction.
- Limited research exists on the impact of these discharges on postoperative emergence delirium.
- This study investigates the correlation between anesthesia induction epileptiform activity and emergence delirium.
Purpose of the Study:
- To determine if epileptiform discharges during anesthesia induction are associated with emergence delirium in children.
- To analyze the relationship between specific epileptiform patterns and the incidence of emergence delirium.
Main Methods:
- A prospective, observational cohort study involving 62 children aged 0.5 to 8 years.
- Electroencephalogram (EEG) monitoring was conducted before and during anesthesia induction.
- Emergence delirium was assessed using the Pediatric Assessment of Emergence Delirium Score.
Main Results:
- 43.5% of children experienced emergence delirium.
- Epileptiform discharges were more frequent in children with emergence delirium (63%) compared to those without (43%).
- Interictal spike events (rhythmic polyspikes, periodic epileptiform discharges, delta with spikes) significantly correlated with emergence delirium (OR=5.6, P=0.004).
Conclusions:
- Emergence delirium in pediatric patients is significantly associated with interictal spike events during anesthesia induction.
- Identifying these EEG patterns may help predict and manage emergence delirium in children.
- Further research can explore interventions to mitigate emergence delirium based on EEG findings.
Background:
Epileptiform discharges frequently occur in children during induction of anaesthesia. However, studies analysing the impact of epileptiform discharges on postoperative emergence delirium in children are still scarce. The aim of this study is to correlate the incidence of epileptiform activity during anaesthesia induction with the occurrence of emergence delirium during stay in the recovery room.
Objectives:
Prospective, observational cohort study in children 0.5 to 8 years old undergoing planned surgery. Bifrontal electroencephalogram electrodes were placed before induction of anaesthesia. Visual electroencephalogram analysis was performed from start of anaesthetic agent administration until intubation with regard to epileptiform patterns: rhythmic polyspikes; periodic epileptiform discharges; delta with spikes; and suppression with spikes. Emergence delirium was assessed during stay in the recovery room using the Pediatric Assessment of Emergence Delirium Score.
Design:
Prospective, observational cohort study.
Setting:
University hospital - Germany/Berlin. Children were included between September 2015 and February 2017.
Patients:
A total of 62 Children, aged 0.5 to 8 years old undergoing planned surgery were included.
Main Outcome Measures:
Primary outcome was emergence delirium. Secondary outcomes, peri-operative Electroencephalography (EEG) data analysis. The presented study analysed an association between emergence delirium and the occurrence of epileptiform discharges during anaesthesia induction.
Results:
A total of 43.5% of the children developed emergence delirium and 56.5% did not. Epileptiform discharges were observed more often in children developing emergence delirium (63%) compared with children not developing emergence delirium (43%). But only the occurrence of interictal spike events - such as rhythmic polyspikes; periodic epileptiform discharges and delta with spikes - were significantly related to emergence delirium (emergence delirium-group 48% vs. nonemergence delirium-group 14%, OR = 5.6 [95% CI: 1.7 to 18.7]; P = 0.004).
Conclusion:
Emergence delirium in children is significantly related to interictal spike events occurring during induction of anaesthesia.
Clinical Trial:
NCT02481999.
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