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Frontal electroencephalogram activity during emergence from general anaesthesia in children with and without
Jonghae Kim1, Hyung-Chul Lee2, Sung-Hye Byun1
1Department of Anaesthesiology and Pain Medicine, Daegu Catholic University Medical Centre, School of Medicine, Daegu Catholic University, Daegu, Republic of Korea.
Insights
Emergence delirium in children is linked to specific EEG patterns. Increased delta wave activity and decreased alpha and beta waves during anesthesia emergence can help predict this condition.
Area of Science:
- Neuroscience
- Anesthesiology
- Pediatrics
Background:
- Emergence delirium (ED) in children post-general anesthesia causes significant distress.
- Predictive electroencephalogram (EEG) markers for ED remain under-investigated.
Purpose of the Study:
- To investigate EEG markers for predicting emergence delirium in pediatric patients.
- To compare EEG wave activity between children with and without ED.
Main Methods:
- Prospective observational study of 60 children (2-10 years) under sevoflurane anesthesia.
- Assessed ED using DSM IV or 5 criteria.
- Compared relative power of low-frequency (delta, theta) and high-frequency (alpha, beta) EEG waves during emergence.
Main Results:
- Children with ED showed higher relative delta wave power (0.579 vs 0.453) and lower alpha (0.155 vs 0.218) and beta wave power (0.114 vs 0.186) compared to non-ED group.
- Receiver operating characteristic analysis indicated good predictive value for delta wave power and frequency ratios.
- Delta wave power and frequency ratios correlated positively with peak PAED scores.
Conclusions:
- Pediatric patients experiencing ED exhibit increased frontal low-frequency (delta) EEG activity.
- Reduced high-frequency (alpha and beta) EEG activity is associated with ED during emergence from anesthesia.
Background:
Emergence delirium (ED) in children after general anaesthesia causes significant distress in patients, their family members, and clinicians; however, electroencephalogram (EEG) markers predicting ED have not been fully investigated.
Methods:
This prospective, single-centre observational study enrolled children aged 2-10 yr old under sevoflurane anaesthesia. ED was assessed according to Diagnostic and Statistical Manual of Mental Disorders (DSM) IV or 5 criteria. The relative power of low-frequency (delta and theta) and high-frequency (alpha and beta) EEG waves during the emergence period was compared between the children with and without ED. The linear relationships between the relative power and peak Paediatric Assessment of Emergence Delirium (PAED) score were investigated.
Results:
Among the 60 patients, 22 developed ED (ED group), whereas the other 38 did not (non-ED group). The relative power of the delta wave was higher (mean [standard deviation], 0.579 [0.083] vs 0.453 [0.090], respectively, P<0.001) in the ED group, whereas that of the alpha and beta waves was lower in the ED group, than in the non-ED group (0.155 [0.063] vs 0.218 [0.088], P=0.005 and 0.114 [0.069] vs 0.186 [0.070], P<0.001, respectively). The areas under the receiver operating characteristic curves of the relative power of the delta wave, low-to-high frequency power ratio, and delta-to-alpha ratio were 0.837 (95% confidence interval, 0.737-0.938), 0.835 (0.735-0.934), and 0.768 (0.649-0.887), respectively. The relative power of the delta wave and the two ratios had a positive linear relationship with the peak PAED scores.
Conclusions:
Paediatric patients developing ED have increased low-frequency (delta) frontal EEG activity with reduced high-frequency (alpha and beta) activity during emergence from general anaesthesia.
Clinical Trial Registration:
NCT03797274.
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