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Chronic Cranial Window Technique for Repeated Cortical Recordings During Anesthesia in Pigs
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Anesthesia-Associated Periodic Discharges.

Khalil S Husari1, Eva K Ritzl

  • 1Comprehensive Epilepsy Center, Department of Neurology, Johns Hopkins University, Baltimore, Maryland, U.S.A.

Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society
|October 10, 2020
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Summary
This summary is machine-generated.

Generalized periodic discharges (GPDs) are common after anesthesia withdrawal and may indicate a transitional encephalopathic state. Recognizing these distinct EEG patterns prevents misdiagnosis and unnecessary treatment for seizure activity.

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Area of Science:

  • Neuroscience
  • Anesthesiology
  • Critical Care Medicine

Background:

  • Anesthetic agents are used for refractory status epilepticus and increased intracranial pressure.
  • Generalized periodic discharges (GPDs) post-anesthesia emergence are reported but their significance is unclear.

Purpose of the Study:

  • To investigate the clinical significance of GPDs following anesthetic-induced burst suppression.
  • To determine if these GPDs are epileptiform and distinguish them from seizure recurrence.

Main Methods:

  • Retrospective observational study of EEG patterns after anesthetic wean.
  • Comparison of patients who developed GPDs with a control group.

Main Results:

  • 14 patients developed transient GPDs (0.5-2.5 Hz) related to anesthetic withdrawal, lasting a median of 40 hours.
  • GPDs were stimulus-dependent and associated with pentobarbital use and systemic infection.
  • No significant difference in status epilepticus relapse between GPD and control groups.

Conclusions:

  • GPDs are common post-anesthetic wean, particularly with pentobarbital, and suggest a transitional encephalopathic state.
  • GPDs are morphologically distinct from emergent status epilepticus.
  • Failure to recognize GPDs can lead to prolonged, unnecessary treatment; systemic infection may be a risk factor.