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Published on: June 11, 2020
A retrospective study of electroencephalography burst suppression in children undergoing general anesthesia
Zhengzheng Gao1, Jianmin Zhang1, Xiaoxue Wang1
1Department of Anesthesiology Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China.
Insights
Electroencephalography (EEG) burst suppression, indicating deep anesthesia, occurred in 56% of pediatric patients. Factors like younger age, sevoflurane, propofol, and hypotension increased its prevalence during general anesthesia.
Area of Science:
- Anesthesiology
- Neuroscience
- Pediatric Critical Care
Background:
- Anesthesia dosages in children typically rely on population pharmacokinetics and hemodynamics, not direct brain activity monitoring.
- Brain function is sensitive to anesthetic agents, necessitating accurate monitoring.
Purpose of the Study:
- To determine the prevalence of electroencephalography (EEG) burst suppression in pediatric patients under general anesthesia.
- To identify factors associated with EEG burst suppression in this population.
Main Methods:
- Retrospective analysis of EEG data from 54 children (1-36 months) receiving sevoflurane or propofol.
- Patients were stratified into two age groups: 1-12 months and 13-36 months.
- Burst suppression defined as voltage ≤ 5.0 mV for > 0.5 seconds; associations with demographics and anesthetics were examined.
Main Results:
- Overall prevalence of EEG burst suppression was 56%, with the highest occurrence during anesthesia induction.
- Sevoflurane anesthesia (18/30 events) and propofol boluses were significantly associated with burst suppression (P=0.024 and P=0.033, respectively).
- Hypotension (P<0.001) and younger age during surgery (P=0.002) were also linked to increased burst suppression.
Conclusions:
- EEG burst suppression is common in pediatric anesthesia, particularly in younger patients.
- Anesthetic agents (sevoflurane, propofol) and physiological states (hypotension) influence its occurrence.
- This highlights the importance of EEG monitoring for optimizing anesthetic depth in children.
Importance:
In children, anesthesia dosages are based on population pharmacokinetics and patient hemodynamics rather than patient-specific brain activity. Brain function is highly susceptible to the effects of anesthetics.
Objective:
The primary objective of this retrospective pilot study was to assess the prevalence of electroencephalography (EEG) burst suppression-a sign of deep anesthesia-in children undergoing general anesthesia.
Methods:
We analyzed EEG in patients aged 1-36 months who received sevoflurane or propofol as the primary anesthetic. Patient enrollment was stratified into two age groups: 1-12 months and 13-36 months. Burst suppression (voltage ≤ 5.0 mV, lasting > 0.5 seconds) was characterized by occurrence over anesthesia time. Associations with patient demographics and anesthetics were determined.
Results:
In total, 54 patients (33 males and 21 females) were included in the study [age 11.0 (5.0-19.5) months; weight 9.2 (6.5-11.0) kg]. The total prevalence of burst suppression was 56% (30/54). Thirty-three percent of patients experienced burst suppression during the surgical phase. The greatest proportion of burst suppression occurred during the induction phase. More burst suppression event occurrences (18/30) were observed in the patient under sevoflurane anesthesia (P = 0.024). Virtually all patients who received propofol boluses had burst suppression (P = 0.033). More burst suppression occurred in patients with hypotension (P < 0.001). During the surgical phase, a younger age was associated with more burst suppression (P = 0.002).
Interpretation:
EEG burst suppression was associated with younger age, inhalation anesthetics, propofol bolus, and lower arterial pressure.
