Electroencephalographic density spectral array monitoring during propofol/sevoflurane coadministration in children,
Iris J de Heer1, Hannah A C Raab1, Stephan Krul1
1Department of Pediatric Anesthesiology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Insights
Combining propofol and sevoflurane in pediatric anesthesia, this study found that Density Spectral Array (DSA) monitoring can guide anesthesia depth. This approach allows for reduced anesthetic drug exposure in children.
Area of Science:
- Anesthesiology
- Neurophysiology
- Pediatric Medicine
Background:
- Propofol and sevoflurane are established anesthetic agents in pediatric care.
- Combining these agents at low doses presents novel anesthetic strategies.
- Monitoring hypnotic effects in children receiving combined anesthetics is challenging due to limitations in current EEG systems.
Purpose of the Study:
- To investigate electroencephalogram (EEG) Density Spectral Array (DSA) monitoring during combined propofol and sevoflurane anesthesia in pediatric patients.
- To assess the correlation between propofol dosage and EEG frequency bands (β, α, θ, δ).
- To evaluate intra-operative EEG power and burst suppression prevalence.
Main Methods:
- Analysis of DSA patterns from 78 pediatric patients (birth to 11 years) undergoing propofol/sevoflurane anesthesia.
- Correlation analysis between variable propofol doses and EEG frequency bands.
- Assessment of total EEG power and burst suppression events.
Main Results:
- A dose-dependent correlation was observed between propofol dosage and β and δ EEG frequencies in children over 1 year old.
- Increasing mean EEG power showed an age-dependent trend, most pronounced in the first year of life.
- Burst suppression occurred in 14.1% of patients.
Conclusions:
- DSA-guided anesthesia with sevoflurane and propofol ensures adequate anesthetic depth in children.
- This combined approach allows for lower anesthetic doses, reducing overall drug exposure.
- DSA monitoring offers a viable method for managing combined anesthesia in pediatric patients.
Introduction:
Propofol and sevoflurane have a long history in pediatric anesthesia. Combining both drugs at low dose levels offers new opportunities. However, monitoring the hypnotic effects of this drug combination in children is challenging, because the currently available processed EEG-based systems are insufficiently validated in young children and the co-administration of anesthetics. This study investigated electroencephalographic density spectral array monitoring during propofol/sevoflurane coadministration with fixed sevoflurane- and variable propofol dosages.
Patients And Methods:
We analyzed the density spectral array pattern recorded during propofol/sevoflurane anesthesia in pediatric patients from birth to 11 years of age. Data from 78 patients were suitable for analysis. The primary outcome parameter of this study was the correlation between variable propofol dosages and the expression of the four electroencephalogram frequency bands β, α, θ, and δ. The main secondary outcome parameters were the intra-operative total EEG power and the prevalence of burst suppression.
Results:
In patients above the age of 1 year, a dose-dependent correlation between the propofol dosage and the relative percentage of β (-12.2%, p < 0.001) and δ (5.1%, p < 0.001) was found. There was an age-dependent trend toward increasing mean EEG power, with the most significant increase in the first year of life. In 14.1% of our patients, at least one episode of burst suppression occurred.
Conclusion:
DSA-guided augmentation of propofol anesthesia with sevoflurane provides sufficient depth of anesthesia at doses usually considered sub-anesthetic in children, leading to less anesthetic drug exposure for the individual child.
