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Related Experiment Videos

Epileptiform activity during opioid anesthesia

L A Kearse1, G Koski, M V Husain

  • 1Department of Anesthesia, Massachusetts General Hospital, Harvard Medical School, Boston 02114.

Electroencephalography and Clinical Neurophysiology
|December 1, 1993
PubMed
Summary
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Opioid administration during surgery can induce epileptiform activity in patients. This seizure-like brain activity, potentially linked to opioids, was reversed by midazolam, an anticonvulsant.

Area of Science:

  • Anesthesiology
  • Neuroscience
  • Pharmacology

Background:

  • The proconvulsant effects of exogenous opioids in humans are not well-established.
  • Opioid analgesics are commonly used in surgical settings, necessitating an understanding of their potential neurological side effects.

Purpose of the Study:

  • To prospectively evaluate the relationship between epileptiform activity and opioid dosage in patients undergoing coronary artery revascularization.
  • To investigate the potential for opioid-induced central nervous system hyperexcitability.

Main Methods:

  • Twenty patients undergoing coronary artery revascularization were enrolled.
  • Electroencephalograms (EEGs) were recorded before and during surgery.
  • Patients received either fentanyl or sufentanil in divided doses, followed by midazolam.

Related Experiment Videos

  • Serum opioid concentrations were measured using radioimmunoassay.

    • Main Results:

    • Nineteen out of 20 patients developed epileptiform activity within minutes of the first opioid dose.
    • This activity, characterized by spike discharges, initially increased with opioid dosage but then declined.
    • Midazolam administration rapidly and significantly attenuated the spike discharges (P = 0.000003).

    Conclusions:

    • Exogenously administered opioids may induce epileptiform activity in humans.
    • The observed dissociation between opioid concentration and discharge frequency suggests a complex mechanism.
    • Midazolam's effectiveness in halting these discharges points to an epileptogenic mechanism initiated by opioids.