异丙酚与七氟醚对小儿麻醉诱导期癫痫样放电发生率的比较
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
Incidence of epileptiform discharges in children during induction of anaesthesia using Propofol versus Sevoflurane
背景与目的
在儿科患者中，常用于麻醉诱导。虽然癫痫样放电可发生在七氟醚诱麻醉导期间，但异丙酚麻醉诱导期间其发生率尚未有文献报道。本研究的目的是比较异丙酚与七氟醚麻醉诱导期间儿童癫痫样放电的发生率。
方 法
对0.5-8岁拟行择期手术的儿童进行前瞻性观察性队列研究。并对其采用异丙酚或七氟醚用于麻醉诱导。在麻醉开始前放置双额脑电图电极。从施用麻醉药物开始直至插管期间进行视觉脑电图分析，以鉴别癫痫样模式，即具有刺突的δ; 节奏性聚糖蛋白; 周期性，癫痫样放电; 或抑制尖峰。
结 果
39名儿童用异丙酚麻醉，18名儿童用七氟醚麻醉。异丙酚组中有36％的儿童出现癫痫样放电，而七氟醚组为67％（p = 0.03）。不同类型的癫痫样放电其发生率不同，如周期性癫痫样放电（七氟醚组39％与异丙酚组3％; p <0.001）。高浓度瑞芬太尼（0.15 mg / kg / min）与低频率癫痫样放电相关（实验5.8; CI 95％1.6 / 21.2; p = 0.008）。
结 论
异丙酚用于小儿麻醉诱导会引起癫痫样放电，但其发生率低于七氟醚。
原始文献摘要
Koch S, Rupp L, Prager C, Mörgeli R, Kramer S, Wernecke KD, Fahlenkamp A, Spies C；Incidence of epileptiform discharges in children during induction of anaesthesia using Propofol versus Sevoflurane.Clin Neurophysiol. 2018 Jun 8;129(8):1642-1648. doi: 10.1016/j.clinph.2018.05.013. [Epub ahead of print]
Background: In pediatric patients, anaesthesia induction is often performed with intravenous Propofol or Sevoflurane inhalation. Although epileptiform discharges have been observed during inductions with Sevoflurane, their occurrence has not been investigated for i.v. Propofol inductions. The aim of this study is to compare the incidence of epileptiform discharges in children during anaesthesia induction using Propofol versus Sevoflurane.
Method:Prospective, observational cohort study in children aged 0.5–8 years undergoing elective surgery. Children were anaesthetized with either Propofol or Sevoflurane. Bi-frontal electroencephalograms electrodes were placed before start of anaesthesia. Visual electroencephalogram analysis was performed from start of anesthetic agent administration until Intubation with regard to identify epileptiform patterns, i.e. delta with spikes; rhythmic polyspikes; periodic, epileptiform discharges; or suppression with spikes.
Results: 39 children were anaesthetized with Propofol, and 18 children with Sevoflurane. Epileptiform discharges were seen in 36% of the children in the Propofol group, versus 67% in the Sevoflurane group (p = 0.03). Incidence of the distinct types of epileptiform discharge differed for periodic, epileptiform discharges (Sevoflurane group 39% vs. Propofol group 3%; p < 0.001). Higher concentration of Remifentanil (0.15 mg/kg/min) was associated with less frequent epileptiform discharges (Exp 5.8; CI 95% 1.6/21.2;p = 0.008).
Conclusion: Propofol i.v. induction of anaesthesia in children triggers epileptiform discharges, whereas to a lesser extent than Sevoflurane does.
麻醉学文献进展分享
联系我们