Emergence delirium in children is not related to intraoperative burst suppression - prospective, observational electrography study

Susanne Koch, Anna-Maria Stegherr, Leopold Rupp, Jochen Kruppa, Christine Prager, Sylvia Kramer, Astrid Fahlenkamp, Claudia Spies, Susanne Koch, Anna-Maria Stegherr, Leopold Rupp, Jochen Kruppa, Christine Prager, Sylvia Kramer, Astrid Fahlenkamp, Claudia Spies

Abstract

Background: Emergence-delirium is the most frequent brain dysfunction in children recovering from general anaesthesia, though the pathophysiological background remains unclear. The presented study analysed an association between emergence delirium and intraoperative Burst Suppression activity in the electroencephalogram, a period of very deep hypnosis during general anaesthesia.

Methods: In this prospective, observational cohort study at the Charité - university hospital in Berlin / Germany children aged 0.5 to 8 years, undergoing planned surgery, were included between September 2015 and February 2017. Intraoperative bi-frontal electroencephalograms were recorded. Occurrence and duration of Burst Suppression periods were visually analysed. Emergence delirium was assessed using the Pediatric Assessment of Emergence Delirium Score.

Results: From 97 children being analysed within this study, 40 children developed emergence delirium, and 57 children did not. Overall 52% of the children displayed intraoperative Burst Suppression periods; however, occurrence and duration of Burst Suppression (Emergence delirium group 55% / 261 + 462 s vs. Non-emergence delirium group 49% / 318 + 531 s) did not differ significantly between both groups.

Conclusions: Our data reveal no correlation between the occurrence and duration of intraoperative Burst Suppression activity and the incidence of emergence delirium. Burst Suppression occurrence is frequent; however, it does not seem to have an unfavourable impact on cerebral function at emergence from general anaesthesia in children.

Trail registration: NCT02481999, June 25, 2015.

Keywords: Burst suppression; EEG: high dose opiates; Paediatrics: pre-operative anxiety.

Conflict of interest statement

Claudia Spies received material support by Narcotrend-Gruppe, MT Monitortechnik GmbH, Maienbaß 27, 24576 Bad Bramstedt. The authors declare no further competing interests.

References

    1. Dahmani S, Delivet H, Hilly J. Emergence delirium in children: an update. Curr Opin Anaesthesiol. 2014;27:309–315. doi: 10.1097/ACO.0000000000000076.
    1. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383:911–922. doi: 10.1016/S0140-6736(13)60688-1.
    1. Somaini M, Engelhardt T, Fumagalli R, Ingelmo PM. Emergence delirium or pain after anaesthesia--how to distinguish between the two in young children: a retrospective analysis of observational studies. Br J Anaesth. 2016;116:377–383. doi: 10.1093/bja/aev552.
    1. Jevtovic-Todorovic V. Functional implications of an early exposure to general anesthesia: are we changing the behavior of our children? Mol Neurobiol. 2013;48:288–293. doi: 10.1007/s12035-013-8488-5.
    1. Berndt N, Rosner J, Haq RU, et al. Possible neurotoxicity of the anesthetic propofol: evidence for the inhibition of complex II of the respiratory chain in area CA3 of rat hippocampal slices. Arch Toxicol. 2018;92:3191–3205. doi: 10.1007/s00204-018-2295-8.
    1. Kreuzer I, Osthaus WA, Schultz A, Schultz B. Influence of the sevoflurane concentration on the occurrence of epileptiform EEG patterns. PLoS One. 2014;9:e89191. doi: 10.1371/journal.pone.0089191.
    1. Koch S, Rupp L, Prager C, Wernecke KD, Kramer S, Fahlenkamp A, Spies C. Emergence delirium in children is related to epileptiform discharges during anaesthesia induction: an observational study. Eur J Anaesthesiol. 2018;35:929–936.
    1. Martin JC, Liley DT, Harvey AS, Kuhlmann L, Sleigh JW, Davidson AJ. Alterations in the functional connectivity of frontal lobe networks preceding emergence delirium in children. Anesthesiology. 2014;121:740–752. doi: 10.1097/ALN.0000000000000376.
    1. Radtke FM, Franck M, Lendner J, Kruger S, Wernecke KD, Spies CD. Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction. Br J Anaesth. 2013;110:i98–105. doi: 10.1093/bja/aet055.
    1. Chan MT, Cheng BC, Lee TM, Gin T, Group CT BIS-guided anesthesia decreases postoperative delirium and cognitive decline. J Neurosurg Anesthesiol. 2013;25:33–42. doi: 10.1097/ANA.0b013e3182712fba.
    1. Whitlock EL, Torres BA, Lin N, et al. Postoperative delirium in a substudy of cardiothoracic surgical patients in the BAG-RECALL clinical trial. Anesth Analg. 2014;118:809–817. doi: 10.1213/ANE.0000000000000028.
    1. Fritz BA, Kalarickal PL, Maybrier HR, et al. Intraoperative electroencephalogram suppression predicts postoperative delirium. Anesth Analg. 2016;122:234–242. doi: 10.1213/ANE.0000000000000989.
    1. Faulk DJ, Twite MD, Zuk J, Pan Z, Wallen B, Friesen RH. Hypnotic depth and the incidence of emergence agitation and negative postoperative behavioral changes. Paediatr Anaesth. 2010;20:72–81. doi: 10.1111/j.1460-9592.2009.03191.x.
    1. Frederick HJ, Wofford K, de Lisle Dear G, Schulman SR. A randomized controlled trial to determine the effect of depth of anesthesia on emergence agitation in children. Anesth Analg. 2016;122:1141–1146. doi: 10.1213/ANE.0000000000001145.
    1. Sikich N, Lerman J. Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Anesthesiology. 2004;100:1138–1145. doi: 10.1097/00000542-200405000-00015.
    1. Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs J. 1997;23:293–297.
    1. Kerson AG, DeMaria R, Mauer E, Joyce C, Gerber LM, Greenwald BM, et al. Validity of the Richmond agitation-sedation scale (RASS) in critically ill children. J Intensive Care. 2016;4:65. doi: 10.1186/s40560-016-0189-5.
    1. Zschocke S. EEG bei diffusen Erkrankungen des Gehirns. In: Hansen H-C, editor. Klinische Elektroenzephalographie. Berlin, Heidelberg, New York: Springer-Verlag; 2011. pp. 314–348.
    1. Costi D, Cyna AM, Ahmed S, et al. Effects of sevoflurane versus other general anaesthesia on emergence agitation in children. Cochrane Database Syst Rev. 2014. 10.1002/14651858.CD007084.
    1. Muhlhofer WG, Zak R, Kamal T, et al. Burst-suppression ratio underestimates absoulte duration of electroencephalogram suppression compared with visual analysis of intraoperative electroencephalogram. Br J Anaesth. 2017;118:755–761. doi: 10.1093/bja/aex054.
    1. Brown EN, Lydic R, Schiff ND. General anesthesia, sleep, and coma. N Engl J Med. 2010;363:2638–2650. doi: 10.1056/NEJMra0808281.
    1. Purdon PL, Pavone KJ, Akeju O, Smith AC, Sampson AL, Lee J, et al. The ageing brain: age-dependent changes in the electroencephalogram during propofol and sevoflurane general anaesthesia. Br J Anaesth. 2015;115:i46–i57. doi: 10.1093/bja/aev213.

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