British Journal of Anaesthesia, 2003, Vol. 91, No. 5 651-655
© 2003 The Board of Management and Trustees of the British Journal of Anaesthesia
Clinical Investigations |
Activation of electrocorticographic activity with remifentanil and alfentanil during neurosurgical excision of epileptogenic focus
Departments of 1 Anesthesia and Pain Management, 2 Neurosurgery, and 3 Medicine (Neurology), The Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, Ontario, Canada M5T 2S8
Corresponding author. E-mail: beheiry@uhnres.utoronto.ca
Background. Opioids are known to stimulate surface electroencephalographic activity in patients with temporal lobe epilepsy. The objective of the current study was to compare the electrocorticographic activation effects of the newer short-acting opioid remifentanil with those of alfentanil during epilepsy surgery under general anaesthesia.
Methods. Thirteen patients undergoing temporal lobe epilepsy surgery under general anaesthesia received alfentanil 30 µg kg–1 and remifentanil 1 µg kg–1 as i.v. boluses in sequence. The design was a randomized double-blind cross-over study. After opening the dura, electrocorticogram (ECoG) electrode contact strips were placed over the temporal and supratemporal neocortex and depth electrodes were inserted in the amygdala and hippocampus. Alfentanil 30 µg kg–1 or remifentanil 1 µg kg–1 were administered randomly in a blinded fashion. The ECoG was recorded continuously before and after the injection of each drug. The interictal epileptiform activity (spikes and sharp waves) above baseline was analysed.
Results. Both drugs increased epileptiform activity especially that recorded from depth electrodes in the temporal limbic structures. No epileptiform activity was recorded from the electrodes overlying the supratemporal neocortex before or after drug administration. The more potent activator was alfentanil, which caused an increase in activation from baseline of 99.8% compared with 67.4% for remifentanil. In addition, alfentanil activated the epileptiform activity in 3 patients in which remifentanil had no effect. There were no changes in heart rate after the opioid boluses. Both remifentanil and alfentanil caused significant reductions in blood pressure at 3 and 5 min after administration.
Conclusion. We conclude that at the doses used in this study, alfentanil is the better opioid for intraoperative activation of the ECoG in neurosurgical patients undergoing resection of a temporal lobe epileptic focus. This pharmacological activation of epileptiform activity assists in localizing and confirming the site of surgical excision. Neither alfentanil nor remifentanil activated epileptiform activity in non-epileptic brain tissue.
Br J Anaesth 2003; 91: 651–5
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