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British Journal of Anaesthesia, 2002, Vol. 89, No. 6 853-856
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigations

Sevoflurane anaesthesia in children after induction of anaesthesia with midazolam and thiopental does not cause epileptiform EEG

K. Nieminen, S. Westerèn-Punnonen, H. Kokki*,{dagger}, H. Yppärilä, A. Hyvärinen and J. Partanen

Department of Anaesthesiology and Intensive Care, Department of Clinical Neurophysiology and Department of Otorhinolaryngology, Kuopio University Hospital, PO Box 1777, FIN-70211 Kuopio, Finland Hannu Kokki, Kuopio University Hospital, PO Box 1777, FIN-70211 Helsinki, Finland


{dagger}Declaration of interest: Dr Kokki has been paid by Abbott for lecture fees.

Background. Sevoflurane is a methyl ether anaesthetic commonly used for induction and maintenance of general anaesthesia in children. Sevoflurane is a non-irritant and acts quickly so induction is usually calm. However, inhalation induction with high concentrations of sevoflurane can cause convulsion-like movements and seizure-like changes in the electroencephalogram (EEG). Little is known about the EEG during maintenance of anaesthesia with sevoflurane, so we planned a prospective trial of sevoflurane maintenance after i.v. induction with benzodiazepine and barbiturate, which is another common induction technique in children.

Methods. EEG recordings were made before premedication with midazolam (0.1 mg kg–1 i.v.), during induction of anaesthesia with thiopental (5 mg kg–1), and during maintenance with sevoflurane (2% end-tidal concentration in air/oxygen without nitrous oxide) in 30 generally healthy, 3- to 8-year-old children having adenoids removed. Noise-free EEG data of good quality were successfully recorded from all 30 children.

Results. Two independent neurophysiologists did not detect epileptiform discharges in any of the recordings.

Conclusion. Premedication with midazolam, i.v. induction with thiopental and maintenance of anaesthesia with 2% sevoflurane in air does not cause epileptiform EEG patterns in children.

Br J Anaesth 2002; 89: 853–6


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