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

Abstract

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 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 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.