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Bindra A. Perioperative pearls on epilepsy surgery. Int Anesthesiol Clin 2023; 61:19-28. [PMID: 37249170 DOI: 10.1097/aia.0000000000000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Ashish Bindra
- Department of Neuroanaesthesiology and Critical Care, JPNA Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, India
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Li X, Wei Y, Xie Y, Shi Q, Zhan Y, Dan W, Jiang L. Effects of Propofol on Cortical Electroencephalograms in the Operation of Glioma-Related Epilepsy. Brain Sci 2023; 13:brainsci13040597. [PMID: 37190562 DOI: 10.3390/brainsci13040597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/26/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Background: A cortical electroencephalogram (ECoG) is often used for the intraoperative monitoring of epilepsy surgery, and propofol is an important intravenous anesthetic, but its effect on EEGs is unclear. Objectives: To further clarify the effect of propofol on cortical ECoGs during glioma-related epilepsy surgery and to clarify the possible clinical value. Methods: A total of 306 patients with glioma were included in the study. Two hundred thirty-nine with glioma-related epilepsy were included in the epilepsy group, and 67 without glioma-related epilepsy were included in the control group. All patients experienced continuous, real-time ECoG monitoring and long-term follow-up after surgery. Results: After injection of low-dose propofol, the rate of activated ECoGs in the epilepsy group (74%) was significantly higher than in the control group (9%). Furthermore, compared with patients in the untreated group, patients in the treated group had lower rates of early and long-term postoperative seizure frequencies and fewer interictal epileptiform discharges (IEDs). Conclusions: Low-dose infusion of propofol can specifically activate ECoGs in epilepsy patients. Therefore, activated ECoGs might provide an accurate and reliable method for identifying potential epileptic zones during glioma-related epilepsy surgery, resulting in better early and long-term prognoses after epilepsy surgery.
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Wada K, Sonoda M, Firestone E, Sakakura K, Kuroda N, Takayama Y, Iijima K, Iwasaki M, Mihara T, Goto T, Asano E, Miyazaki T. Sevoflurane-based enhancement of phase-amplitude coupling and localization of the epileptogenic zone. Clin Neurophysiol 2022; 134:1-8. [PMID: 34922194 PMCID: PMC8766927 DOI: 10.1016/j.clinph.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/05/2021] [Accepted: 11/03/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Phase-amplitude coupling between high-frequency (≥150 Hz) and delta (3-4 Hz) oscillations - modulation index (MI) - is a promising, objective biomarker of epileptogenicity. We determined whether sevoflurane anesthesia preferentially enhances this metric within the epileptogenic zone. METHODS This is an observational study of intraoperative electrocorticography data from 621 electrodes chronically implanted into eight patients with drug-resistant, focal epilepsy. All patients were anesthetized with sevoflurane during resective surgery, which subsequently resulted in seizure control. We classified 'removed' and 'retained' brain sites as epileptogenic and non-epileptogenic, respectively. Mixed model analysis determined which anesthetic stage optimized MI-based classification of epileptogenic sites. RESULTS MI increased as a function of anesthetic stage, ranging from baseline (i.e., oxygen alone) to 2.0 minimum alveolar concentration (MAC) of sevoflurane, preferentially at sites showing higher initial MI values. This phenomenon was accentuated just prior to sevoflurane reaching 2.0 MAC, at which time, the odds of a site being classified as epileptogenic were enhanced by 86.6 times for every increase of 1.0 MI. CONCLUSIONS Intraoperative MI best localized the epileptogenic zone immediately before sevoflurane reaching 2.0 MAC in this small cohort of patients. SIGNIFICANCE Prospective, large cohort studies are warranted to determine whether sevoflurane anesthesia can reduce the need for extraoperative, invasive evaluation.
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Affiliation(s)
- Keiko Wada
- Department of Anesthesiology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 1878551, Japan,Department of Anesthesiology and Critical Care, Yokohama City University Graduate School of Medicine, Yokohama, 2360004, Japan
| | - Masaki Sonoda
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA,Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama 2360004, Japan
| | - Ethan Firestone
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA,Department of Physiology, Wayne State University, Detroit, MI 48201, USA
| | - Kazuki Sakakura
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA,Department of Neurosurgery, University of Tsukuba, Tsukuba, 3058575, Japan
| | - Naoto Kuroda
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA,Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai 9808575, Japan
| | - Yutaro Takayama
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama 2360004, Japan,Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 1878551, Japan
| | - Keiya Iijima
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 1878551, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 1878551, Japan
| | - Takahiro Mihara
- Department of Anesthesiology and Critical Care, Yokohama City University Graduate School of Medicine, Yokohama, 2360004, Japan,Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama, 2360027, Japan
| | - Takahisa Goto
- Department of Anesthesiology and Critical Care, Yokohama City University Graduate School of Medicine, Yokohama, 2360004, Japan
| | - Eishi Asano
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA,Department of Neurology, Children’s Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA,E.A. and T.M. share the senior authorship. Corresponding Authors: Eishi Asano, M.D., Ph.D., M.S. (C.R.D.S.A.), Address: Division of Pediatric Neurology, Children’s Hospital of Michigan, Wayne State University. 3901 Beaubien St., Detroit, MI, 48201, USA, Phone: +1-313-745-5547, FAX: +1-313-745-9435, and Tomoyuki Miyazaki, M.D., Ph.D., Address: Department of Physiology/Anesthesiology, Yokohama City University Graduate School of Medicine. 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan, Phone: +81-45-787-2918, FAX: +81-45-787-2917,
| | - Tomoyuki Miyazaki
- Department of Anesthesiology and Critical Care, Yokohama City University Graduate School of Medicine, Yokohama, 2360004, Japan,Department of Physiology, Yokohama City University Graduate School of Medicine, Yokohama 2360004, Japan,E.A. and T.M. share the senior authorship. Corresponding Authors: Eishi Asano, M.D., Ph.D., M.S. (C.R.D.S.A.), Address: Division of Pediatric Neurology, Children’s Hospital of Michigan, Wayne State University. 3901 Beaubien St., Detroit, MI, 48201, USA, Phone: +1-313-745-5547, FAX: +1-313-745-9435, and Tomoyuki Miyazaki, M.D., Ph.D., Address: Department of Physiology/Anesthesiology, Yokohama City University Graduate School of Medicine. 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan, Phone: +81-45-787-2918, FAX: +81-45-787-2917,
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Wong BJ, Agarwal R, Chen MI. Anesthesia for the Pediatric Patient With Epilepsy and Minimally Invasive Surgery for Epilepsy. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-021-00457-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kacar Bayram A, Yan Q, Isitan C, Rao S, Spencer DD, Alkawadri R. Effect of anesthesia on electrocorticography for localization of epileptic focus: Literature review and future directions. Epilepsy Behav 2021; 118:107902. [PMID: 33819715 DOI: 10.1016/j.yebeh.2021.107902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 11/20/2022]
Abstract
Intraoperative electrocorticography (ECoG) is a useful technique to guide resections in epilepsy surgery and is mostly performed under general anesthesia. In this systematic literature review, we seek to investigate the effect of anesthetic agents on the quality and reliability of ECoG for localization of the epileptic focus. We conducted a systematic search using PubMed and EMBASE until January 2019, aiming to review the effects of anesthesia on ECoG yield. Fifty-eight studies were included from 1016 reviewed. There are favorable reports for dexmedetomidine and remifentanil during ECoG recording. There is inadequate, or sometimes conflicting, evidence to support using enflurane, isoflurane, sevoflurane, and propofol. There is evidence to avoid halothane, nitrous oxide, etomidate, ketamine, thiopental, methohexital, midazolam, fentanyl, and alfentanil due to undesired effects. Depth of anesthesia, intraoperative awareness, and surgical outcomes were not consistently evaluated. Available studies provide helpful information about the effect of anesthesia on ECoG to localize the epileptic focus. The proper use of anesthetic agents and careful dose titration, and effective communication between the neurophysiologist and anesthesiologist based on ECoG activity are essential in optimizing recordings. Anesthesia is a crucial variate to consider in the design of studies investigating ECoG and related biomarkers.
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Affiliation(s)
- Ayse Kacar Bayram
- Comprehensive Epilepsy Center, Dept. of Neurology, School of Medicine, Yale University, Yale New Haven Hospital, New Haven, CT, United States; Department of Pediatrics, Division of Pediatric Neurology, University of Health Sciences, Kayseri City Hospital, Kayseri, Turkey.
| | - Qi Yan
- Comprehensive Epilepsy Center, Dept. of Neurology, School of Medicine, Yale University, Yale New Haven Hospital, New Haven, CT, United States
| | - Cigdem Isitan
- Human Brain Mapping Program, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Shilpa Rao
- Department of Anesthesiology, School of Medicine, Yale University, New Haven, CT, United States
| | - Dennis D Spencer
- Comprehensive Epilepsy Center, Dept. of Neurology, School of Medicine, Yale University, Yale New Haven Hospital, New Haven, CT, United States
| | - Rafeed Alkawadri
- Comprehensive Epilepsy Center, Dept. of Neurology, School of Medicine, Yale University, Yale New Haven Hospital, New Haven, CT, United States; Human Brain Mapping Program, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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6
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Effects of sevoflurane anesthesia on intraoperative high-frequency oscillations in patients with temporal lobe epilepsy. Seizure 2020; 82:44-49. [DOI: 10.1016/j.seizure.2020.08.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/08/2020] [Accepted: 08/28/2020] [Indexed: 11/24/2022] Open
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7
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Nelson JH, Brackett SL, Oluigbo CO, Reddy SK. Robotic Stereotactic Assistance (ROSA) for Pediatric Epilepsy: A Single-Center Experience of 23 Consecutive Cases. CHILDREN-BASEL 2020; 7:children7080094. [PMID: 32784564 PMCID: PMC7465763 DOI: 10.3390/children7080094] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/24/2020] [Accepted: 08/01/2020] [Indexed: 11/18/2022]
Abstract
Robotic assisted neurosurgery has become increasingly utilized for its high degree of precision and minimally invasive approach. Robotic stereotactic assistance (ROSA®) for neurosurgery has been infrequently reported in the pediatric population. The goal of this case series was to describe the clinical experience, anesthetic and operative management, and treatment outcomes for pediatric patients with intractable epilepsy undergoing ROSA® neurosurgery at a single-center institution. Patients who underwent implantation of stereoelectroencephalography (SEEG) leads for intractable epilepsy with ROSA® were retrospectively evaluated between August 2016 and June 2018. Demographics, perioperative management details, complications, and preliminary seizure outcomes after resective or ablative surgery were reviewed. Nineteen children who underwent 23 ROSA® procedures for SEEG implantation were included in the study. Mean operative time was 148 min. Eleven patients had subsequent resective or ablative surgery, and ROSA® was used to assist with laser probe insertion in five patients for seizure foci ablation. In total, 148 SEEG electrodes were placed without any perioperative complications. ROSA® is minimally invasive, provides superior accuracy for electrode placement, and requires less time than traditional surgical approaches for brain mapping. This emerging technology may improve the perioperative outcomes for pediatric patients with intractable epilepsy since large craniotomies are avoided; however, long-term follow-up studies are needed.
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Affiliation(s)
- Jonathon H. Nelson
- Division of Anesthesiology, Pain and Perioperative Medicine, Children’s National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, DC 20010, USA;
- Correspondence:
| | - Samantha L. Brackett
- Division of Anesthesiology, Pain and Perioperative Medicine, Children’s National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, DC 20010, USA;
| | - Chima O. Oluigbo
- Division of Neurosurgery, Children’s National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, DC 20010, USA;
| | - Srijaya K. Reddy
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, Nashville, TN 37232, USA;
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Vakani R, Nair DR. Electrocorticography and functional mapping. HANDBOOK OF CLINICAL NEUROLOGY 2019; 160:313-327. [DOI: 10.1016/b978-0-444-64032-1.00020-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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9
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Sonkajärvi E, Rytky S, Alahuhta S, Suominen K, Kumpulainen T, Ohtonen P, Karvonen E, Jäntti V. Epileptiform and periodic EEG activities induced by rapid sevoflurane anaesthesia induction. Clin Neurophysiol 2018; 129:638-645. [DOI: 10.1016/j.clinph.2017.12.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 11/09/2017] [Accepted: 12/09/2017] [Indexed: 10/18/2022]
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Ochoa JG, Hentgarden D, Paulzak A, Ogden M, Pryson R, Lammle M, Rusyniak WG. Subtle pathological changes in neocortical temporal lobe epilepsy. Epilepsy Behav 2017; 71:17-22. [PMID: 28441637 DOI: 10.1016/j.yebeh.2017.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 12/07/2016] [Accepted: 01/07/2017] [Indexed: 11/24/2022]
Abstract
UNLABELLED This was a prospective observational study to correlate the clinical symptoms, electrophysiology, imaging, and surgical pathology of patients with temporal lobe epilepsy (TLE) without hippocampal sclerosis. We selected consecutive patients with TLE and normal MRI undergoing temporal lobe resection between April and September 2015. Clinical features, imaging, and functional data were reviewed. Intracranial monitoring and language mapping were performed when it was required according to our team recommendation. Prior to hippocampal resection, intraoperative electrocorticography was performed using depth electrodes in the amygdala and the hippocampus. The resected hippocampus was sent for pathological analysis. RESULTS Five patients with diagnosis with non-lesional TLE were included. We did not find distinctive clinical features that could be a characteristic of non-lesional TLE. The mean follow-up was 13.2months (11-15months); 80% of patients achieved Engel Class I outcome. There was no distinctive electrographic findings in these patients. Histopathologic analysis was negative for mesial temporal sclerosis. A second blinded independent neuropathologist with expertise in epilepsy found ILAE type I focal cortical dysplasia in the parahippocampal gyrus in all patients. A third independent neuropathologist reported changes in layer 2 with larger pyramidal neurons in 4 cases but concluded that none of these cases met the diagnostic criteria of FCD. Subtle pathological changes could be associated with a parahippocampal epileptic zone and should be investigated in patients with MRI-negative TLE. This study also highlights the lack of interobserver reliability for the diagnosis of mild cortical dysplasia. Finally, selective amygdalo-hippocampectomy or laser ablation of the hippocampus may not control intractable epilepsy in this specific population.
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Affiliation(s)
- Juan G Ochoa
- Department of Neurology, University of South Alabama, United States.
| | - Diana Hentgarden
- Department of Neurology, University of South Alabama, United States
| | - Audrey Paulzak
- Department of Neurosurgery, University of Rochester, United States
| | - Melissa Ogden
- Department of Neurology, University of South Alabama, United States
| | - Richard Pryson
- Department of Pathology, Cleveland Clinic Foundation, United States
| | - Markus Lammle
- Department of Radiology, University of South Alabama, United States
| | - Walter G Rusyniak
- Department of Neurosurgery, University of South Alabama, United States
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Lane MA, Kahlenberg CA, Li Z, Kulandaival K, Secore KL, Thadani VM, Bujarski KA, Kobylarz EJ, Roberts DW, Tosteson TD, Jobst BC. The implantation effect: delay in seizure occurrence with implantation of intracranial electrodes. Acta Neurol Scand 2017; 135:115-121. [PMID: 27531652 DOI: 10.1111/ane.12662] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE A transient decrease in seizure frequency has been identified during therapeutic brain stimulation trials with stimulator in patients in the inactive sham group. This study was performed to examine whether the implantation of intracranial electrodes decreases seizure occurrence and explores factors that may be associated. METHODS A retrospective review of 193 patients was performed, all evaluated with both scalp video EEG monitoring and intracranial EEG (iEEG) monitoring. Data about the number of seizures per day during the monitoring period, the number of days until the first seizure, anti-epileptic drugs (AEDs), pain medications, types of implanted electrodes, and anesthetic agents were reviewed. We conducted a repeated measure analysis for counted data using generalized estimating equations with a log-link function and adjustment for number of days and anti-epileptic medication load on the previous day to compare seizure frequencies between scalp and iEEG monitoring. RESULTS The time to the first seizure was significantly prolonged during iEEG monitoring as compared to scalp monitoring after correction for AED withdrawal (hazard ratio: 0.81, CI 0.69-0.96). During scalp video EEG monitoring, patients experienced an average of 1.09 seizures/day vs 1.27 seizures/day during iEEG monitoring (P=.066). There was no significant difference in seizure frequency in patients that received craniotomy vs burr holes only for intracranial implantation. An increasing number of electrodes implanted increased the delay to seizures (P=.01). Of all anesthetic agents used, desflurane seemed to have an anticonvulsive effect compared to other anesthetics (P=.006). Pain medication did not influence delay to seizures. SIGNIFICANCE Seizures are delayed during iEEG as opposed to scalp monitoring illustrating the "implantation effect" previously observed. Surgical planning should account for longer monitoring periods, particularly when using larger intracranial arrays.
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Affiliation(s)
- M. A. Lane
- Department of Neurology; Dartmouth Hitchcock Medical Center; Lebanon NH USA
| | - C. A. Kahlenberg
- Department of Neurology; Dartmouth Hitchcock Medical Center; Lebanon NH USA
| | - Z. Li
- Norris Cotton Cancer Center; Biostatistics Shared Resource; Lebanon NH USA
| | - K. Kulandaival
- Department of Neurology; Hanemann Hospital; Philadelphia PA USA
| | - K. L. Secore
- Department of Neurology; Dartmouth Hitchcock Medical Center; Lebanon NH USA
| | - V. M. Thadani
- Department of Neurology; Dartmouth Hitchcock Medical Center; Lebanon NH USA
| | - K. A. Bujarski
- Department of Neurology; Dartmouth Hitchcock Medical Center; Lebanon NH USA
| | - E. J. Kobylarz
- Department of Neurology; Dartmouth Hitchcock Medical Center; Lebanon NH USA
| | - D. W. Roberts
- Department of Neurosurgery; Dartmouth Hitchcock Medical Center; Lebanon NH USA
| | - T. D. Tosteson
- Division of Biostatistics; Department of Biomedical Data Science; Geisel School of Medicine at Dartmouth; Hanover NH USA
| | - B. C. Jobst
- Department of Neurology; Dartmouth Hitchcock Medical Center; Lebanon NH USA
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12
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Ahmadi E, Katnani HA, Daftari Besheli L, Gu Q, Atefi R, Villeneuve MY, Eskandar E, Lev MH, Golby AJ, Gupta R, Bonmassar G. An Electrocorticography Grid with Conductive Nanoparticles in a Polymer Thick Film on an Organic Substrate Improves CT and MR Imaging. Radiology 2016; 280:595-601. [PMID: 26844363 DOI: 10.1148/radiol.2016142529] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To develop an electrocorticography (ECoG) grid by using deposition of conductive nanoparticles in a polymer thick film on an organic substrate (PTFOS) that induces minimal, if any, artifacts on computed tomographic (CT) and magnetic resonance (MR) images and is safe in terms of tissue reactivity and MR heating. Materials and Methods All procedures were approved by the Animal Care and Use Committee and complied with the Public Health Services Guide for the Care and Use of Animals. Electrical functioning of PTFOS for cortical recording and stimulation was tested in two mice. PTFOS disks were implanted in two mice; after 30 days, the tissues surrounding the implants were harvested, and tissue injury was studied by using immunostaining. Five neurosurgeons rated mechanical properties of PTFOS compared with conventional grids by using a three-level Likert scale. Temperature increases during 30 minutes of 3-T MR imaging were measured in a head phantom with no grid, a conventional grid, and a PTFOS grid. Two neuroradiologists rated artifacts on CT and MR images of a cadaveric head specimen with no grid, a conventional grid, and a PTFOS grid by using a four-level Likert scale, and the mean ratings were compared between grids. Results Oscillatory local field potentials were captured with cortical recordings. Cortical stimulations in motor cortex elicited muscle contractions. PTFOS implants caused no adverse tissue reaction. Mechanical properties were rated superior to conventional grids (χ(2) test, P < .05). The temperature increase during MR imaging for the three cases of no grid, PTFOS grid, and conventional grid was 3.84°C, 4.05°C, and 10.13°C, respectively. PTFOS induced no appreciable artifacts on CT and MR images, and PTFOS image quality was rated significantly higher than that with conventional grids (two-tailed t test, P < .05). Conclusion PTFOS grids may be an attractive alternative to conventional ECoG grids with regard to mechanical properties, 3-T MR heating profile, and CT and MR imaging artifacts. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Emad Ahmadi
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (E.A., R.A., M.Y.V., G.B.), Massachusetts General Hospital, Harvard Medical School, 75 Third Ave, Room 1.402, Charlestown, MA 02129; Advanced X-ray Imaging Sciences Center, Department of Radiology (E.A., L.D.B., M.H.L., R.G.), and Department of Neurosurgery (H.A.K., E.E.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Division of Neurotoxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Ark (Q.G.); and Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (A.J.G.)
| | - Husam A Katnani
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (E.A., R.A., M.Y.V., G.B.), Massachusetts General Hospital, Harvard Medical School, 75 Third Ave, Room 1.402, Charlestown, MA 02129; Advanced X-ray Imaging Sciences Center, Department of Radiology (E.A., L.D.B., M.H.L., R.G.), and Department of Neurosurgery (H.A.K., E.E.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Division of Neurotoxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Ark (Q.G.); and Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (A.J.G.)
| | - Laleh Daftari Besheli
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (E.A., R.A., M.Y.V., G.B.), Massachusetts General Hospital, Harvard Medical School, 75 Third Ave, Room 1.402, Charlestown, MA 02129; Advanced X-ray Imaging Sciences Center, Department of Radiology (E.A., L.D.B., M.H.L., R.G.), and Department of Neurosurgery (H.A.K., E.E.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Division of Neurotoxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Ark (Q.G.); and Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (A.J.G.)
| | - Qiang Gu
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (E.A., R.A., M.Y.V., G.B.), Massachusetts General Hospital, Harvard Medical School, 75 Third Ave, Room 1.402, Charlestown, MA 02129; Advanced X-ray Imaging Sciences Center, Department of Radiology (E.A., L.D.B., M.H.L., R.G.), and Department of Neurosurgery (H.A.K., E.E.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Division of Neurotoxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Ark (Q.G.); and Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (A.J.G.)
| | - Reza Atefi
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (E.A., R.A., M.Y.V., G.B.), Massachusetts General Hospital, Harvard Medical School, 75 Third Ave, Room 1.402, Charlestown, MA 02129; Advanced X-ray Imaging Sciences Center, Department of Radiology (E.A., L.D.B., M.H.L., R.G.), and Department of Neurosurgery (H.A.K., E.E.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Division of Neurotoxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Ark (Q.G.); and Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (A.J.G.)
| | - Martin Y Villeneuve
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (E.A., R.A., M.Y.V., G.B.), Massachusetts General Hospital, Harvard Medical School, 75 Third Ave, Room 1.402, Charlestown, MA 02129; Advanced X-ray Imaging Sciences Center, Department of Radiology (E.A., L.D.B., M.H.L., R.G.), and Department of Neurosurgery (H.A.K., E.E.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Division of Neurotoxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Ark (Q.G.); and Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (A.J.G.)
| | - Emad Eskandar
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (E.A., R.A., M.Y.V., G.B.), Massachusetts General Hospital, Harvard Medical School, 75 Third Ave, Room 1.402, Charlestown, MA 02129; Advanced X-ray Imaging Sciences Center, Department of Radiology (E.A., L.D.B., M.H.L., R.G.), and Department of Neurosurgery (H.A.K., E.E.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Division of Neurotoxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Ark (Q.G.); and Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (A.J.G.)
| | - Michael H Lev
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (E.A., R.A., M.Y.V., G.B.), Massachusetts General Hospital, Harvard Medical School, 75 Third Ave, Room 1.402, Charlestown, MA 02129; Advanced X-ray Imaging Sciences Center, Department of Radiology (E.A., L.D.B., M.H.L., R.G.), and Department of Neurosurgery (H.A.K., E.E.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Division of Neurotoxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Ark (Q.G.); and Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (A.J.G.)
| | - Alexandra J Golby
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (E.A., R.A., M.Y.V., G.B.), Massachusetts General Hospital, Harvard Medical School, 75 Third Ave, Room 1.402, Charlestown, MA 02129; Advanced X-ray Imaging Sciences Center, Department of Radiology (E.A., L.D.B., M.H.L., R.G.), and Department of Neurosurgery (H.A.K., E.E.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Division of Neurotoxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Ark (Q.G.); and Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (A.J.G.)
| | - Rajiv Gupta
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (E.A., R.A., M.Y.V., G.B.), Massachusetts General Hospital, Harvard Medical School, 75 Third Ave, Room 1.402, Charlestown, MA 02129; Advanced X-ray Imaging Sciences Center, Department of Radiology (E.A., L.D.B., M.H.L., R.G.), and Department of Neurosurgery (H.A.K., E.E.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Division of Neurotoxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Ark (Q.G.); and Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (A.J.G.)
| | - Giorgio Bonmassar
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (E.A., R.A., M.Y.V., G.B.), Massachusetts General Hospital, Harvard Medical School, 75 Third Ave, Room 1.402, Charlestown, MA 02129; Advanced X-ray Imaging Sciences Center, Department of Radiology (E.A., L.D.B., M.H.L., R.G.), and Department of Neurosurgery (H.A.K., E.E.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Division of Neurotoxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Ark (Q.G.); and Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (A.J.G.)
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Shetty A, Pardeshi S, Shah VM, Kulkarni A. Anesthesia considerations in epilepsy surgery. Int J Surg 2015; 36:454-459. [PMID: 26188082 DOI: 10.1016/j.ijsu.2015.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 06/28/2015] [Accepted: 07/14/2015] [Indexed: 11/16/2022]
Abstract
Epilepsy surgeries can be done under general anesthesia or with local anesthesia and sedation. Epilepsy surgery done under general anesthesia have similar goals as any other neurosurgical procedure, except in patients with temporal lobe epilepsy requiring cortical mapping or electrocorticography (ECoG) where depth of anesthesia has to be reduced. Since seizure focus localization can be done preoperatively with modern diagnostic tools, general anesthesia is popular even for these patients. It is comfortable for both the surgeon and the patient. For intraoperative ECoG or cortical mapping awake craniotomy is the preferred technique.
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Affiliation(s)
- Anita Shetty
- Neuroanesthesia Fellowship Programme, Department of Anesthesia, Seth GS Medical College & KEM Hospital, Mumbai, India.
| | - Swarada Pardeshi
- Department of Anesthesia, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Viraj M Shah
- Department of Anesthesia, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Aarti Kulkarni
- Department of Anesthesia, Seth GS Medical College & KEM Hospital, Mumbai, India
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Dexmedetomidine anesthesia enhances spike generation during intra-operative electrocorticography: A promising adjunct for epilepsy surgery. Epilepsy Res 2015; 109:65-71. [DOI: 10.1016/j.eplepsyres.2014.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 09/30/2014] [Accepted: 10/18/2014] [Indexed: 11/20/2022]
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Bindra A, Chouhan RS, Prabhakar H, Chandra PS, Tripathi M. Perioperative anesthetic implications of epilepsy surgery: a retrospective analysis. J Anesth 2014; 29:229-34. [PMID: 25288505 DOI: 10.1007/s00540-014-1919-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Accepted: 09/05/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Drug-resistant epilepsy (DRE) occurs in about 30 % of individuals with epilepsy. For seizure control, a wide range of surgical procedures are performed, depending on the underlying pathology. To address the anesthetic and perioperative concerns in these patients, we analyzed the data of persons with DRE who underwent epilepsy surgery at our institute. METHODS A retrospective analysis of patients who underwent epilepsy surgery from 2005-2010 was performed. For data collection and analysis, patients were divided into three groups: Group I (temporal lobe epilepsy), Group II (extratemporal lobe epilepsy), and Group III (multilobar epilepsy and others). RESULTS A total of 241 surgical procedures were performed on 235 persons with DRE. The procedures included temporal (149) and extratemporal (47) lobe resection, hemispherotomy (31), corpus callosotomy (5), vagus nerve stimulation (3), and implantation of invasive cerebral electrodes (6). General anesthesia was the more common anesthetic technique; awake craniotomy was performed in only five cases. Intraoperative neuromonitoring was used most frequently in Group II. Patients in Group III had the longest intraoperative course and the greatest blood loss. The overall incidence of postoperative mechanical ventilation was 17.84 %, with 53.84 % of patients in Group III alone. At one-year follow-up, a good outcome was seen in 78 % of temporal lobe resection, 55 % of extratemporal cortical resection, 82 % of hemispherotomy, and 80 % of corpus callosotomy procedures. CONCLUSIONS Careful preoperative selection and meticulous perioperative management are the most significant factors for success of epilepsy surgery. Although temporal and extratemporal lobe surgeries have a fairly stable perioperative course, multilobar epilepsy requiring disconnective surgery poses a greater challenge.
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Affiliation(s)
- Ashish Bindra
- Department of Neuroanesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, 110 029, India,
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Bilotta F, Titi L, Lanni F, Stazi E, Rosa G. Training anesthesiology residents in providing anesthesia for awake craniotomy: learning curves and estimate of needed case load. J Clin Anesth 2013; 25:359-366. [PMID: 23965201 DOI: 10.1016/j.jclinane.2013.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 01/22/2013] [Accepted: 01/29/2013] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To measure the learning curves of residents in anesthesiology in providing anesthesia for awake craniotomy, and to estimate the case load needed to achieve a "good-excellent" level of competence. DESIGN Prospective study. SETTING Operating room of a university hospital. SUBJECTS 7 volunteer residents in anesthesiology. MEASUREMENTS Residents underwent a dedicated training program of clinical characteristics of anesthesia for awake craniotomy. The program was divided into three tasks: local anesthesia, sedation-analgesia, and intraoperative hemodynamic management. The learning curve for each resident for each task was recorded over 10 procedures. Quantitative assessment of the individual's ability was based on the resident's self-assessment score and the attending anesthesiologist's judgment, and rated by modified 12 mm Likert scale, reported ability score visual analog scale (VAS). This ability VAS score ranged from 1 to 12 (ie, very poor, mild, moderate, sufficient, good, excellent). The number of requests for advice also was recorded (ie, resident requests for practical help and theoretical notions to accomplish the procedures). MAIN RESULTS Each task had a specific learning rate; the number of procedures necessary to achieve "good-excellent" ability with confidence, as determined by the recorded results, were 10 procedures for local anesthesia, 15 to 25 procedures for sedation-analgesia, and 20 to 30 procedures for intraoperative hemodynamic management. CONCLUSIONS Awake craniotomy is an approach used increasingly in neuroanesthesia. A dedicated training program based on learning specific tasks and building confidence with essential features provides "good-excellent" ability.
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Affiliation(s)
- Federico Bilotta
- Department of Anesthesiology, Critical Care and Pain Medicine, Section of Neuroanesthesia and Neurocritical Care, "Sapienza" University of Rome, Rome 00199, Italy.
| | - Luca Titi
- Department of Anesthesiology, Critical Care and Pain Medicine, Section of Neuroanesthesia and Neurocritical Care, "Sapienza" University of Rome, Rome 00199, Italy
| | - Fabiana Lanni
- Department of Anesthesiology, Critical Care and Pain Medicine, Section of Neuroanesthesia and Neurocritical Care, "Sapienza" University of Rome, Rome 00199, Italy
| | - Elisabetta Stazi
- Department of Anesthesiology, Critical Care and Pain Medicine, Section of Neuroanesthesia and Neurocritical Care, "Sapienza" University of Rome, Rome 00199, Italy
| | - Giovanni Rosa
- Department of Anesthesiology, Critical Care and Pain Medicine, Section of Neuroanesthesia and Neurocritical Care, "Sapienza" University of Rome, Rome 00199, Italy
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Chui J, Manninen P, Valiante T, Venkatraghavan L. The anesthetic considerations of intraoperative electrocorticography during epilepsy surgery. Anesth Analg 2013; 117:479-86. [PMID: 23780418 DOI: 10.1213/ane.0b013e318297390c] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Epilepsy surgery is a well-established therapeutic intervention for patients with medically refractory seizures. Success of epilepsy surgery depends on the accurate localization and complete removal of the epileptogenic zone. Despite the advances in presurgical localization modalities, electrocorticography is still used in approximately 60% to 70% of the epilepsy centers in North America to guide surgical resection of the epileptogenic lesion and to assess for completeness of surgery. In this review, we discuss the principles and intraoperative use of electrocorticography, the effect of anesthetic drugs on electrocorticography, and the use of pharmacoactivation for intraoperative localization of epileptogenic zone.
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Affiliation(s)
- Jason Chui
- Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 399, Bathurst St., Toronto, Ontario, Canada M5T 2S8
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Roth J, Olasunkanmi A, Ma TS, Carlson C, Devinsky O, Harter DH, Weiner HL. Epilepsy control following intracranial monitoring without resection in young children. Epilepsia 2012; 53:334-41. [DOI: 10.1111/j.1528-1167.2011.03380.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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MORIOKA T, SAYAMA T, MUKAE N, HAMAMURA T, YAMAMOTO K, KIDO T, SAKATA A, SASAKI T. Nonconvulsive Status Epilepticus During Perioperative Period of Cerebrovascular Surgery. Neurol Med Chir (Tokyo) 2011; 51:171-9. [DOI: 10.2176/nmc.51.171] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - Tomomi KIDO
- Department of Clinical Laboratory, Kyushu Rosai Hospital
| | - Ayumi SAKATA
- Department of Clinical Chemistry and Laboratory Medicine, Kyushu University Hospital
| | - Tomio SASAKI
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
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Kim SH, Song GS, Sung SK, Son DW. A Case of Seizure in a Patient Following Percutaneous Endoscopic Lumbar Discectomy. KOREAN JOURNAL OF SPINE 2011. [DOI: 10.14245/kjs.2011.8.1.55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Sung Hoon Kim
- Department of Neurosurgery, Pusan National University College of Medicine, Yangsan, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Pusan National University College of Medicine, Yangsan, Korea
| | - Soon Ki Sung
- Department of Neurosurgery, Pusan National University College of Medicine, Yangsan, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Pusan National University College of Medicine, Yangsan, Korea
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Relationship between regional cerebral blood flow and electrocorticographic activities under sevoflurane and isoflurane anesthesia. J Clin Neurophysiol 2010; 27:110-5. [PMID: 20505374 DOI: 10.1097/wnp.0b013e3181d64da1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aims of this study are (1) to assess the effects of volatile anesthetics on regional cerebral blood flow (rCBF) and electrocorticography (ECoG), and (2) to investigate the relationship between rCBF and ECoG influenced by volatile anesthetics. The authors measured rCBF using laser Doppler flowmetry and ECoG simultaneously and continuously from the same cortex during craniotomy, using the specially arranged probe. Patients received intravenous anesthetics with nitrous oxide until craniotomy, and after opening of dura, volatile anesthetic, either isoflurane or sevoflurane, was started and was gradually increased for the measurement. Four of the nine cases (44.4%) of the sevoflurane group showed no change both in rCBF and ECoG. In three cases (33.3%), rCBF increased as the frequency of the paroxysmal activities increased. In two cases (22.2%), decreased rCBF was accompanied by slow waves. In 12 cases of the isoflurane group, no apparent rCBF and ECoG changes were seen, except a case with decreased rCBF and slow waves. This is the first report of simultaneous recordings of regional CBF and neuronal activity under general anesthesia. During sevoflurane and isoflurane anesthesia <2.5 minimum alveolar anesthetic concentration, rCBF is affected by ECoG activities rather than pharmacologic action of inhalational anesthetics.
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Abstract
PURPOSE OF REVIEW Epilepsy is a clinical disorder of paroxysmal recurring seizures, the diagnosis excluding alcohol or drug withdrawal seizures or such recurring exogenous events as repeated insulin-induced hypoglycemia. Epilepsy has a profound impact on each individual diagnosed with this disease. RECENT FINDINGS New antiepileptic drugs (AEDs) have been a major change in the approach to management of patients with epilepsy. These drugs tend to have fewer significant drug interactions and less severe side effects. Nonetheless, first-generation AEDs are still widely used. Propofol and desflurane have reliable anticonvulsant effects, whereas remifentanil in larger doses and sevoflurane appear to support epileptiform activity, although the clinical significance of these observations is unclear. SUMMARY The primary concerns for providing anesthesia to the patient with epilepsy are the capacity of anesthetics to modulate or potentiate seizure activity and the interaction of anesthetic drugs with AEDs. Proconvulsant and anticonvulsant properties have been reported for virtually every anesthetic such that these properties become elements of the anesthetic plan in the patient with epilepsy. Moreover, AEDs have many physiologic and pharmacologic effects that can have an impact on an anesthetic.
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Affiliation(s)
- W Andrew Kofke
- Departments of Anesthesiology and Critical Care and Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Abstract
PURPOSE OF REVIEW In this review we focus on recent findings in the anesthetic management of patients undergoing craniotomy while awake, and propose a structured approach to the clinical practice of 'anesthesia' for awake neurosurgery. RECENT FINDINGS The increasing use of functional neurosurgery and recent evidence favoring resection of tumor involving eloquent cortex has expanded the indications for awake craniotomy, a procedure needing a fully cooperative patient and expert intraoperative anesthetic management. Despite the shorter hospital stay, the more recently published studies have highlighted perioperative anesthetic complications and have proposed ways to improve anesthesia techniques for awake procedures in adults and children. SUMMARY Although anesthesia for awake craniotomy is usually a well tolerated procedure it requires an extensive knowledge of the principles underlying neuroanesthesia and of specific technical strategies including local anesthesia for scalp blockade, advanced airway management, dedicated sedation protocols, and skillful management of hemodynamics.
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In vivo mapping of temporospatial changes in glucose utilization in rat brain during epileptogenesis: an 18F-fluorodeoxyglucose–small animal positron emission tomography study. Neuroscience 2009; 162:972-9. [DOI: 10.1016/j.neuroscience.2009.05.041] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 05/16/2009] [Accepted: 05/20/2009] [Indexed: 11/23/2022]
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Pedroviejo V, Ayuso M, Jiménez A. [Anesthesia for procedures other than neurosurgery in the adult with epilepsy]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2009; 56:425-435. [PMID: 19856689 DOI: 10.1016/s0034-9356(09)70423-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Epilepsy is a common disease affecting between 1% and 2% of the general population. The incidence increases with age. Given the complicated etiology and pathogenesis of this disease, epileptic patients of all ages may require anesthesia. The perioperative care of these patients involves a number of special considerations, although the main issues to deal with are pharmacologic. This review gives an overview of the etiopathogenesis and pathophysiology of epilepsy and describes the general characteristics of antiepileptic drug therapy. The anesthetic implications of chronic treatment with antiepileptic agents and the interactions between these drugs and common anesthetics are discussed in more detail.
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Affiliation(s)
- V Pedroviejo
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid.
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Lega BC, Wilfong AA, Goldsmith IL, Verma A, Yoshor D. Cortical Resection Tailored to Awake, Intraoperative Ictal Recordings and Motor Mapping in the Treatment of Intractable Epilepsia Partialis Continua: Technical Case Report. Oper Neurosurg (Hagerstown) 2009; 64:ons195-6; discussion ons196. [DOI: 10.1227/01.neu.0000335656.12271.a9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Objective:
Epilepsia partialis continua (EPC) is a form of status epilepticus that is characterized by continuous simple partial seizures and can occur as a manifestation of a variety of underlying pathological processes. Because these seizures typically take onset within or close to motor cortex, the treatment of refractory EPC with resective surgery risks significant postoperative deficits.
Clinical Presentation:
We describe our experience using ictal recordings obtained intraoperatively during awake craniotomy, in conjunction with direct cortical stimulation mapping, to tailor surgical resections in 2 patients with refractory EPC. Both patients had pan-hemispheric pathologies that made extraoperative recording difficult.
Intervention:
Awake craniotomy takes advantage of a unique feature of refractory EPC, namely the near-continuous presence of focal seizure activity. It allows the surgeon to record seizures in the operating room and precisely define the anatomic location of epileptic activity, to resect the seizure focus, and to both visually and electrographically confirm successful cessation of EPC after resection, all within a single operation. We used standard methods of awake craniotomy to finely tailor a cortical resection to the epileptogenic cortex while sparing nearby eloquent motor areas. The precision of awake mapping made this approach safe and effective.
Conclusion:
The cases we describe demonstrate the role of focal resection in the treatment of EPC. Standard techniques of awake craniotomy have application in the treatment of this challenging problem.
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Affiliation(s)
- Bradley C. Lega
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Angus A. Wilfong
- Department of Neurology, and Division of Pediatric Neurology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Ian L. Goldsmith
- Peter Kellaway Section of Neurophysiology, Department of Neurology, Baylor College of Medicine, Houston, Texas
| | - Amit Verma
- Department of Neurology, The Methodist Neurological Institute, Houston, Texas
| | - Daniel Yoshor
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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Voss LJ, Sleigh JW, Barnard JPM, Kirsch HE. The Howling Cortex: Seizures and General Anesthetic Drugs. Anesth Analg 2008; 107:1689-703. [PMID: 18931234 DOI: 10.1213/ane.0b013e3181852595] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Veronesi MC, Kubek DJ, Kubek MJ. Isoflurane exacerbates electrically evoked seizures in amygdala-kindled rats during recovery. Epilepsy Res 2008; 82:15-20. [PMID: 18674885 DOI: 10.1016/j.eplepsyres.2008.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2007] [Revised: 05/21/2008] [Accepted: 06/18/2008] [Indexed: 11/29/2022]
Abstract
Neuroexcitatory effects of isoflurane during or following anesthesia are controversial, particularly in epileptic patients. In contrast, halothane is generally considered to be highly anticonvulsant. Kindling is an animal model of epilepsy suitable for studying the effects of anesthetic agents on the epileptic brain. Fully kindled, Sprague-Dawley rats were either untreated or received a 5 min exposure to isoflurane or halothane 30 min prior to a seizure and compared to seizures in the absence of prior anesthesia. Afterdischarge duration was assessed via electroencephalographs recorded from electrodes implanted in the basolateral amygdala and behavioral seizure stereotypy (stages I-V) was simultaneously recorded and analyzed using digital video for all seizures. Total seizure duration and clonus duration were significantly (P<0.05) increased 30 min after isoflurane but not halothane exposure relative to pre-treatment control. These results are the first to demonstrate that isoflurane exacerbates electrically evoked secondarily generalized seizures in fully kindled animals during recovery. These results also show that the kindling paradigm is useful for evaluating the mechanism of anesthetic agents that may be proconvulsant in epileptic subjects.
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Affiliation(s)
- Michael C Veronesi
- Program in Medical Neuroscience, Indiana University School of Medicine, 635 Barnhill Drive, Room MS5022, Indianapolis, IN 46202, United States
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Mizuno J, Muroya M, Gauss T, Yamada Y, Arita H, Hanaoka K. Effect of 2.5% sevoflurane, at PaCO2 30 mmHg for epileptic focus resection, on hemodynamics and hepatic and renal functions. J Anesth 2007; 21:108-9. [PMID: 17285429 DOI: 10.1007/s00540-006-0456-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Accepted: 09/20/2006] [Indexed: 10/23/2022]
Affiliation(s)
- Ju Mizuno
- Department of Anesthesiology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 108-8329, Japan
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Kopjas NN, Jones RT, Bany B, Patrylo PR. Reeler mutant mice exhibit seizures during recovery from isoflurane-induced anesthesia. Epilepsy Res 2006; 69:87-91. [PMID: 16466907 DOI: 10.1016/j.eplepsyres.2005.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Revised: 12/13/2005] [Accepted: 12/13/2005] [Indexed: 11/28/2022]
Abstract
Reeler mice are a model of cortical malformation with enhanced seizure susceptibility. Data suggest that the propensity to anesthesia-induced seizures may be enhanced in animal models with developmental anomalies. Consequently, reeler mice were monitored behaviorally before, during and after isoflurane anesthesia. During recovery, 12% of reeler homozygotes had class I/II seizures while the remaining 88% exhibited convulsive seizures entailing opisthotonus and forepaw drumming. Similar behavior was not observed in controls. These data reveal that reeler mice display isoflurane-induced seizures and provide support for the hypothesis that developmental anomalies may predispose the central nervous system to anesthesia-induced seizures.
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Affiliation(s)
- Nicholas N Kopjas
- Department of Physiology, Southern Illinois University School of Medicine, Carbondale, IL 62901, USA
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Voss LJ, Ludbrook G, Grant C, Sleigh JW, Barnard JPM. Cerebral cortical effects of desflurane in sheep: comparison with isoflurane, sevoflurane and enflurane. Acta Anaesthesiol Scand 2006; 50:313-9. [PMID: 16480464 DOI: 10.1111/j.1399-6576.2006.00914.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Different volatile anesthetic agents have differing propensities for inducing seizures. A measure of the predilection to develop seizures is the presence of interictal spike discharges (spikes) on the electrocorticogram (ECoG). In this study, we investigated the propensity of desflurane to induce cortical spikes and made a direct objective comparison with enflurane, isoflurane, and sevoflurane. The ECoG effects of desflurane have not been previously reported. METHODS After establishment of invasive monitoring and a parasagittal array of eight electrodes to record the ECoG; eight adult merino sheep were given a series of short inhalational anesthetics (using desflurane, enflurane, sevoflurane and isoflurane); each titrated to ECoG burst suppression. Anesthetic effect was estimated by the effects on the approximate entropy of the ECoG. The effect of anesthetic on the spike-rate in the ECoG was analyzed using a non-linear mixed-effect method with a sigmoid Emax model. RESULTS A similar 'depth of anesthesia' was achieved for each agent, as estimated by the approximate entropy. The mean (SD) values of Emax for the spike-rate vs. approximate entropy relationship were desflurane 0.5 (0.9), enflurane 17.2 (4.0), isoflurane 0.7 (1.2), and sevoflurane 5.3 (1.2) spikes/min. The spike rate caused by desflurane was similar to isoflurane and significantly lower than that of enflurane (P < 0.001), and sevoflurane (P = 0.009). CONCLUSION Desflurane induces minimal cerebral cortical spike activity when administered to burst suppression, consistent with its low propensity for inducing seizures in non-epileptic brains. The agents can be ranked by their relative ability to cause spike activity: enflurane >> sevoflurane > isoflurane = desflurane.
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Affiliation(s)
- L J Voss
- Waikato Clinical School, University of Auckland, Hamilton, New Zealand.
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Kurita N, Kawaguchi M, Hoshida T, Nakase H, Sakaki T, Furuya H. Effects of Nitrous Oxide on Spike Activity on Electrocorticogram Under Sevoflurane Anesthesia in Epileptic Patients. J Neurosurg Anesthesiol 2005; 17:199-202. [PMID: 16184063 DOI: 10.1097/01.ana.0000178914.36157.c8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We sought to investigate the effects of nitrous oxide on intraoperative electrocorticogram (ECoG) spike activities in 11 patients with intractable epilepsy. Grid electrodes were placed on the brain surface, and ECoG was recorded under the following conditions: 1.5 minimal alveolar anesthetic concentration (MAC) sevoflurane without nitrous oxide and 1.5 MAC sevoflurane with 50% nitrous oxide. The number of spikes for 5 minutes and the percentage of leads with spikes of total leads measured were assessed in each condition. The median numbers (25-75th) of spikes without and with nitrous oxide were 127 (87-368) and 61 (43-247), respectively. The numbers of spikes with nitrous oxide were significantly lower than those without nitrous oxide (P<0.05). The median percentages of leads with spikes without and with nitrous oxide were 68 (25-81) and 61 (28-70), respectively, and there were no significant differences in percentages of leads with spikes between the conditions. These results indicate that nitrous oxide attenuated the frequency of spikes on ECoG in epileptic patients, although it did not affect the extent of areas with spike activity.
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Affiliation(s)
- Naoko Kurita
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan and Department of Neurosurgery, Nara Prefectural Nara Hospital, Nara, Japan
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Abstract
The volatile anaesthetics sevoflurane and desflurane feature new and promising properties. Their low blood and tissue solubility enables rapid onset of and emergence from anaesthesia, thus enhancing patient safety and comfort. This article is designed as an up-to-date review of the pharmacokinetic and pharmacodynamic properties of modern volatile anaesthetics. The first part focuses on pharmacokinetic issues such as substance properties, uptake and elimination. The second part covers the effects of inhaled anaesthetics on organ systems, with emphasis on the central nervous system, the cardiovascular system, the respiratory tract, liver and kidneys.
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Affiliation(s)
- Benedikt Preckel
- Department of Anaesthesiology, Düsseldorf University Hospital, Düsseldorf, Germany.
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Kurita N, Kawaguchi M, Hoshida T, Nakase H, Sakaki T, Furuya H. The Effects of Sevoflurane and Hyperventilation on Electrocorticogram Spike Activity in Patients with Refractory Epilepsy. Anesth Analg 2005; 101:517-523. [PMID: 16037170 DOI: 10.1213/01.ane.0000158606.31021.1f] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED We investigated the effects of sevoflurane and hyperventilation on intraoperative electrocorticogram (ECoG) spike activity in 13 patients with intractable epilepsy. Grid electrodes were placed on the brain surface and ECoG was recorded under the following conditions: 1) 0.5 minimal alveolar anesthetic concentration (MAC) sevoflurane, 2) 1.5 MAC sevoflurane, and 3) 1.5 MAC sevoflurane with hyperventilation. The number of spikes per 5 min and the percentage of leads with spikes were assessed in each condition. In 4 patients with chronically implanted-subdural electrodes, the leads with seizure onset and with spikes during the interictal periods in the awake state were compared with those during sevoflurane anesthesia at 0.5 MAC and 1.5 MAC. The number of spikes and the percentage of leads with spikes were significantly more under 1.5 MAC sevoflurane anesthesia compared with those under 0.5 MAC sevoflurane (P < 0.05). The induction of hyperventilation significantly increased the number of spikes and percentage of leads with spikes (P < 0.05). With 0.5 MAC sevoflurane, the leads with spikes were similar to those at seizure onset in the awake state, whereas with 1.5 MAC sevoflurane, spikes were similar to those occurring during interictal periods in the awake state. These results indicate that sevoflurane and hyperventilation can affect the frequency and extent of ECoG spike activity in patients with intractable epilepsy. Careful attention should be paid to the concentration of sevoflurane used and ventilatory status when intraoperative EcoG is used to localize epileptic lesions. IMPLICATIONS Electrocorticogram can be used to define the location and extent of epileptic foci during epilepsy surgery. However, electrocorticogram can be affected by anesthetic technique. The present study found that sevoflurane concentration and hyperventilation affected the frequency and the extent of electrocorticogram spike activity in epileptic patients.
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Affiliation(s)
- Naoko Kurita
- Departments of *Anesthesiology and †Neurosurgery, Nara Medical University, Kashihara; ‡Department of Neurosurgery, Nara Prefectural Nara Hospital, Nara, Japan
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Abstract
Sevoflurane has become the volatile agent of choice for inhalation induction of anesthesia. Hemodynamic stability and lack of respiratory irritation have justified its rapid extension to pediatric inhalation induction. The epileptogenic potential of sevoflurane has been suspected since the first case reports of abnormal movements in children without a history of epilepsy. The objectives of this short review are to: (i) analyze clinical and electroencephalographic (EEG) features supporting epileptogenic activity of sevoflurane, (ii) identify factors which may modulate that activity, and (iii) suggest guidelines of clinical practice to limit expression of this epileptiform phenomenon, which has thus far unknown morbidity. The use of sevoflurane may be associated with cortical epileptiform EEG signs, usually without clinical manifestation. No lasting neurological or EEG sequelae have been described thus far, and the potential morbidity of this epileptogenic effect is unknown. The use of sevoflurane in children, with its remarkable cardiovascular profile, should include a number of precautions. Among them, the limitation of the depth of anesthesia is essential. The wide use of cerebral function monitoring (the most simple being the EEG), may permit optimization of sevoflurane dose and avoidance of burst suppression and major epileptiform signs in fragile subjects, notably the very young and the very old.
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Affiliation(s)
- Isabelle Constant
- Service d'Anesthésie-Réanimation, Hopital d'enfants Armand Trousseau, Assistance-Publique, Hôpitaux de Paris, Paris VI University, Paris, France.
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Holmström A, Akeson J. Sevoflurane induces less cerebral vasodilation than isoflurane at the same A-line autoregressive index level. Acta Anaesthesiol Scand 2005; 49:16-22. [PMID: 15675976 DOI: 10.1111/j.1399-6576.2004.00576.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The use of sevoflurane in neuroanesthesia is still under debate. Comparison of dose-dependent vasodilatory properties between sevoflurane and isoflurane, the more traditional neuroanesthetic agent, requires comparable dosing of the agents. A-line autoregressive index (AAI) provides reproducible individual measurement of anesthetic depth. METHODS Sevoflurane and isoflurane, in randomized order, were titrated to a stable AAI of 15-20 in each of 18 ASA I or II patients. The mean flow velocity (Vmca) and pulsatility index (PI) in the middle cerebral artery were measured with transcranial Doppler at an end-tidal CO2 of 4.5%. RESULTS For sevoflurane Vmca was 18% lower [95% confidence interval (CI) 12-22%; P < 0.00001] and PI was 23% higher (95% CI 12-33%; P = 0.0013) than for isoflurane. Mean arterial blood pressure did not differ between the two agents. The minimum alveolar concentration (MAC) fraction necessary to reach the intended AAI level was 13% higher (95% CI 5-20%; P = 0.0079) with sevoflurane than with isoflurane. CONCLUSION Sevoflurane induced less cerebral vasodilation than isoflurane at the same depth of anesthesia, measured by AAI, and hence seems more favorable for clinical neuroanesthesia. In our opinion the difference between sevoflurane and isoflurane in the MAC fraction required to attain the same AAI level demonstrates the limitations of MAC in defining the level of anesthesia.
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Affiliation(s)
- A Holmström
- Department of Anesthesia and Intensive Care, Malmö University Hospital, Lund University, Malmö, Sweden.
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Akeson J, Didriksson I. Convulsions on anaesthetic induction with sevoflurane in young children. Acta Anaesthesiol Scand 2004; 48:405-7. [PMID: 15025599 DOI: 10.1111/j.1399-6576.2004.00365.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Increased worldwide use for paediatric anaesthesia of the volatile anaesthetic agent sevoflurane has mainly resulted from its low blood-gas partition coefficient and low airway irritability, providing smooth conditions for rapid induction of anaesthesia. Nevertheless, there are several clinical and experimental reports suggesting a correlation between exposure to sevoflurane and generalized clonic or tonic seizure activity. We report two clinical episodes of convulsions associated with the induction of sevoflurane anaesthesia in young children. CASE 1: during induction of anaesthesia with sevoflurane by facemask in a 3-year-old healthy boy, there were symmetrical clonic seizure-like movements of the upper extremities for 60 s. CASE 2: on re-induction of anaesthesia with sevoflurane because of profuse bleeding following nasal adenoidectomy in a 4-year-old healthy girl with a family history of epilepsy, there were symmetrical tonic and clonic seizure-like movements for 30-40 s in the upper and lower extremities. Both episodes ceased spontaneously. Although no EEG was recorded, it cannot be excluded that both episodes resulted from seizure activity within the CNS. Based on our observations and reports by others we suggest that, until further notice, sevoflurane should be avoided or at least used cautiously in patients where clinical epileptic activity has been verified or is strongly suspected.
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Affiliation(s)
- J Akeson
- Department of Anaesthesia and Intensive Care, Lund University, Malmö University Hospital, Malmö, Sweden.
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Moe MC, Berg-Johnsen J, Larsen GA, Røste GK, Vinje ML. Sevoflurane reduces synaptic glutamate release in human synaptosomes. J Neurosurg Anesthesiol 2002; 14:180-6. [PMID: 12172289 DOI: 10.1097/00008506-200207000-00002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Volatile anesthetics reduce excitatory synaptic transmission in the mammalian brain. In the present study, the effect of sevoflurane on synaptic glutamate release, free cytosolic Ca2+ ([Ca2+]i), and glutamate uptake was investigated using isolated presynaptic terminals prepared from human cerebral cortex. The tissue was obtained from standard temporal lobe specimens removed because of epilepsy. The glutamate release and [Ca2+]i was measured as the fluorescence of nicotinamide adenine dinucleotide phosphate (NADPH) and fura-2, respectively. The uptake of radiolabeled glutamate was measured in a beta-scintillation counter. Membrane depolarization with 4-aminopyridine for three minutes evoked a Ca2+-dependent glutamate release of 3.4 +/- 0.5 nmol/mg. Sevoflurane 2.5 and 4.0% attenuated the evoked release by 45 and 55%, respectively. The evoked increase in [Ca2+]i was not significantly altered by the anesthetic agent. The uptake studies were performed in the high-affinity area, and Km was calculated to 19.3 +/- 5.7 x 10(-6) M and Vmax to 5.7 +/- 1.0 micromol g(-1) min(-1). The Km and Vmax values were not significantly altered by sevoflurane 2.5%. These results demonstrate that sevoflurane in the human brain reduces Ca2+-dependent glutamate release. The exact mode of action is still to be resolved.
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Affiliation(s)
- Morten C Moe
- Institute for Surgical Research and Department of Neurosurgery, Rikshospitalet University Hospital, Oslo, Norway
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