A Rapid Increase in the Inspired Concentration of Desflurane Is Not Associated with Epileptiform Encephalogram

• Published in: Anesthesia and analgesia Vol. 101; no. 2; pp. 396 - 400
• Main Authors: Vakkuri, Anne P., Seitsonen, Elina R., Jäntti, Ville H., Särkelä, Mika, Korttila, Kari T., Paloheimo, Markku P.J., Yli-Hankala, Arvi M.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01-08-2005; Lippincott
• Subjects: Adult; Anesthesia; Anesthesia, General; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Inhalation - administration & dosage; Anesthetics, Inhalation - adverse effects; Biological and medical sciences; Double-Blind Method; Electrocardiography - drug effects; Electroencephalography - drug effects; Ephedrine - administration & dosage; Ephedrine - therapeutic use; Epilepsy - chemically induced; Epilepsy - physiopathology; Female; Humans; Hypotension - drug therapy; Intraoperative Complications - drug therapy; Isoflurane - administration & dosage; Isoflurane - adverse effects; Isoflurane - analogs & derivatives; Male; Medical sciences; Methyl Ethers - administration & dosage; Monitoring, Intraoperative; Tachycardia - physiopathology; Vasoconstrictor Agents - administration & dosage; Vasoconstrictor Agents - therapeutic use; Volatile compound; Nervous system diseases; General anesthetic; Desflurane; Epilepsy; Central nervous system disease; Anesthesia; Cerebral disorder; Halogen Organic compounds
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/01.ANE.0000156562.33415.78

The large inspired concentration of sevoflurane (S) during mask induction of anesthesia can induce epileptiform electroencephalogram (EEG) associated with tachycardia. Tachycardia is also seen when the concentration of desflurane (D) is abruptly increased. It is not known whether this is associated with epileptiform EEG similar to S. We studied EEG and heart rate (HR) during rapidly increased concentrations of S or D in 31 females during the postintubation period of anesthesia. Anesthesia was induced with propofol and remifentanil, and the tracheas were intubated. Patients were randomized to receive either S or D in nitrous oxide-oxygen mixture after intubation, at a small dose first. After 10 min, S or D vaporizer was advanced to the highest reading of the vaporizer (7% for S, 18% for D) for 5 min. HR and EEG were recorded. Epileptiform EEG activity was recorded in eight of 15 patients in group S and in none in group D (P < 0.05). HR increased in both groups. In group S, HR increased gradually and the highest HR value was 84 bpm at 5 min after the increase in sevoflurane concentration. In group D, HR increased to 93 bpm 2 min after the increase in desflurane concentration (no significant difference, S versus D). A rapid increase in the concentration of S frequently induces epileptiform EEG during normoventilation. Tachycardia during increasing concentrations of D is not associated with epileptiform EEG.