Emergence delirium in children is related to epileptiform discharges during anaesthesia induction: An observational study
Authors: Claudia D Spies
Astrid Fahlenkamp
Klaus D Wernecke
Leopold Rupp
Susanne Koch
Christine Prager
Sylvia Kramer
Journal: European Journal of Anaesthesiology (2018)
Discipline: CLINICAL MEDICINE
Keywords: Epileptiform discharges; emergence delirium; children; anaesthesia induction; electroencephalogram
Affiliations: From the Department of Anaesthesiology and Operative Intensive Care Medicine (SK, LR, SK, AF, CDS), Department of Paediatrics and Neurology, Charit√© - Universit√§tsmedizin Berlin, Campus Virchow-Klinikum and Campus Charit√© Mitte (CP), Institute of Medical Biometry, Charit√© - Universit√§tsmedizin Berlin (KDW) and CRO Sostana GmbH, Berlin, Germany (KDW).

Abstract:  Background: Epileptiform discharges frequently occur in children during induction of anaesthesia. However, studies analysing the impact of epileptiform discharges on postoperative emergence delirium in children are still scarce. The aim of this study is to correlate the incidence of epileptiform activity during anaesthesia induction with the occurrence of emergence delirium during stay in the recovery room. Objectives: Prospective, observational cohort study in children 0.5 to 8 years old undergoing planned surgery. Bifrontal electroencephalogram electrodes were placed before induction of anaesthesia. Visual electroencephalogram analysis was performed from start of anaesthetic agent administration until intubation with regard to epileptiform patterns: rhythmic polyspikes; periodic epileptiform discharges; delta with spikes; and suppression with spikes. Emergence delirium was assessed during stay in the recovery room using the Pediatric Assessment of Emergence Delirium Score. Design: Prospective, observational cohort study. Setting: University hospital - Germany/Berlin. Children were included between September 2015 and February 2017. Patients: A total of 62 Children, aged 0.5 to 8 years old undergoing planned surgery were included. Main outcome measures: Primary outcome was emergence delirium. Secondary outcomes, peri-operative Electroencephalography (EEG) data analysis. The presented study analysed an association between emergence delirium and the occurrence of epileptiform discharges during anaesthesia induction. Results: A total of 43.5% of the children developed emergence delirium and 56.5% did not. Epileptiform discharges were observed more often in children developing emergence delirium (63%) compared with children not developing emergence delirium (43%). But only the occurrence of interictal spike events - such as rhythmic polyspikes; periodic epileptiform discharges and delta with spikes - were significantly related to emergence delirium (emergence delirium-group 48% vs. nonemergence delirium-group 14%, OR = 5.6 [95% CI: 1.7 to 18.7]; P = 0.004). Conclusion: Emergence delirium in children is significantly related to interictal spike events occurring during induction of anaesthesia. Clinical trial: NCT02481999. 

Retracted: No

PubPeer comments:
 Figure 1 was pointed out to my by a reader * Cyan boxes: Two parts of the DSP panel appear to look very similar * Pink boxes: Two parts of the PED panel appear to look very similar Could the authors please clarify if these EEG patterns should look so similar? I am not an expert, but I would have expected EEG patterns to be less repetitive than ECG plots.  , 
 Figure 1 also looks identical to Figure 1 presented in another paper by overlapping authors, i.e.  Incidence of epileptiform discharges in children during induction of anaesthesia using Propofol versus Sevoflurane , by Susanne Koch et al., Clinical Neurophysiology (2018), doi: 10.1016 j.clinph.2018.05.013 - https: pubpeer.com publications CAC546BBC012BAFEFD683D6635DD0B In this paper, reference 3 (Vakkuri et al 2001) is given next to the mentioning of Figure 1, but that paper shows a different set of panels. Can the authors please clarify if this figure shows measurements obtained by the authors? ,