Incidence of epileptiform discharges in children during induction of anaesthesia using Propofol versus Sevoflurane
Authors: Susanne Koch
Rudolf Mörgeli
Sylvia Kramer
Klaus Dieter Wernecke
Astrid Fahlenkamp
Leopold Rupp
Christine Prager
Claudia Spies
Journal: Clinical Neurophysiology (2018)
Discipline: NEUROSCIENCE & BEHAVIOR
Keywords: Epileptiform discharges; General anaesthesia; Infant; Preschool children; Propofol
Affiliations: Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Germany; Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: ., Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Germany; Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany., Department of Paediatria and Neurology (CVK), Charité-Universitätsmedizin Berlin, Germany; Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany., Institute of Medical Biometry, Charité-Universitätsmedizin Berlin, Sostana GmbH, Berlin, Germany.

Abstract:  Objective: In pediatric patients, anaesthesia induction is often performed with intravenous Propofol or Sevoflurane inhalation. Although epileptiform discharges have been observed during inductions with Sevoflurane, their occurrence has not been investigated for i.v. Propofol inductions. The aim of this study is to compare the incidence of epileptiform discharges in children during anaesthesia induction using Propofol versus Sevoflurane. Methods: Prospective, observational cohort study in children aged 0.5-8 years undergoing elective surgery. Children were anaesthetized with either Propofol or Sevoflurane. Bi-frontal electroencephalograms electrodes were placed before start of anaesthesia. Visual electroencephalogram analysis was performed from start of anesthetic agent administration until Intubation with regard to identify epileptiform patterns, i.e. delta with spikes; rhythmic polyspikes; periodic, epileptiform discharges; or suppression with spikes. Results: 39 children were anaesthetized with Propofol, and 18 children with Sevoflurane. Epileptiform discharges were seen in 36% of the children in the Propofol group, versus 67% in the Sevoflurane group (p = 0.03). Incidence of the distinct types of epileptiform discharge differed for periodic, epileptiform discharges (Sevoflurane group 39% vs. Propofol group 3%; p &lt; 0.001). Higher concentration of Remifentanil (≥0.15 µg/kg/min) was associated with less frequent epileptiform discharges (Exp 5.8; CI 95% 1.6/21.2; p = 0.008). Conclusions: Propofol i.v. induction of anaesthesia in children triggers epileptiform discharges, whereas to a lesser extent than Sevoflurane does. Significance: Presuming that epileptiform discharges have an impact on postoperative brain function, it is advisable to use Propofol rather than Sevoflurane and higher level of Remifentanil for anaesthesia induction in children. 

Retracted: No

PubPeer comments:
 The method for measuring mature miR-296-5p would not work as described. A standard reverse transcription kit will not prepare mature miRNAs for amplification. Instead, a microRNA-specific RT strategy would be needed, specifically in this case a stem-loop RT primer strategy, as reflected in the  forward primer described in the methods section. However, the  forward and  reverse primers also appear to have been switched, a feature shared with numerous other articles claiming to amplify mature miR-296-5p with unclear methods. The absence of apparent understanding that miRNAs must be RT d and amplified differently from other RNAs diminishes confidence in the miRNA portions of the paper. ,