Quantitative EEG During Anesthesia Emergence in Children

Study Overview
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Brief Summary
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Most drugs used in general anesthesia work on various receptors in the human brain, causing unconsciousness, loss of memory, and loss of reflection of the autonomic nervous system. After the anesthesia, baseline physiological function will be attained by administration of some reversal drugs or as the time goes by. In this process, various side effects may occur. Emergence delirium (ED) is a representative behavioral disturbance after general anesthesia in children and that can cause several problems during the recovery period. Previous EEG studies reported that this phenomenon is related to hyperexcitation of the brain, and occurrence of epileptiform discharges during anesthesia induction may indicate an increased vulnerability for the development of a functional brain disorder in these children. However, to the best of our knowledge, there is no studies concern evaluating quantitative EEG parameters for prediction of this postoperative negative behavior in children.

Official Title
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Quantitative Frontal Electroencephalography (EEG) and Postoperative Emergence Delirium Following General Anesthesia in Children: a Prospective Observational Study

Conditions
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Brain Waves, Psychology, Children, Anesthesia, General, Electroencephalography, Child Behavior

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Children aged between 2 and 10 years of American Society of Anesthesiologists physical status (ASA PS) I or II who are planned to receive surgery under general anesthesia Exclusion Criteria: If the guardian and the subject are difficult to evaluate normally due to language barriers/language disorders/delay or autistic disorder with developmental delay, neurological disorders or psychiatric diseases associated with symptoms of agitation, anxiety, attention deficit, sleep disturbances, etc refusal of consent Recent history (within a month) of received general anesthesia or surgery presence of congenital or other genetic conditions thought to influence brain development

Ages Eligible for Study
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Minimum Age: 2 Years
Maximum Age: 10 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Occurrence of Emergence delirium | On arrival at post-anesthesia care unit (PACU), patients are checked post-anesthesia emergence delirium (PAED). The PAED scale is a validated observational measure of 5 aspects of child behavior (caregiver eye contact, purposeful movement, evidence of awareness of surroundings, restlessness, and inconsolability). Ratings are summed to produce a total score ranging from 0 to 20; greater scores indicate greater severity. If the PAED score is greater than 12, investigators define emergence delirium. | During 60 minutes after PACU admission | 
| Relative power of each brain waves | Original frontal EEG segments are attained via 2 channel bispectral index monitoring (BIS VISTA™, Aspect Medical Systems, Inc. MA, USA) during the anesthesia period. The EEG is then segmented into 4 s epochs and fast Fourier transform (FFT) analysis is performed for each of these segments. FFT of all these selected EEG segments are computed in the following frequency bands: Delta: 1-4 Hz Theta: 4-8 Hz Alpha: 8-13 Hz Beta: 13-30 Hz And then, the relative power of each frequency bands to the total power of the sum is calculated. | From the cessation of sevoflurane inhalation to the extubation of airway devices such as tracheal tubes or laryngeal mask airway | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| modified Yale preoperative anxiety score (mYPAS) | mYPAS is the assessment tool for measure the anxiety before induction. Higher score indicates higher anxiety. | before anesthesia induction (about 30 min before the surgery) | 
| PAED score during PACU stay | On arrival at post-anesthesia care unit (PACU) and every 10 min from then, patients were checked PAED. The PAED scale is a validated observational measure of 5 aspects of child behavior (caregiver eye contact, purposeful movement, evidence of awareness of surroundings, restlessness, and inconsolability). Ratings are summed to produce a total score ranging from 0 to 20; greater scores indicate greater severity. | During 60 min after PACU admission | 
| FLACC score on initial, 10, 20, and 30 min | Face, legs, activity, cry, and consolability (FLACC) score is checked every 10min after PACU admission | During 60 minutes after PACU admission] | 
| Watcha scale on initial, 10, 20, and 30 min | On arrival and 10, 20, and 30 min after PACU admission, patients were checked Watcha scale as following 4-point scale calm crying, but can be consoled Crying, cannot be consoled Agitated and thrashing around Higher score indicates higher agitation. | During 60 minutes after PACU admission | 
| Delta-theta to alpha-beta ratio (DTABR) | From the relative power of each brain waves, the investigators calculated the ratio as follows: DTABR = (Delta wave + Theta wave)/(alpha wave + beta wave) | From the cessation of sevoflurane inhalation to the extubation of airway devices such as tracheal tubes or laryngeal mask airway | 
| Delta to alpha ratio | From the relative power of each brain waves, the investigators calculated the ratio as follows: DAR = Delta wave / alpha wave | From the cessation of sevoflurane inhalation to the extubation of airway devices such as tracheal tubes or laryngeal mask airway | 
| Theta to beta ratio (TBR) | From the relative power of each brain waves, the investigators calculated the ratio as follows: TBR = Theta wave / beta wave | From the cessation of sevoflurane inhalation to the extubation of airway devices such as tracheal tubes or laryngeal mask airway |