Isoelectric Electroencephalography in Infants and Toddlers during Anesthesia for Surgery: An International Observational Study

作者：Ian Yuan, Ting Xu, Justin Skowno, Bingqing Zhang, Andrew Davidson, Britta S. von Ungern‐Sternberg, David Sommerfield, Jianmin Zhang, Xingrong Song, Mazhong Zhang, Ping Zhao, Hua‐Cheng Liu, Yifei Jiang, Yunxia Zuo, Jurgen C. de Graaff, László Vutskits, Vanessa A. Olbrecht, Peter Szmuk, C. Dean Kurth, for the BRAIN Collaborative Investigators · 发表于：Anesthesiology · 年份：2022 · DOI：10.1097/aln.0000000000004262 · 被引用次数：36 · 研究领域：Anesthesia and Sedative Agents、Anesthesia and Neurotoxicity Research、Intensive Care Unit Cognitive Disorders

BACKGROUND: Intraoperative isoelectric electroencephalography (EEG) has been associated with hypotension and postoperative delirium in adults. This international prospective observational study sought to determine the prevalence of isoelectric EEG in young children during anesthesia. The authors hypothesized that the prevalence of isoelectric events would be common worldwide and associated with certain anesthetic practices and intraoperative hypotension. METHODS: Fifteen hospitals enrolled patients age 36 months or younger for surgery using sevoflurane or propofol anesthetic. Frontal four-channel EEG was recorded for isoelectric events. Demographics, anesthetic, emergence behavior, and Pediatric Quality of Life variables were analyzed for association with isoelectric events. RESULTS: Isoelectric events occurred in 32% (206 of 648) of patients, varied significantly among sites (9 to 88%), and were most prevalent during pre-incision (117 of 628; 19%) and surgical maintenance (117 of 643; 18%). Isoelectric events were more likely with infants younger than 3 months (odds ratio, 4.4; 95% CI, 2.57 to 7.4; P < 0.001), endotracheal tube use (odds ratio, 1.78; 95% CI, 1.16 to 2.73; P = 0.008), and propofol bolus for airway placement after sevoflurane induction (odds ratio, 2.92; 95% CI, 1.78 to 4.8; P < 0.001), and less likely with use of muscle relaxant for intubation (odds ratio, 0.67; 95% CI, 0.46 to 0.99; P = 0.046]. Expired sevoflurane was higher in patients with isoelectric even...