Abstract
The aim of this study is to describe the effect of sedation and analgesia on postoperative amplitude-integrated EEG (aEEG) in newborns with congenital heart disease (CHD) undergoing heart surgery. This is a consecutive series of 26 newborns with CHD of which 16 patients underwent cardiopulmonary bypass (CPB) surgery and 10 patients did not. aEEG was monitored for at least 12 h preoperatively and started within the first 6 h postoperatively for 48 h. Outcome was assessed at 1 year of age. All 26 patients showed a normal preoperative continuous cerebral activity with sleep-wake cycles (SWC). The postoperative duration to return to normal background activity with SWC was similar for both groups. Independent of group assignment, patients requiring midazolam had a significantly later onset of a normal SWC than those without midazolam (p = 0.03). Three patients in the CPB group and two in the non-CPB group showed continuous low voltage or flat trace after administration of fentanyl. These changes did not correlate with neurodevelopmental outcome. Sedation with midazolam has a transient effect on the background activity, whereas fentanyl can induce a severe pathologic background pattern. The significance of these changes on outcome is not yet clear. Thus, more attention should be paid to these effects when interpreting aEEG in this population.
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Abbreviations
- aEEG:
-
amplitude-integrated electroencephalogram
- BIS:
-
bispectral index
- BS:
-
burst suppression
- CHD:
-
congenital heart disease
- CLV:
-
continuous low voltage
- CPB:
-
cardiopulmonary bypass
- CNV:
-
continuous normal voltage
- SWC:
-
sleep-wake cycle
- DNV:
-
discontinuous normal voltage
- HIE:
-
hypoxic-ischemic encephalopathy
- FT:
-
flat tracing
- MDI:
-
mental developmental index
- PDI:
-
psychomotor developmental index
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Supported by the Anna Muller Grocholski-Foundation and the Foundation for Scientific Research of the University of Zurich.
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Bernet, V., Latal, B., Natalucci, G. et al. Effect of Sedation and Analgesia on Postoperative Amplitude-Integrated EEG in Newborn Cardiac Patients. Pediatr Res 67, 650–655 (2010). https://doi.org/10.1203/PDR.0b013e3181da44ba
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DOI: https://doi.org/10.1203/PDR.0b013e3181da44ba
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