• Susanne Koch, Leopold Rupp, Christine Prager, Klaus D Wernecke, Sylvia Kramer, Astrid Fahlenkamp, and Claudia D Spies.
• From the Department of Anaesthesiology and Operative Intensive Care Medicine (SK, LR, SK, AF, CDS), Department of Paediatrics and Neurology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte (CP), Institute of Medical Biometry, Charité - Universitätsmedizin Berlin (KDW) and CRO Sostana GmbH, Berlin, Germany (KDW).
• Eur J Anaesthesiol. 2018 Dec 1; 35 (12): 929-936.

BackgroundEpileptiform 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.ObjectivesProspective, 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.DesignProspective, observational cohort study.SettingUniversity hospital - Germany/Berlin. Children were included between September 2015 and February 2017.PatientsA total of 62 Children, aged 0.5 to 8 years old undergoing planned surgery were included.Main Outcome MeasuresPrimary 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.ResultsA 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).ConclusionEmergence delirium in children is significantly related to interictal spike events occurring during induction of anaesthesia.Clinical TrialNCT02481999.

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