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Alfentanil Mediated Activation of Epileptiform Activity in the Electrocorticogram During Resection of Epileptogenic Foci

Published online by Cambridge University Press:  18 September 2015

Keene Daniel L. ,
David Roberts ,
Splinter William M. ,
Michael Higgin  and
Enrique Ventureyra
Keene Daniel L.*
Affiliation:
Division of Neurology, Department of Pediatric Department of Surgery Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa.
David Roberts
Affiliation:
Department of Anaesthesia Department of Surgery Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa.
Splinter William M.
Affiliation:
Department of Anaesthesia Department of Surgery Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa.
Michael Higgin
Affiliation:
Division of Neurosurgery Department of Surgery Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa.
Enrique Ventureyra
Affiliation:
Division of Neurosurgery Department of Surgery Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa.
*
Division of Neurology, Department of Pediatrics, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, Canada K1H 8L1
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Abstract:

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Purpose:

Alfentanil is a potent, short-acting opioid agent which has been used during balanced anaesthesia in children undergoing the surgical excision of epileptic foci. After the observation that this agent had the potential to induce epileptic seizures, we questioned the frequency of this occurrence in this group of patients.

Method:

Twelve patients (6 males, 6 females) undergoing surgical excision of an epileptic foci were prospectively followed. For each patient an electrocorticogram was recorded for 30 minutes before and after receiving alfentanil 20 pg/kg intravenously. The frequency of epileptiform abnormalities before and after drug administration was evaluated. When the electrocorticogram no longer showed the effects of alfentanil administration, methohexital 0.5 ug/kg was given intravenously.

Results:

Alfentanil induced significant activation of epileptiform discharges among 83% of these patients. Twenty-five per cent had an electrographic seizure. In comparison, methohexital induced significant activation of epileptiform discharges in 50% of these patients. None experienced electrographic seizures.

Conclusions:

As alfentanil can induce electrographic seizures in patients known to have epilepsy, caution is advised in its use in this group of patients.

Résumé:

RÉSUMÉ:But:

L'alfentanil est un agent opioïde puissant de courte durée qui a été utilisé pendant l'anesthésie équilibrée chez des enfants qui subissent une excision chirurgicale d'un foyer épileptique. Suite à l'observation que cet agent pouvait induire des crises épileptiques, nous en avons évalué la fréquence chez ce groupe de patients.

Méthodes:

Douze patients (6 garcons et 6 filles), qui ont subi une excision chirugicale d'un foyer épileptique, ont été suivis de façon prospective. Un électrocorticogramme a été enregistré chez tous les patients pendant 30 minutes avant et après 1'administration intraveineuse de 20 ug/kg d'alfentanil. Nous avons évalué la fréquence d'anomolies épileptiformes avant et après l'administration de l'alfentanil. Quand l'électrocorticogramme ne montrait plus d'effet de l'alfentanil, du méthohexital à la dose de 0.5 |xg/kg a été administré par voie intraveineuse.

Résultats:

L'alfentanil induit une activation significative des décharges épileptiformes chez 83% de ces patients. 25% ont eu une crise electrographique. Par contre, le méthohexital a induit une activation significative des décharges épileptiformes chez 50% de ces patients et aucun n'a présenté de crise électrographique.

Conclusions:

Comme l'alfentanil peut induire des crises électrographiques chez les patients connus comme épileptiques, on doit l'employer avec prudence chez ces patients.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 24 , Issue 1 , February 1997 , pp. 29 - 36
Copyright
Copyright © Canadian Neurological Sciences Federation 1997

References

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