This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (14) Citing Articles via Google Scholar Google Scholar Articles by Iijima, T. Articles by Sankawa, H. Search for Related Content PubMed PubMed Citation Articles by Iijima, T. Articles by Sankawa, H.

---

GENERAL ARTICLES

The Epileptogenic Properties of the Volatile Anesthetics Sevoflurane and Isoflurane in Patients with Epilepsy

Takehiko Iijima, DDS, DMSc, PhD^*, Zenkou Nakamura, DDS, DMSc, Yasuhide Iwao, MD, DMSc^*, and Hiroshi Sankawa, MD, DMSc^*

*Department of Anesthesiology, Kyorin University School of Medicine; and Section of Dentistry, Tokyo Metropolitan Higashiyamato Medical Center for the Severely Disabled, Tokyo, Japan

Address correspondence and reprint requests to Takehiko Iijima, DDS, DMSc, PhD, Department of Anesthesiology, Kyorin University of Medicine, 6-20-2 Sinkawa Mitaka, Tokyo 181-8611, Japan. Address e-mail to iijmt{at}kyorin-u.ac.jp

No study comparing epileptogenicity of sevoflurane to other volatile anesthetics has been performed. We compared the epileptogenic properties of sevoflurane to isoflurane in patients with epilepsy. In 24 mentally and/or physically disabled patients, 12 with epilepsy and 12 without epilepsy, electroencephalograms were recorded under anesthesia with 1.0 minimum alveolar anesthetic concentration (MAC), 1.5 MAC, and then 2.0 MAC sevoflurane or isoflurane under three ventilatory conditions: (A) 100% oxygen, and end-tidal CO₂ partial pressure (ETCO₂) = 40 mm Hg, (B) 50% oxygen, 50% nitrous oxide, ETCO₂ = 40 mm Hg, and (C) 100% oxygen, ETCO₂ = 20 mm Hg. Spike activity was evaluated as a spike-and-wave index (% durations of spike and wave). The spike-and-wave index increased (P < 0.05) from 1.99% ± 0.96% during 1.0 MAC sevoflurane to 6.14% ± 4.45% during 2.0 MAC sevoflurane in (A) in the epilepsy group, while no spike activity was observed in the nonepilepsy group. Only a few spikes were observed under isoflurane anesthesia, 0.04% ± 0.04% in (A), with no spikes in (B) and (C). Supplementation with 50% nitrous oxide or hyperventilation (P < 0.05) suppressed the occurrence of spikes. Sevoflurane has a stronger epileptogenic property than isoflurane, but nitrous oxide or hyperventilation counteracts this specific epileptogenic property.

Implications: The stronger epileptogenicity of sevoflurane than isoflurane was confirmed in a controlled study in patients with epilepsy. Hyperventilation and supplementation of nitrous oxide under sevoflurane anesthesia suppressed epileptogenicity. A combination of sevoflurane and nitrous oxide may be a safer method for seizure-prone patients than the use of sevoflurane alone.

This article has been cited by other articles:

				L. J. Voss, J. W. Sleigh, J. P. M. Barnard, and H. E. Kirsch The Howling Cortex: Seizures and General Anesthetic Drugs Anesth. Analg., November 1, 2008; 107(5): 1689 - 1703. [Abstract] [Full Text] [PDF]

				Y. Oda, S. Toriyama, K. Tanaka, T. Matsuura, N. Hamaoka, M. Morino, and A. Asada The Effect of Dexmedetomidine on Electrocorticography in Patients with Temporal Lobe Epilepsy Under Sevoflurane Anesthesia Anesth. Analg., November 1, 2007; 105(5): 1272 - 1277. [Abstract] [Full Text] [PDF]

				K. W. Hatton, J. T. McLarney, T. Pittman, and B. G. Fahy Vagal Nerve Stimulation: Overview and Implications for Anesthesiologists Anesth. Analg., November 1, 2006; 103(5): 1241 - 1249. [Abstract] [Full Text] [PDF]

				N. Kurita, M. Kawaguchi, T. Hoshida, H. Nakase, T. Sakaki, and H. Furuya The Effects of Sevoflurane and Hyperventilation on Electrocorticogram Spike Activity in Patients with Refractory Epilepsy Anesth. Analg., August 1, 2005; 101(2): 517 - 523. [Abstract] [Full Text] [PDF]

				S. M. Mirsattari, M. D. Sharpe, and G. B. Young Treatment of Refractory Status Epilepticus With Inhalational Anesthetic Agents Isoflurane and Desflurane Arch Neurol, August 1, 2004; 61(8): 1254 - 1259. [Abstract] [Full Text] [PDF]

				M. Chinzei, S. Sawamura, M. Hayashida, T. Kitamura, H. Tamai, and K. Hanaoka Change in Bispectral Index During Epileptiform Electrical Activity Under Sevoflurane Anesthesia in a Patient with Epilepsy Anesth. Analg., June 1, 2004; 98(6): 1734 - 1736. [Abstract] [Full Text] [PDF]

				F. Wappler, P. Bischoff, G. D. Politis, and M. S. Quigg Is Fast Induction with Sevoflurane Associated with an Increased Anesthetic Risk in Pediatric Patients? * Response Anesth. Analg., April 1, 2003; 96(4): 1239 - 1240. [Full Text] [PDF]

				E. I Eger II, D. Gong, Y. Xing, D. E. Raines, and P. Flood Acetylcholine Receptors and Thresholds for Convulsions from Flurothyl and 1,2-Dichlorohexafluorocyclobutane Anesth. Analg., December 1, 2002; 95(6): 1611 - 1615. [Abstract] [Full Text] [PDF]