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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.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999