Free
Correspondence  |   November 2007
Sevoflurane and Epileptiform Extrapolation?
Author Affiliations & Notes
  • Benjamin Julliac, M.D.
    *
  • *Pellegrin University Hospital, Bordeaux, France.
Article Information
Correspondence
Correspondence   |   November 2007
Sevoflurane and Epileptiform Extrapolation?
Anesthesiology 11 2007, Vol.107, 855. doi:10.1097/01.anes.0000287354.61016.b7
Anesthesiology 11 2007, Vol.107, 855. doi:10.1097/01.anes.0000287354.61016.b7
In Reply:—
We thank Dr. Soto for raising this important point and appreciate the opportunity to reply.
Sevoflurane can be proconvulsive at high alveolar concentrations.1,2 Our study demonstrated that rapid inhalation induction may result in the occurrence of epileptiform discharge. The important question is whether these epileptiform discharges result in deleterious brain effects.
The postoperative clinical outcome of the patients included in our study was outside the scope of our article. However, we did not observe any especially prolonged recovery or postoperative clinical seizure, although we did not do any systematic postoperative assessment. The question of the deleterious clinical effects of nonconvulsive seizure remains a matter of debate.3 For this reason, although we cannot demonstrate that nonconvulsive epileptiform discharges are damaging for the brain, we cannot demonstrate the opposite, either.
We agree that it would be interesting to study perioperative morbidity associated with sevoflurane-related epileptiform action. However, for evident ethical reasons, we cannot schedule a new study where we purposely use epileptogenic sevoflurane concentrations to answer these questions.
However, sevoflurane remains a safe anesthetic agent because of its pharmacologic and clinical properties. Our purpose is not to contraindicate inhalation induction with sevoflurane, especially when the risk–benefit ratio is in favor of this technique. To decrease the risk of the occurrence of epileptiform discharges, incremental induction might be used.4 
*Pellegrin University Hospital, Bordeaux, France.
References
Jaaskelainen SK, Kaisti K, Suni L, Hinkka S, Scheinin H: Sevoflurane is epileptogenic in healthy subjects at surgical levels of anesthesia. Neurology 2003; 61:1073–8Jaaskelainen, SK Kaisti, K Suni, L Hinkka, S Scheinin, H
Julliac B, Guehl D, Chopin F, Arne P, Burbaud P, Sztark F, Cros AM: Factors for the occurrence of electroencephalogram abnormalities during induction of anesthesia with sevoflurane in nonepileptic patients. Anesthesiology 2007; 106:243–51Julliac, B Guehl, D Chopin, F Arne, P Burbaud, P Sztark, F Cros, AM
Young G, Jordan K: Do non-convulsive seizures damage the brain? Yes. Arch Neurol 1998; 55:117–9Young, G Jordan, K
Ha MF, Faes M, Moutard ML, Murat I, Constant I: EEG epileptoid signs during sevoflurane induction in children: A comparative study between incremental and rapid induction (abstract). Eur J Anaesthesiol 2006; A1Ha, MF Faes, M Moutard, ML Murat, I Constant, I