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Exclusion criteria were non-elective procedures, neurosurgical procedures and the use of premedication. Anaesthesia maintained with sevoflurane as the sole anaesthetic agent was the main inclusion criterion. We included children from birth to 6 years of age, scheduled to undergo elective surgery in the Erasmus MC-Sophia Children's Hospital. Methodsįollowing local research ethics committee approval, informed consent was obtained from the parents of all the children. The primary outcome parameter of this prospective observational study in children < 6 years of age was to determine the correlation between DSA and various non-steady-state sevoflurane concentrations. We decided to investigate the additional value of DSA in children undergoing sevoflurane anaesthesia. However, DSA has not yet been widely implemented in the daily practice of paediatric anaesthesia. One of the major advantages of real-time DSA EEG monitoring is the lack of any delay in detecting even subtle changes in the depth of hypnosis. Compared with processed EEG monitoring, DSA provides real-time EEG information 3. The power spectrum is encoded in different colours blue implies minimal power and red implies high or maximal power 1, 2. Encephalographic DSA is a three-dimensional method to display EEG signals consisting of the EEG frequency (y-axis), the power of the EEG signal (originally the z-axis, but colour-coded to be integrated into a two-dimensional plot) and the development of the EEG power spectrum over time (x-axis). Future research should address this issue, aiming to clarify whether the emergence of θ oscillations in infants helps to prevent sevoflurane overdosing.Įlectroencephalographic density spectral array (DSA) monitoring has been proposed to facilitate the interpretation of unprocessed electroencephalogram (EEG) signals in patients undergoing general anaesthesia 1. In cases where anaesthesia was too deep, this presented as burst suppression on the electroencephalogram, θ disappeared, leaving the electroencephalographic activity in the δ range. In infants younger than 6 months-old, α and β coherence are absent, whereas θ and δ oscillations have already emerged.

The main finding was that different end-tidal concentrations of sevoflurane produce age-dependent changes in the density spectral array power spectrum. In infants < 6 months of age, the relative percentages of density spectral array did not correlate with end-tidal sevoflurane. There was a significant correlation between end-tidal sevoflurane and density spectral array in the age groups 6–12 months (p < 0.05) and 1–6 years (p < 0.0001).

We included 104 children, aged 12 months). The primary aim of this prospective observational study, performed in a tertiary children's hospital, was to identify the clinical applicability and validity of density spectral array monitoring in infants and children during sevoflurane anaesthesia. Electroencephalographic density spectral array monitoring has been developed to facilitate the interpretation of unprocessed electroencephalogram signals.

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