Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2013.10.013
Brazilian Journal of Anesthesiology
Scientific Article

The impact of different antiepileptic drugs on the sedation of children during magnetic resonance imaging

Impacto de diferentes medicamentos antiepilépticos na sedação de crianças durante a ressonância magnética

Isil Davarci; Murat Karcioglu; Kasim Tuzcu; Fatmagul Basarslan; Ramazan Davran; Erhan Yengil; Cahide Yilmaz; Selim Turhanoglu

http://dx.doi.org/10.1016/j.bjane.2013.10.013 Braz J Anesthesiol, vol.64, n5, p.320-325, 2014
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Abstract

Background and objectives:The induction and inhibition of cytochrome P450 isoenzymes by antiepileptic drugs lead to changes in the clearance of anesthetic drugs eliminated via hepatic metabolism. We investigated the duration of the sedation and additional anesthetic needs during magnetic resonance imaging in epileptic children receiving antiepileptic drugs that cause either enzyme induction or inhibition.Methods:In American Society of Anesthesiology I–II, 120 children aged 3–10 years were included. Group 1: children using antiepileptic drugs that cause cytochrome P450 enzyme induction; Group 2: those using antiepileptic drugs that cause inhibition; and Group 3: those that did not use antiepileptic drugs. Sedation was induced with the use of 0.05 mg kg−1 midazolam and 1 mg kg−1 propofol. An additional 0.05 mg kg−1 of midazolam and rescue propofol (0.5 mg kg−1) were administered and repeated to maintain sedation. The duration of sedation and the additional sedation needed were compared.Results:The duration of the initial dose was significantly shorter in Group I compared with groups II and III (p = 0.001, p = 0.003, respectively). It was significantly longer in Group II compared with groups I and III (p = 0.001, p = 0.029, respectively). The additional midazolam needed for adequate sedation was increased in Group I when compared with groups II and III (p = 0.010, p = 0.001, respectively). In addition, the rescue propofol dose was significantly higher only in Group I when compared with Group III (p = 0.002).Conclusion:In epileptic children, the response variability to the initial sedative agents during the magnetic resonance imaging procedure resulting from the inhibition or induction of the cytochrome P450 isoenzymes by the antiepileptic drugs mandated the titration of anesthetic agents.

Keywords

Epilepsy, Pediatric, Antiepileptics, Sedation, MRI

Resumo

Justificativa e objetivos:A indução e a inibição das isoenzimas do citocromo P450 pelos medicamentos antiepilépticos levam a alterações na depuração de medicamentos anestésicos eliminados pelo metabolismo hepático. Investigamos a duração da sedação e a necessidade adicional de anestésicos durante a ressonância magnética em crianças epilépticas que receberam antiepilépticos que causam a indução ou a inibição de enzimas.Métodos:Foram incluídas no estudo 120 crianças, estado físico ASA I-II, entre 3-10 anos. Grupo 1: em uso de antiepilépticos que causam a indução de enzimas do citocromo P450; Grupo 2: em uso de antiepilépticos que causam a inibição de enzimas do citocromo P450; e Grupo 3: que não usavam antiepilépticos. A sedação foi induzida com midazolam (0,05 mg kg−1) e propofol (1 mg kg−1). Um adicional de 0,05 mg kg−1 de midazolam e resgate com 0,5 mg kg−1 de propofol foram administrados e repetidos para manter a sedação. A duração da sedação e a sedação adicional necessária foram comparadas.Resultados:A duração da dose inicial foi significativamente menor no Grupo I em comparação com os grupos II e III (p = 0,001, p = 0,003, respectivamente) e significativamente maior no Grupo II em comparação com os grupos I e III (p = 0,001, p = 0,029, respectivamente). A necessidade de midazolam adicional para sedação adequada foi maior no Grupo I em comparação com os grupos II e III (p = 0,010, p = 0,001, respectivamente). Além disso, a dose de resgate de propofol foi significativamente maior apenas no Grupo I em comparação com o Grupo III (p = 0,002).Conclusão:Em crianças epilépticas, a variabilidade da resposta aos agentes sedativos iniciais durante a ressonância magnética, resultante da inibição ou indução das isoenzimas do citocromo P450 pelos medicamentos antiepiléticos, exigiu a titulação dos agentes anestésicos.

Palavras-chave

Epilepsia, Pediátrica, Antiepilépticos, Sedação, RM

References

Maranhao MV, Gomes EA, de Carvalho PE. Epilepsy and anesthesia. Rev Bras Anestesiol. 2011;61:124-236.

Eker HE, Yalcin Cok O, Aribogan A. Children on phenobarbital monotherapy requires more sedatives during MRI. Paediatr Anaesth. 2011;21:998-1002.

Kofke WA. Anesthetic management of the patient with epilepsy or prior seizures. Curr Opin Anaesthesiol. 2010;23:391-9.

Perks A, Cheema S, Mohanraj R. Anaesthesia and epilepsy. Br J Anaesth. 2012;108:562-71.

Tan L, Yu JT, Sun YP. The influence of cytochrome oxidase CYP2A6, CYP2B6, and CYP2C9 polymorphisms on the plasma concentrations of valproic acid in epileptic patients. Clin Neurol Neurosurg. 2010;112:320-3.

Wilfong AA. Monotherapy in children and infants. Neurology. 2007;69:S17-22.

Anderson GD. Pharmacogenetics and enzyme induction/inhibition properties of antiepileptic drugs. Neurology. 2004;63:S3-8.

Cohen M, Sadhasivam S, Vinks AA. Pharmacogenetics in perioperative medicine. Curr Opin Anaesthesiol. 2012;25:419-27.

Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96:1004-17.

Cote CJ, Wilson S. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update. Pediatrics. 2006;118:2587-602.

Isik B, Arslan M, Tunga AD. Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery. Paediatr Anaesth. 2006;16:748-53.

Weldon BC, Watcha MF, White PF. Oral midazolam in children: effect of time and adjunctive therapy. Anesth Analg. 1992;75:51-5.

Malviya S, Voepel-Lewis T, Tait AR. Depth of sedation in children undergoing computed tomography: validity and reliability of the University of Michigan Sedation Scale (UMSS). Br J Anaesth. 2002;88:241-5.

Machata AM, Willschke H, Kabon B. Propofol-based sedation regimen for infants and children undergoing ambulatory magnetic resonance imaging. Br J Anaesth. 2008;101:239-43.

Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth. 1995;7:89-91.

Malviya S, Voepel-Lewis T, Tait AR. Pentobarbital vs chloral hydrate for sedation of children undergoing MRI: efficacy and recovery characteristics. Paediatr Anaesth. 2004;14:589-95.

Demir G, Cukurova Z, Eren G. The effect of "multiphase sedation" in the course of computed tomography and magnetic resonance imaging on children, parents and anesthesiologists. Rev Bras Anestesiol. 2012;62:511-9.

Matsunaga T, Maruyama M, Harada E. Expression and induction of CYP3As in human fetal hepatocytes. Biochem Biophys Res Commun. 2004;318:428-34.

Madan A, Graham RA, Carroll KM. Effects of prototypical microsomal enzyme inducers on cytochrome P450 expression in cultured human hepatocytes. Drug Metab Dispos. 2003;31:421-31.

Perucca E. Clinical implications of hepatic microsomal enzyme induction by antiepileptic drugs. Pharmacol Ther. 1987;33:139-44.

Patsalos PN, Perucca E. Clinically important drug interactions in epilepsy: general features and interactions between antiepileptic drugs. Lancet Neurol. 2003;2:347-56.

Anderson GD. A mechanistic approach to antiepileptic drug interactions. Ann Pharmacother. 1998;32:554-63.

Perucca E, Hedges A, Makki KA. A comparative study of the relative enzyme inducing properties of anticonvulsant drugs in epileptic patients. Br J Clin Pharmacol. 1984;18:401-10.

Kilbaugh TJ, Friess SH, Raghupathi R. Sedation and analgesia in children with developmental disabilities and neurologic disorders. Int J Pediatr. 2010:189142.

Slovis TL. Sedation and anesthesia issues in pediatric imaging. Pediatr Radiol. 2011;41:514-6.

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