Preterms, neonates and children up to six month of age are prone to exhibit burst suppression while receiving even moderate dosages of anesthetics.
Innerhofer P., Oswald E., Moriz B., Innerhofer-Pompernigg N., Mittermayr M.
Medical University of Innsbruck, Dept of Anaesthesiology & Intensive Care, Innsbruck, Austria
Background: To explore whether routinely applied dosages of anaesthetics result in unwanted burst supression, we retrospectively analyzed collected EEG (Narcotrend®) of children aged 0-6 years undergoing general anaesthesia. 
Materials and methods: Children who underwent surgery between July 2013 and March 2015 and received general anaesthesia with EEG monitoring were included. Data were collected from anaesthesia records and the Narcotrend® database. Collected data were analyzed at predefined time points (induction, 10 min thereafter, before, 5 and 15 min after incision and time of wound closure). Average values of sevoflurane and continuously administered propofol were calculated as mean of values recorded for the 6 time points.
Results: Data of 172 children undergoing anaesthesia with EEG monitoring for various types of general pediatric surgery were analyzed. Children received median dosages of propofol (0-3.6 mg/kg) or sevoflurane for induction and fentanyl (1.8-4 µg/kg), anaesthesia was maintained with sevoflurane (1.1-2.4 et vol%) in most cases, only in 18 children (> 12 months) propofol (4.9-5.9mg/kg/h) was used continuously.
Preterms, neonates and children 1-6 months showed in 94.4%, 100% and 69.2% episodes of burst suppression while in children aged 7-12 months, 13-36 months and 37-72 months burst suppression was detected in 58%, 31% and 23%. In all preterms and neonates burst suppression occurred at multiple time points while this was only true for 46%, 8%, 4% and 1% in children aged 1-6 months, 7-12 months, 13-36 months and 37-72 months. (Fig1,2).
Conclusion(s): Our preliminary data show that children up to six month of age are very susceptible to develop enduring phases of burst suppression even if exposed to low dosages of anaesthetics. Thus, EEG based monitoring should be used to guide administration of hypnotics especially in the very young children.