A retrospective study of electroencephalography burst suppression in children undergoing general anesthesia

IMPORTANCE: In children, anesthesia dosages are based on population pharmacokinetics and patient hemodynamics rather than patient‐specific brain activity. Brain function is highly susceptible to the effects of anesthetics. OBJECTIVE: The primary objective of this retrospective pilot study was to assess the prevalence of electroencephalography (EEG) burst suppression—a sign of deep anesthesia—in children undergoing general anesthesia. METHODS: We analyzed EEG in patients aged 1–36 months who received sevoflurane or propofol as the primary anesthetic. Patient enrollment was stratified into two age groups: 1–12 months and 13–36 months. Burst suppression (voltage ≤ 5.0 mV, lasting > 0.5 seconds) was characterized by occurrence over anesthesia time. Associations with patient demographics and anesthetics were determined. RESULTS: In total, 54 patients (33 males and 21 females) were included in the study [age 11.0 (5.0–19.5) months; weight 9.2 (6.5–11.0) kg]. The total prevalence of burst suppression was 56% (30/54). Thirty‐three percent of patients experienced burst suppression during the surgical phase. The greatest proportion of burst suppression occurred during the induction phase. More burst suppression event occurrences (18/30) were observed in the patient under sevoflurane anesthesia (P = 0.024). Virtually all patients who received propofol boluses had burst suppression (P = 0.033). More burst suppression occurred in patients with hypotension (P < 0.001). During the surgical phase, a younger age was associated with more burst suppression (P = 0.002). INTERPRETATION: EEG burst suppression was associated with younger age, inhalation anesthetics, propofol bolus, and lower arterial pressure.