Electroencephalogram Signatures of Agitation Induced by Sevoflurane and Its Association With Genetic Polymorphisms

Background: Volatile anesthetic-induced agitation, also called paradoxical excitation, is not uncommon during anesthesia induction. Clinically, patients with agitation may lead to self-injury or disrupt the operative position, increasing the incidence of perioperative adverse events. The study was d...

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Autores principales:	Shuai Zhao, Linlin Han, Ruihui Zhou, Shiqian Huang, Yafeng Wang, Feng Xu, Shaofang Shu, Leiming Xia, Xiangdong Chen
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	sevoflurane anesthesia agitation paradoxical excitation electroencephalogram folate metabolism Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/d1f02dcf78e0426cbe8cc888254f2955
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spelling	oai:doaj.org-article:d1f02dcf78e0426cbe8cc888254f29552021-12-01T15:21:51ZElectroencephalogram Signatures of Agitation Induced by Sevoflurane and Its Association With Genetic Polymorphisms2296-858X10.3389/fmed.2021.678185https://doaj.org/article/d1f02dcf78e0426cbe8cc888254f29552021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.678185/fullhttps://doaj.org/toc/2296-858XBackground: Volatile anesthetic-induced agitation, also called paradoxical excitation, is not uncommon during anesthesia induction. Clinically, patients with agitation may lead to self-injury or disrupt the operative position, increasing the incidence of perioperative adverse events. The study was designed to investigate clinical features of sevoflurane-induced agitation and examined whether any gene polymorphisms can potentially be used to predict agitation.Methods: One hundred seventy-six patients underwent anesthesia induction with sevoflurane were included in this study. Frontal electroencephalogram (EEG), electromyography (EMG), and hemodynamics were recorded continuously during anesthesia induction. DNA samples were genotyped using the Illumina Infinium Asian Screening Array and the SNaPshot technology. Genetic association was analyzed by genome-wide association study. Logistic regression analysis was used to determine the role of variables in the prediction of agitation.Results: Twenty-five (14.2%) patients experienced agitation. The depth of anesthesia index (Ai index) (p < 0.001), EMG (p < 0.001), heart rate (HR) (p < 0.001), and mean arterial pressure (MAP) (p < 0.001) rapidly increased during the agitation. EEG exhibited a shift toward high frequencies with spikes during agitation. The fast waves (alpha and beta) were more pronounced and the slow rhythms (delta) were less prominent during the occurrence of agitation. Moreover, three SNPs in the methionine synthase reductase (MTRR) gene were correlated to the susceptibility to agitation (p < 5.0 × 10−6). Carrying rs1801394 A > G (odds ratio 3.50, 95% CI 1.43–9.45) and/or rs2307116 G > A (3.31, 1.36–8.95) predicted a higher risk of agitation.Discussion: This study suggests that the agitation/paradoxical excitation induced by sevoflurane is characterized as increases in Ai index, EMG, HR and MAP, and the high frequency with spikes in EEG. Moreover, our results provide preliminary evidence for MTRR genetic polymorphisms, involving folate metabolism function, may be related to the susceptibility to agitation.Clinical Trial Number and Registry URL: ChiCTR1900026218; http://www.chictr.org.cn/showproj.aspx?proj=40655.Shuai ZhaoLinlin HanRuihui ZhouShiqian HuangYafeng WangFeng XuShaofang ShuLeiming XiaXiangdong ChenFrontiers Media S.A.articlesevofluraneanesthesiaagitationparadoxical excitationelectroencephalogramfolate metabolismMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	sevoflurane anesthesia agitation paradoxical excitation electroencephalogram folate metabolism Medicine (General) R5-920
spellingShingle	sevoflurane anesthesia agitation paradoxical excitation electroencephalogram folate metabolism Medicine (General) R5-920 Shuai Zhao Linlin Han Ruihui Zhou Shiqian Huang Yafeng Wang Feng Xu Shaofang Shu Leiming Xia Xiangdong Chen Electroencephalogram Signatures of Agitation Induced by Sevoflurane and Its Association With Genetic Polymorphisms
description	Background: Volatile anesthetic-induced agitation, also called paradoxical excitation, is not uncommon during anesthesia induction. Clinically, patients with agitation may lead to self-injury or disrupt the operative position, increasing the incidence of perioperative adverse events. The study was designed to investigate clinical features of sevoflurane-induced agitation and examined whether any gene polymorphisms can potentially be used to predict agitation.Methods: One hundred seventy-six patients underwent anesthesia induction with sevoflurane were included in this study. Frontal electroencephalogram (EEG), electromyography (EMG), and hemodynamics were recorded continuously during anesthesia induction. DNA samples were genotyped using the Illumina Infinium Asian Screening Array and the SNaPshot technology. Genetic association was analyzed by genome-wide association study. Logistic regression analysis was used to determine the role of variables in the prediction of agitation.Results: Twenty-five (14.2%) patients experienced agitation. The depth of anesthesia index (Ai index) (p < 0.001), EMG (p < 0.001), heart rate (HR) (p < 0.001), and mean arterial pressure (MAP) (p < 0.001) rapidly increased during the agitation. EEG exhibited a shift toward high frequencies with spikes during agitation. The fast waves (alpha and beta) were more pronounced and the slow rhythms (delta) were less prominent during the occurrence of agitation. Moreover, three SNPs in the methionine synthase reductase (MTRR) gene were correlated to the susceptibility to agitation (p < 5.0 × 10−6). Carrying rs1801394 A > G (odds ratio 3.50, 95% CI 1.43–9.45) and/or rs2307116 G > A (3.31, 1.36–8.95) predicted a higher risk of agitation.Discussion: This study suggests that the agitation/paradoxical excitation induced by sevoflurane is characterized as increases in Ai index, EMG, HR and MAP, and the high frequency with spikes in EEG. Moreover, our results provide preliminary evidence for MTRR genetic polymorphisms, involving folate metabolism function, may be related to the susceptibility to agitation.Clinical Trial Number and Registry URL: ChiCTR1900026218; http://www.chictr.org.cn/showproj.aspx?proj=40655.
format	article
author	Shuai Zhao Linlin Han Ruihui Zhou Shiqian Huang Yafeng Wang Feng Xu Shaofang Shu Leiming Xia Xiangdong Chen
author_facet	Shuai Zhao Linlin Han Ruihui Zhou Shiqian Huang Yafeng Wang Feng Xu Shaofang Shu Leiming Xia Xiangdong Chen
author_sort	Shuai Zhao
title	Electroencephalogram Signatures of Agitation Induced by Sevoflurane and Its Association With Genetic Polymorphisms
title_short	Electroencephalogram Signatures of Agitation Induced by Sevoflurane and Its Association With Genetic Polymorphisms
title_full	Electroencephalogram Signatures of Agitation Induced by Sevoflurane and Its Association With Genetic Polymorphisms
title_fullStr	Electroencephalogram Signatures of Agitation Induced by Sevoflurane and Its Association With Genetic Polymorphisms
title_full_unstemmed	Electroencephalogram Signatures of Agitation Induced by Sevoflurane and Its Association With Genetic Polymorphisms
title_sort	electroencephalogram signatures of agitation induced by sevoflurane and its association with genetic polymorphisms
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/d1f02dcf78e0426cbe8cc888254f2955
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Electroencephalogram Signatures of Agitation Induced by Sevoflurane and Its Association With Genetic Polymorphisms

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