Several studies have shown that occurrence of Burst Suppression is associated with cognitive complications after surgery and anesthesia and sedation during Intensive Care Management. Recente studies present contradictory evidence...
But we know that BS is not a normal EEG pattern so... ??
Very interesting question,was it explored in the Pediatric age group?
Why no studies were done in Pediatrics?
If it is observational with only EEG recordings, it seems doable?
Deliberate Burst Suppression is rarely used, except to control Epileptic Status.
In this situation it may be arguable which will cause the worse cognitive impairment the disease or the treatment. Both have a high mortality. The agents used to achieve burst suppression will usually have profound cardiovascular effects requiring (often large amounts of) exogenous catecholamine support and obligatory ventilatory support.
Sustained Burst Sup. (v. deep anaesthesia) is not entered into without a damn good reason. Not sure if this answers your question.
There is one study showing high incidence of suppression during anesthesia in children but without outcome analysis: doi: 10.1213/ANE.0000000000004221
Simon Perrin: my question was an "academic" one, to trigger discussion..
Brief periods of Burst suppression during paeds. anaesthesia would be common.
From your article;
The median (interquartile range [IQR]) number of isoelectric events per patient was 3 (0–31), cumulative isoelectric time per patient was 12 seconds (0–142 seconds), isoelectric time per event was 3 seconds (0–4 seconds), and percent of total isoelectric over anesthetic time was 0.1% (0%–2.2%). The greatest proportion of isoelectric events occurred between induction and incision. Isoelectric events were associated with higher American Society of Anesthesiologists (ASA) physical status, propofol bolus, endotracheal tube use, and lower arterial pressure during surgical phase.
It is technically difficult in a young child to guarantee anaesthesia and good surgical conditions without occasional overshoot particularly during induction of anaesthesia. That appears to be what is seen here.
I think the problem is a bit complicated as usual. Association between BS and cognitive problems does not mean causal relation. BS is a abnormal phenomenon in the EEG, that is for sure. However, it may occur due to brain insult such as hypoxia during cardiac arrest. So BS itself might not result the cognitive problem but instead both BS and cognitive problems might be induced by the same cause affecting the brain function.
Jukka Kortelainen , I fully agree with your view. BS translates an abnormal cerebral state, probably the result of a failure in energy production ( doi: 10.1073/pnas.1121461109) and may be caused by several reasons. That's why I suggest that should be avoided during anesthesia and sedation, independently of some negative studies regarding association of BS to cognitive complications ( ENGAGES trial for example..).. The question here was just a trigger for discussion ...
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