Abstracts

Rationale: In most EEG laboratories sedation is a routine procedure, demanding nursing services to be available for drug administration. This adds costs and potential side effects. The quality of the EEG trace and its interpretation is affected by the fast activity induced by several medications used for sedation. The EEG laboratory at the Children’s Hospital of Eastern Ontario (CHEO) created in 1977 has the practice of sedating for EEG only in exceptional cases. In CHEO, the skillful techniques and strategically appointment scheduling has enabled high quality data acquisition from patient groups of all ages. Our objective is to report the success rate and frequency of non-sedated sleep EEG studies in a busy referral Pediatric EEG laboratory, and describe some of the necessary settings in an EEG lab to avoid routine sedation in pediatric population. Methods: A retrospective EEG patient chart review was conducted for 2006 to 2008. Non-urgent routine EEG performed in all children 0 to 18 years were quantified. Test Failures, non-sedative sleep and sedated sleep EEG studies were quantified. Populations were characterized accordingly with variables of age, and recording’s daytime and sedation medications when used. The 4 Technologists in the department were then asked about the potential factors involved in avoiding sedation for EEG studies in pediatric population. Results: An annual average of 1800 pediatric EEG studies were done. 8 to 12 studies were performed on a daily basis during weekdays, from 8 am to 4 pm. Each technologist had 1 hour average, to perform the study, maximum of 5 studies per technologist per day. A failed study was called after 20 minutes of attempt. Sleep was obtained in 36% of all studies. The success rate was higher in children younger than 4 years of age (57%). Only in 2% of the EEG studies sedation was required. In all sedation cases the patient had global developmental delay, autism or mayor behavioral problems. In 75% of sedation studies EEG was coordinated after sedation with chloral hydrate for magnetic resonance imaging on the same patient. The overall failure to obtain an EEG was 3.9%. The most significant factors in successfully obtaining a non-sedated sleep EEG considered by the EEG technologists were: 1- Appointment scheduling at nap times. 2- Partial sleep deprivation as follows:1-4 years: normal sleep time with no morning nap until appointment time at 11 am or 1 pm; 4-10 years: bed time by 9 pm and wakeup at 5 am, plus no naps during travel to hospital; 10-18 years: bedtime by 12 am wakeup at 5 am. 3- Appropriate Room environment (controlled noise and lights, parental cooperation). Conclusions: Sedation for EEG procedure in Pediatric population can be avoided in almost the totality of the cases if simple factors and settings are considered. When sedation is absolutely required, this can be coordinated when another procedure requiring sedation will be performed. This allows an EEG lab to function without routine sedation services.