In a recently published article, Julliac et al .1describe risk factors for the occurrence of electroencephalographic abnormalities with sevoflurane anesthesia. Although it is appropriate to state that “induction with high sevoflurane concentrations may trigger epileptiform electroencephalographic activity” and “only electroencephalographic monitoring allowed the diagnosis,” the final sentence of the article seems to extrapolate electroencephalographic findings to clinical safety. Did the patients with epileptiform activity demonstrate a postictal state? Was recovery prolonged? The decision to perform an inhalation induction with sevoflurane, as with all clinical decisions, should indeed undergo “careful consideration,” but the risk–benefit analysis should be based on evidence-based trials of clinical outcomes. No studies to date have demonstrated that intraoperative epileptiform activity during induction of anesthesia translates into adverse clinical outcomes, postoperative seizure activity, or other perioperative morbidity, and findings of this well-done study should not be extrapolated to inappropriate clinical conclusions.

Stony Brook University, Stony Brook, New York. roysoto@yahoo.comor

Julliac B, Guehl D, Chopin F, Arne P, Burbaud P, Sztark F, Cros AM: Risk factors for the occurrence of electroencephalogram abnormalities during induction of anesthesia with sevoflurane in nonepileptic patients. Anesthesiology 2007; 106:243–51