A 10-year-old boy with a known history of idiopathic generalized epilepsy is scheduled for adenoidectomy. The anaesthetist wishes to avoid the volatile agent that can produce spike-and-wave discharges and frank electroencephalographic seizure activity, particularly at concentrations above 2 MAC and during hypocapnia. Which agent should be avoided?

• A Isoflurane
• B Desflurane
• C Sevoflurane
• D Enflurane ✓

Explanation

Enflurane uniquely produces a high-voltage spike-and-wave pattern on the EEG and can precipitate tonic-clonic seizure activity, especially at deep levels of anaesthesia combined with hypocapnia from hyperventilation. It is therefore relatively contraindicated in epileptic patients. Isoflurane, sevoflurane and desflurane depress cortical electrical activity and are considered acceptable in epilepsy. This proconvulsant property is the classic distinguishing CNS feature of enflurane examined from standard anaesthesia texts.

Reference: Morgan and Mikhail's Clinical Anesthesiology, 6th ed.

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