Purpose

Sedation with chloral hydrate or anesthesia using propofol allow ocular examination and testing in young children, but these drugs may affect electrophysiologic recordings. We compared the flash and pattern ERGs and VEPs recorded with each drug in a cohort of young children enrolled in a prospective study of optic nerve hypoplasia (ONH) syndrome.

Methods

ERGs and VEPs to light-adapted, standard, full-field flashes, to standard and steady-state pattern-reversal (PR) were recorded with cycloplegia in 9 participants. Age range at the first session, with chloral hydrate was 8–23 mo; at the second session with propofol it was 20–29 mo. Examiners masked to the drug and clinical conditions measured the waveforms for longitudinal, paired comparisons between the sessions.

Results

Flash ERG amplitudes did not differ between sessions; peak times were longer at the second session (propofol) by clinically insignificant amounts (< 2 ms, p = 0.002). Standard PERGs had larger amplitudes and later peaks in the second session (propofol) than with chloral hydrate (P50 2.9 vs 4.7 μV, p = 0.016 and 43 vs 52 ms, p < 0.001; N95 4.0 vs 6.1 μV, p = 0.003 and 91 vs 98.5 ms p = 0.034.). These differences were present for those with an interval of > 10 mo between sessions (n = 5, 10 eyes) but not for those with a shorter inter-test interval (< 8 mo, p > 0.05, n = 4). Magnitudes of the steady-state PERGs did not differ between tests but the waveforms had earlier peaks at the second test with propofol. Flash VEP waveforms were present in 10/18 eyes and showed 72% agreement for recordability between sessions. Standard pattern VEPs were recordable in only a few eyes in this cohort with ONH.

Conclusions

Light-adapted flash ERG waveforms were generally similar with chloral hydrate and with propofol. Larger PERGs with later peaks, found in the second session (propofol) could reflect maturation of the PERG generators, as the differences found were associated with a greater age difference between the sessions, but we do not rule out that small differences in the waveforms may be drug-related. There are insufficient VEP data from these children with ONH to identify drug-related or maturational effects on VEPs.

中文翻译：

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在幼儿中使用水合氯醛镇静和丙泊酚麻醉重复测量 ERG 和 VEP

目的

水合氯醛镇静或丙泊酚麻醉可以对幼儿进行眼部检查和测试，但这些药物可能会影响电生理记录。我们比较了参加视神经发育不全 (ONH) 综合征前瞻性研究的一组幼儿中每种药物记录的闪光和模式 ERG 和 VEP。

方法

在 9 名参与者的睫状肌麻痹中记录了 ERG 和 VEP，以适应光、标准、全场闪光、标准和稳态模式反转 (PR)。第一次使用水合氯醛的年龄范围为 8-23 个月；在丙泊酚的第二次会议上是 20-29 个月。对药物和临床状况不知情的检查者测量了波形，以进行会话之间的纵向配对比较。

结果

Flash ERG 幅度在会话之间没有差异；第二次治疗（丙泊酚）的峰值时间较长，临床上微不足道（< 2 ms，p  = 0.002）。与水合氯醛相比，标准 PERG 在第二次治疗（异丙酚）中的波幅更大，峰值更晚（P50 2.9 vs 4.7 μV，p  =  0.016 和 43 vs 52 ms，p  <  0.001；N95 4.0 vs 6.1 μV，p  =  0.003 和 91与 98.5 毫秒 p  =  0.034。）。这些差异存在于会话之间间隔> 10 个月（n  = 5, 10 只眼睛）的那些人，但对于那些测试间间隔较短的人（< 8 个月，p  > 0.05，n = 4)。稳态 PERG 的幅度在测试之间没有差异，但波形在丙泊酚的第二次测试中具有较早的峰值。Flash VEP 波形出现在 10/18 只眼睛中，并且在会话之间的可记录性显示 72% 的一致性。在这个 ONH 队列中，只有几只眼睛可以记录标准模式的 VEP。

结论

光适应闪光 ERG 波形与水合氯醛和异丙酚大致相似。在第二次会议（丙泊酚）中发现的较大的 PERG 与较晚的峰值可以反映 PERG 发生器的成熟，因为发现的差异与会话之间较大的年龄差异有关，但我们不排除波形的微小差异可能与毒品有关。这些患有 ONH 的儿童的 VEP 数据不足，无法确定药物相关或成熟对 VEP 的影响。