Efficacy of the bispectral index and Observer’s Assessment of Alertness/Sedation Scale in monitoring sedation during spinal anesthesia: A randomized clinical trial

Lim, Tae Woo; Choi, Yi Hwa; Kim, Jong Yeop; Choi, Jong Bum; Lee, Soo Kyung; Youn, Eun Ji; Lee, Jun Suck

doi:10.1177/0300060519893165

Cited by 16 publications

(15 citation statements)

References 40 publications

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“…A significant correlation between the BIS value and MOAA/S score was observed, as reported in previous studies [ 16 – 21 ]. However, the average value of the BIS for specific sedation level showed difference.…”

Section: Discussionsupporting

confidence: 88%

“…In the current study, we targeted patients who were undergoing surgery under spinal anesthesia and were treated with dexmedetomidine, which was administered as described in the pharmacopeia (a popular method). A significant correlation between the BIS value and MOAA/S score was observed, as reported in previous studies [16][17][18][19][20][21]. However, the average value of the BIS for specific sedation level showed difference.…”

Section: Discussionsupporting

confidence: 85%

“…However, the average value of the BIS for specific sedation level showed difference. In one study, where a manual infusion of dexmedetomidine was used, the BIS values for moderate sedation (OAA/S score = 3) and deep sedation (OAA/S score = 1–2) were 69.3 and 62.6, respectively [ 21 ]. In another study, which used the TCI of dexmedetomidine, a BIS value of 66.12 was reported for moderate sedation (MOAA/S score = 3) [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

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Verification of the performance of the Bispectral Index as a hypnotic depth indicator during dexmedetomidine sedation

Lee

et al. 2022

Anesth Pain Med

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Background: Differences in the effects of propofol and dexmedetomidine sedation on electroencephalogram patterns have been reported previously. However, the reliability of the Bispectral Index (BIS) value for assessing the sedation caused by dexmedetomidine remains debatable. The purpose of this study is to evaluate the correlation between the BIS value and the Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) scale in patients sedated with dexmedetomidine. Methods: Forty-two patients (age range, 20–80 years) who were scheduled for elective surgery under spinal anesthesia were enrolled in this study. Spinal anesthesia was performed using 0.5% bupivacaine, which was followed by dexmedetomidine infusion (loading dose, 0.5–1 μg/kg for 10 min; maintenance dose, 0.3–0.6 μg/kg/h). The MOAA/S score was used to evaluate the level of sedation, and the Vital Recorder program was used to collect data (vital signs and BIS values). Results: A total of 215082 MOAA/S scores and BIS data pairs were analyzed. The baseline variability of the BIS value was 7.024%, and the decrease in the BIS value was associated with a decrease in the MOAA/S score. The correlation coefficient and prediction probability between the two measurements were 0.566 (P < 0.0001) and 0.636, respectively. The mean ± standard deviation values of the BIS were 87.22 ± 7.06, 75.85 ± 9.81, and 68.29 ± 12.65 when the MOAA/S scores were 5, 3, and 1, respectively. Furthermore, the cut-off BIS values in the receiver operating characteristic analysis at MOAA/S scores of 5, 3, and 1 were 82, 79, and 73, respectively. Conclusion: The BIS values were significantly correlated with the MOAA/S scores. Thus, the BIS along with the clinical sedation scale might prove useful in assessing the hypnotic depth of a patient during sedation with dexmedetomidine.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

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Verification of the performance of the Bispectral Index as a hypnotic depth indicator during dexmedetomidine sedation

Lee

et al. 2022

Anesth Pain Med

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“…(1) Basic clinical indicators were recorded by medical staff in our hospital including extubation time, recovery time, breathing recovery time, and orientation recovery time. (2) e observer's assessment of awareness/sedation (OAA/S) score [10] was used to evaluate the state of consciousness of patients immediately after operation, 1 h after operation, 3 h after operation, and 1 d after operation. e higher the OAA/S score, the better the patient's state of consciousness.…”

Section: Discussionmentioning

confidence: 99%

Anesthesia Effect of Remifentanil Combined with Propofol in Laparoscopic Cholecystectomy and Its Impact on Postoperative Cognitive Recovery

Jiang¹,

Wang

Ni³

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To investigate the anesthesia effect of remifentanil combined with propofol for laparoscopic cholecystectomy and its impact on postoperative cognitive recovery. Methods. A total of 120 patients who underwent laparoscopic cholecystectomy in our hospital from February 2019 to June 2021 were recruited and assigned into either control group or experimental group at a ratio of 1 : 1 via the random number table method. The patients in the control group were anesthetized with fentanyl combined with propofol, and the patients in the experimental group were anesthetized with remifentanil combined with propofol. The clinical basic indicators (extubation time, recovery time, breathing recovery time, and orientation recovery time), and observer’s assessment of awareness/sedation (OAA/S) scores and complications were compared between the two groups. Results. There was no significant difference in extubation time between the two groups ( P > 0.05 ). The postoperative wake-up time, respiratory recovery time, and orientation recovery time of the experimental group were significantly better than those of the control group ( P < 0.05 ). The OAA/S scores of the patients in the experimental group were significantly higher than those in the control group immediately after surgery, 1 h after surgery, and 3 h after surgery ( P < 0.05 ). There was no significant difference in the OAA/S scores between the two groups on the 1st day after operation ( P > 0.05 ). The incidence of complications in the experimental group was significantly lower than that in the control group ( P < 0.05 ). Conclusion. Remifentanil + propofol for laparoscopic cholecystectomy patients has a significant anesthesia effect. This strategy effectively shortens the extubation, awakening, respiratory recovery, orientation recovery time of patients, and OAA/S score, suggest a minor impact on the postoperative cognitive function and state of consciousness. It has a high safety profile and thus is worthy of clinical application.

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“…Additionally, evaluation of the sedation level using the OAA/S score is highly subjective, which is a limitation. The BIS value does not necessarily accurately correlate with the sedation level 36 , 37 . Development of objective assessment methods will facilitate more accurate evaluation of the sedation level.…”

Section: Discussionmentioning

confidence: 95%

Comparison of intravenous sedation using midazolam versus dexmedetomidine in elderly patients with dementia: a randomized cross-over trial

Morimoto

Hayashi

Yao

et al. 2022

Sci Rep

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Differences between the effects of intravenous sedation with midazolam (MID) and dexmedetomidine (DEX) on the cerebral function of elderly patients with severe dementia are unclear. This study aimed to compare the effects of intravenous sedation with MID or DEX on parameters such as brain waves and cerebral blood flow (CBF). This cross-over study analyzed 12 patients with severe dementia, with each patient receiving both drug treatments. Each drug was administered until a Modified Observer’s Assessment of Alertness/Sedation (OAA/S) score of 2 was reached. Bispectral index (BIS) and normalized tissue hemoglobin index (nTHI), which reflects CBF using near-infrared spectroscopy, were measured. Mann–Whitney U, Wilcoxon signed-rank, and Friedman tests, and multiple regression analysis were performed. While a similar decline in BIS values was observed in both groups (P < 0.030), there was a significant decrease in nTHI up to 11% in the MID group (P = 0.005). In the DEX group, nTHI values did not differ from baseline. When an OAA/S score of 2 was just achieved, CBF in the MID group (− 5%) was significantly lower than in the DEX group (± 0%). In dementia patients, sedation with MID resulted in a decrease in CBF, while the CBF value was maintained during sedation with DEX.

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Efficacy of the bispectral index and Observer’s Assessment of Alertness/Sedation Scale in monitoring sedation during spinal anesthesia: A randomized clinical trial

Cited by 16 publications

References 40 publications

Verification of the performance of the Bispectral Index as a hypnotic depth indicator during dexmedetomidine sedation

Verification of the performance of the Bispectral Index as a hypnotic depth indicator during dexmedetomidine sedation

Anesthesia Effect of Remifentanil Combined with Propofol in Laparoscopic Cholecystectomy and Its Impact on Postoperative Cognitive Recovery

Comparison of intravenous sedation using midazolam versus dexmedetomidine in elderly patients with dementia: a randomized cross-over trial

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