Sedation monitoring during open muscle biopsy in children by Comfort Score and Bispectral Index – a prospective analysis

Abstract

Bispectral Index provides an additional helpful tool to guide sedation/analgesia in minor surgical procedures in children. BIS values ≤60 correlated with sufficient depth of sedation and prevented unintended awareness. Additionally, BIS measurement allowed for distinct regulation of depth of sedation without prolonged sedation/analgesia due to unintended overdose.

Instruments to assess patient comfort during hospitalization: A psychometric review

“…Different authors validated the CS in PICU (Bear & Ward‐Smith, ; Brunow de Carvalho, Lucas da Silva, Paulo, Fonseca, & Belli, ; Courtman, Wardurgh, & Petros, ; Froom et al., ; Ista et al., ; Lamas et al., ; Nievas, Spentzas, & Bogue, ; Triltsch et al., ; Tschiedel, Müller, Schara, Felderhoff‐Müser, & Dohna‐Schwake, ). Some others authors also assessed the comfort of neonates by using the CS (Blauer, ; Cury, Martinez, & Carlotti, ; Franck, Ridout, Howard, Peters, & Honour, ; Van Dijk et al., ; Wielenga, de Vos, de Leeuw, & de Haan, ), Comfort Neo Scale (Monique Van Dijk et al., ), Modified Comfort Scale (Gjerstad, Wagner, Henrichsen, & Storm, ; Lee & Young, ) and Adapted Comfort Scale (Caljouw et al., ).…”

Visual Distraction During Sleep Induction with Propofol in Pediatric Patients – Can Cartoon Watching Influence the Sedative Dose?

“…To provide a second and more objective instrument we added BIS to the sedation protocol. We are fully aware that the use of BIS is not only limited due to its interindividual differences [29], but also reflects sedation depth with an uncertain delay of seconds. As sleep induction generally is a short process of a few minutes the delay of BIS might falsify the documented time until sleep onset to a relevant extent.…”

“…Additionally, the Bispectral Index (BIS) provides an objective method to monitor the patient's level of consciousness via electroencephalography (EEG)signal-analysis. Although its benefit is controversially discussed [22] it still provides objective data with good correlation to clinical sedation scores [8,20,23,24,27], and its use is safe [29].…”

The Influence of BIS Monitoring on Sedative Dose in Pediatric Patients Undergoing Open Muscle Biopsies – a Randomized Controlled Trial

“…This is also true if sedation with propofol and remifentanil is monitored using BIS [31]. In particular, sedation for open muscle biopsy in children under sedation/analgesia with propofol and remifentanil and advanced sedation monitoring using bispectral index (BIS) and Comfort Score (CS) is safe [28].…”

“…Nevertheless, the benefit of additional BIS monitoring is controversial because many factors such as impedance, stimulation, medication and electrical interferences can influence score measurement, and optimal ranges for BIS scores still cannot be clearly defined and are different according to individual [21]. Nevertheless several studies have shown that BIS ranges between 50 and 70 [11,16,28] are safe. In deep sedation (as in muscle biopsies), the utility of CS alone is limited because adequately anesthetized and oversedated patients may clinically appear similar.…”