The Use of Bispectral Index Monitoring Does Not Change Intraoperative Exposure to Volatile Anesthetics in Children

Abstract

The exposure of infants and children to volatile anesthetics, such as sevoflurane, has been a topic of concern with respect to the potential risk for long term neurocognitive effects. The primary objective of this study was to determine whether the perioperative utilization of Bispectral Index (BIS) monitoring alters the sevoflurane delivery and exposure to children. This is a prospective randomized trial of two groups of healthy ambulatory day surgery patients (2 to 12 years). The patients in both groups had the BIS applied soon after the induction of general anesthesia, but only the anesthesiologists in the group randomized to BIS visible were able to see the BIS values. All of the patients received general anesthesia with sevoflurane. This study found no difference in the overall exposure to sevoflurane between both groups (mean end-tidal sevoflurane level of 1.8 in both groups, P = 084). The duration of time in the recovery room, the time to meet discharge criteria, the Pediatric Agitation Emergence Delirium (PAED) scores and the Face, Legs, Activity, Cry, Consolability (FLACC) scores were not statistically different between the groups. The application and utilization of intraoperative BIS monitoring does not alter the sevoflurane administration nor the discharge readiness nor the recovery profile in healthy ambulatory children.

EEG-Parameter-Guided Anesthesia for Prevention of Emergence Delirium in Children

“…Sullivan’s trial found that in 54 children aged 2–12 undergoing orthopedic surgery, the BIS-monitoring group (maintaining BIS values of 40–60) reduced sevoflurane exposure compared with the normal group, but the difference was not statistically significant [ 49 ]. In our trial, however, the intraoperative EtSevo was significantly reduced in the E group.…”

“…In addition, another study reported that BIS monitoring for the guidance of propofol–remifentanil anesthesia did not result in a reduced consumption of remifentanil [ 51 ]. Some researchers also found that using BIS monitoring did not influence the extubation time and discharge time [ 49 , 52 ]. Our results were similar to those in the above reports; the remifentanil infusion rate and MAP in the anesthesia maintenance period were similar between the two groups, and extubation time and discharge time also showed no differences between the two groups.…”

“…In 2015, Mehmet et al found that using the BIS for monitoring anesthesia depth reduced postoperative pain in pediatric patients undergoing dental surgery [ 53 ]. A randomized controlled study also found that using the BIS for monitoring anesthesia depth could reduce FLACC scores and NRS scores, even though no statistical significance was found [ 49 ]. These were consistent with our trial results, which indicated that monitoring EEG parameters intraoperatively could effectively reduce pain scores within 30 min from extubation.…”

Multiparametric Monitoring of Hypnosis and Nociception-Antinociception Balance during General Anesthesia—A New Era in Patient Safety Standards and Healthcare Management

“…The sum of these values results in the numerical values called Spectral Entropy. The first algorithm ever to be used in the clinical practice has been defined and applied in the M-Entropy modules S/5 (GE Healthcare, Helsinki, Finland) [ 10 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. The EEG data are collected through an adhesive sensor made of three electrodes applied on the fronto-temporal region.…”

“…The usage of monitoring techniques for the degree of hypnosis in the case of pediatric patients is limited and is not validated. Numerous studies have analyzed the statistical correlations between BIS and Entropy for different age groups but have not identified strong statistical correlations between BIS/Entropy values and anesthetic drugs concentrations in infants vs. pediatric patients (aged over 1 year old) [ 42 ]. Davidson et al carried out a study regarding the performance of BIS and Entropy for different age groups in pediatric patients.…”