Validation of the Bispectral Index Monitor for Measuring the Depth of Sedation in Children

Sadhasivam, Senthilkumar; Ganesh, Arjunan; Robison, Amy; Kaye, Robin; Watcha, Mehernoor F.

doi:10.1213/01.ane.0000184115.57837.30

Cited by 103 publications

(72 citation statements)

References 25 publications

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“…These results are consistent with previous studies that validated the BIS against UMSS in sedated children. 15,24 There has been only 1 other study utilizing the BIS for oral sedation of pediatric dental patients. Religa et al 28 found an association between BIS values and behavior during oral sedations, using the AAPD sedation guidelines, which are a scale based on behavioral responsiveness to stimuli.…”

Section: Discussionmentioning

confidence: 99%

Bispectral Index Monitoring of Sedation Depth in Pediatric Dental Patients

Haberland

Baker

Liu³

2011

Anesthesia Progress

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The bispectral index ( BIS ) monitor records electroencephalogram waveforms and provides an objective measure of the hypnotic effect of a sedative drug on brain activity. The aim of this pilot study was to use the BIS monitor to evaluate the depth of procedural sedation in pediatric dental patients and to assess if the BIS monitor readings correlate with a validated pediatric sedation scale, the University of Michigan Sedation Scale ( UMSS ), in determining the level of sedation in these patients. Thirty-five pediatric dental patients requiring sedation were studied prospectively. A baseline BIS reading was obtained and during the procedure an independent observer recorded the BIS every 5 minutes. The operator, who was blinded to the BIS results, determined the UMSS scale at the same 5-minute interval. The patients were monitored postoperatively for 1 hour. There was a significant but moderate correlation between BIS values and UMSS scores ( Spearman's rank correlation r 5 20.574, P , .0001). Percentage of agreement and kappa coefficient using all the observations were also calculated. The percentage of agreement was 37.8%, the kappa coefficient was 0.18 (P , .0001), and the weighted kappa coefficient 0.26 (P , .0001). A lack of correlation was noted between the deeper levels of UMSS sedation scores and BIS values. This study demonstrated a significant correlation between BIS values and the UMSS score in pediatric dental patients undergoing mild to moderate sedation. Based on our results, it appears that the BIS monitor may be useful during mild or moderate sedations to establish the level of sedation objectively without the need to stimulate the patient.

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Section: Discussionmentioning

confidence: 99%

Bispectral Index Monitoring of Sedation Depth in Pediatric Dental Patients

Haberland

Baker

Liu³

2011

Anesthesia Progress

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“…Patients received incremental doses of morphine 0.05 mg/kg at the end of surgery titrated to respiratory rate (RR) of 16-18/min after discontinuation of remifentanil infusion. Depth of anesthesia was monitored using Bispectral Index (BIS ® ) XP (Aspect Medical Systems, MA, USA) [18] or electroencephalography criteria by the intraoperative neuro monitoring team, a standard monitor for these surgeries. Post operatively, they received morphine through PCA.…”

Section: Perioperative Protocol and Clinical Outcomes Data Collectionmentioning

confidence: 99%

Fatty Acid Amide Hydrolase–morphine Interaction Influences Ventilatory Response to Hypercapnia and Postoperative Opioid Outcomes in Children

et al. 2016

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Aim: Fatty acid amide hydrolase (FAAH) degrades anandamide, an endogenous cannabinoid. We hypothesized that FAAH variants will predict risk of morphine-related adverse outcomes due to opioid-endocannabinoid interactions. Patients & methods:In 101 postsurgical adolescents receiving morphine analgesia, we prospectively studied ventilatory response to 5% CO 2 (HCVR), respiratory depression (RD) and vomiting. Blood was collected for genotyping and morphine pharmacokinetics. Results: We found significant FAAH-morphine interaction for missense (rs324420) and several regulatory variants, with HCVR (p < 0.0001) and vomiting (p = 0.0339). HCVR was more depressed in patients who developed RD compared with those who did not (p = 0.0034), thus FAAH-HCVR association predicts risk of impending RD from morphine use. Conclusion: FAAH genotypes predict risk for morphine-related adverse outcomes.

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“…The COMFORT scale appears to be the most suitable for use in critically ill children [13,[16][17][18]23] and the University of Michigan scale for the evaluation of sedation during procedures [21].…”

Section: Clinical Scalesmentioning

confidence: 99%

“…Use of BIS during procedures that require sedation in children Several studies have demonstrated the utility of BIS to control the level of sedation when performing invasive procedures in children, finding a good correlation with clinical scales such as the sedation agitation scale, Ramsay Scale, and University of Michigan scale [10,21,36,37]. Values of BIS around 70 are considered appropriate [32].…”

Section: Bispectral Indexmentioning

confidence: 99%

Monitoring sedation in the critically ill child

Lamas

López‐Herce

2010

Anaesthesia

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SummarySedation is an essential part of the management of the critically ill child, and its monitoring must be individualised and continuous in order to adjust drug doses according to the clinical state. There is no ideal method for evaluating sedation in the critically ill child. Haemodynamic variables have not been found to be useful. Clinical scales are useful when sedation is moderate, but are limited by their subjective nature, the use of stimuli, and the impossibility of evaluating profoundly sedated patients or those receiving neuromuscular blocking drugs; in addition, many of these scales have not been evaluated in children. The COMFORT scale is the most appropriate, as it was designed and validated for critically ill children requiring mechanical ventilation. Electroencephalography‐derived methods permit continuous monitoring, provide an early indication of changes in the level of sedation, and facilitate a rapid adjustment of medication. However, these methods were designed and validated for patients under anaesthesia and their results cannot be fully extrapolated to the critically ill patient; in addition, some of them have not been validated in small children and there is still little experience in critically ill children. The main indications for the use of these methods are in patients with deep sedation and/or neuromuscular blockade. The bispectral index is the most widely used method at the present time. Analysis and comparison of the efficacy of the different methods for evaluating sedation in the critically ill child is required.

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Validation of the Bispectral Index Monitor for Measuring the Depth of Sedation in Children

Cited by 103 publications

References 25 publications

Bispectral Index Monitoring of Sedation Depth in Pediatric Dental Patients

Bispectral Index Monitoring of Sedation Depth in Pediatric Dental Patients

Fatty Acid Amide Hydrolase–morphine Interaction Influences Ventilatory Response to Hypercapnia and Postoperative Opioid Outcomes in Children

Monitoring sedation in the critically ill child

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