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Can analysis of the bispectral index prove helpful when monitoring titration of doses of midazolam and ketamine for sedation during paediatric cardiac catheterization

Published online by Cambridge University Press:  20 December 2007

Ayse Baysal ,
Tugcin Bora Polat ,
Yalim Yalcin  and
Ahmet Celebi
Ayse Baysal*
Affiliation:
The Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
Tugcin Bora Polat
Affiliation:
The Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
Yalim Yalcin
Affiliation:
The Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
Ahmet Celebi
Affiliation:
The Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
*
Correspondence to: Dr Ayse Baysal, 45 ADA Mimoza 1a D:15, Atasehir, Istanbul, Turkey. Tel: +90 216 4562436; Fax: +90 262 6417260 (TUBITAK-Marmara Research Center); E-mail: ayse_baysal11@yahoo.com
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Abstract

Objective

We investigated the use of the bispectral index for monitoring sedation during cardiac catheterization. The scores for the bispectral index may not reflect correct values in children, but may be helpful during titration of sedatives such as midazolam and ketamine.

Methods

We conducted a prospective randomized clinical trial in 126 patients scheduled for cardiac catheterization in a teaching hospital. They ranged in age from 4 months to 15 years. In 66 patients, sedation was performed without use of the bispectral index, while the index was used in the other 60 patients. The data collected included heart rate, mean arterial pressure, respiratory rate, saturation of oxygen, amount of sedatives, awakening time and adverse effects. We subdivided the patients into age-related groups for each parameter.

Results

The demographic data were not statistically different. Monitoring with the bispectral index in those aged from 1 to 3 years revealed use of lower doses of midazolam, at 2.09 mg per kg per hr, with standard deviation of 0.36, and similarly lowers doses of ketamine, at 2.07 mg per kg per hr, with standard deviation of 0.22, the values in those not monitored being 2.93, with standard deviation of 0.45, and 2.96 with standard deviation of 0.51 respectively, these difference being statistically significant (p = 0.001 and p = 0.04, respectively). In those aged from 3 to 6 years of age, dosage of midazolam was 2.09, with deviation of 0.36, and of ketamine 1.78, with deviation of 0.27, following use of the bispectral index, compared to 2.89 with deviation of 0.28, and 2.62 with deviation of 0.69 respectively, when the bispectral index was not used, these again being significant differences (p = 0.033 and p = 0.04). The requirements for respiratory support and adverse effects were also significantly lower when using the bispectral index (p less than 0.05). No significant difference was found regarding dosages at the ages of 4 months to 1 year, and 6 to 15 years. The awakening time, however, was shorter with use of the index in those aged from 1 to 6 years.

Conclusions

When using the bispectral index for monitoring sedation during catheterization in children, we noted decreased need for doses of midazolam and ketamine, a lower need for respiratory support and less adverse effects.

Keywords

Catheter procedurescongenital heart diseaseneurological monitoring
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 1 , February 2008 , pp. 51 - 57
Copyright
Copyright © Cambridge University Press 2008

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References

1. Joint Commission on Accreditation of Healthcare Organization. 2001 sedation and anesthesia care standards. Oakbrook Terrace (IL): JCAHO, Joint Commission on Accreditation of Healthcare Organizations, 2005.Google Scholar
2. Levine, DA. Novel monitoring techniques for use with procedural sedation. Curr Opin Pediatr 2005; 17: 351–354.CrossRefGoogle ScholarPubMed
3. Krauss, B, Green, SM. Procedural sedation and analgesia in children. Lancet 2006; 367: 766–780.CrossRefGoogle ScholarPubMed
4. Agrawal, D, Feldman, HA, Krauss, B, Waltzman, ML. Can bispectral index monitoring quantify depth of sedation during procedural sedation and analgesia in the pediatric emergency department? Ann Emerg Med 2004; 43: 247–255.CrossRefGoogle Scholar
5. Malviya, S, Voepel-Lewis, T, Tait, AR, Merkel, S, Tremper, K, Naughton, N. Depth of sedation in children undergoing computed tomography: validity and reliability of the University of Michigan Sedation Scale. Br J Anesth 2002; 88: 241–245.CrossRefGoogle ScholarPubMed
6. McDermott, NB, VanSickle, T, Motas, D, Friesen, RH. Validation of the bispectral index monitor during conscious and deep sedation in children. Anesth Analg 2003; 97: 39–43.CrossRefGoogle ScholarPubMed
7. Overly, FL, Wright, RO, Connor, FA, Jay, GD, Linakis, JG. Bispectral analysis during deep sedation of pediatric oral surgery patients. J Oral Maxillofac Surg 2005; 63: 215–219.CrossRefGoogle ScholarPubMed
8. Akin, A, Esmaoglu, A, Guler, G, Demircioglu, R, Narin, N, Boyaci, A. Propofol and propofol-ketamine in pediatric patients undergoing cardiac catheterization. Pediatr Cardiol 2005; 26: 553–557.CrossRefGoogle ScholarPubMed
9. Aneja, R, Heard, AMB, Fletcher, JE, Heard, CMB. Sedation monitoring of children by the Bispectral Index in the pediatric intensive care unit. Pediatr Crit Care Med 2003; 4: 60–64.CrossRefGoogle ScholarPubMed
10. Morse, Z, Kaizu, M, Sano, K, Kanri, T. BIS monitoring during midazolam and midazolam-ketamine conscious intravenous sedation for oral surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94: 420–424.CrossRefGoogle ScholarPubMed
11. Triltsch, AE, Nestmann, G, Orawa, H, et al. . Bispectral index versus Comfort score to determine the level of sedation in pediatric intensive care unit patients: a prospective study. Crit Care 2005; 9: R9–R17.CrossRefGoogle ScholarPubMed
12. Miner, JR, Fringer, R, Siegel, T, Gaetz, A, Ling, L, Biros, M. Serial bispectral index scores in patients undergoing observation for sedative overdose in the emergency department. Am J Emerg Med 2006; 24: 53–57.CrossRefGoogle ScholarPubMed
13. Liu, J. Electroencephalogram bispectral analysis predicts the depth of midazolam-induced sedation. Anesthesiology 1996; 84: 64–69.CrossRefGoogle ScholarPubMed
14. Johansen, JW, Sebel, PS. Development and clinical application of electroencephalographic (EEG) bispectrum monitoring. Anesthesiology 2000; 93: 1336–1344.CrossRefGoogle ScholarPubMed
15. Sakai, M, Edmonds, HL, Tsueda, K, et al. . Effect of ketamine on clinical endpoints of hypnosis and EEG variables during propofol infusion. Acta Anaesthesiol Scand 1999; 43: 212–216.CrossRefGoogle ScholarPubMed
16. Friedberg, BL. The effect of a dissociative dose of ketamine on the bispectral index during propofol hypnosis. J Clin Anesth 1999; 11: 4–7.CrossRefGoogle ScholarPubMed
17. Parker, RI, Mahan, RA, Giugliano, D, Parker, MM. Efficacy and safety of intravenous midazolam and ketamine as sedation for therapeutic and diagnostic procedures in children. Pediatrics 1997; 99: 427–432.CrossRefGoogle ScholarPubMed
18. Cheuk, DKL, Wong, WHS, Ma, E, et al. . Use of midazolam and ketamine as sedation for children undergoing minor operative procedures. Support Care Cancer 2005; 13: 1001–1009.CrossRefGoogle ScholarPubMed
19. Kissin, I. Depth of anesthesia and bispectral index monitoring. Anesth Analg 2000; 90: 1114–1117.CrossRefGoogle ScholarPubMed
20. Bahn, EL, Holt, KR. Procedural sedation and analgesia: a review and new concepts. Emerg Med Clin N Am 2005; 23: 503–517.CrossRefGoogle ScholarPubMed
21. Steward, DJ. A simplified scoring system for the post-operative recovery room. Can Anaesth Soc J 1975; 22: 111–113.CrossRefGoogle ScholarPubMed
22. Denman, WT, Swanson, EL, Rosow, D, Ezbicki, K, Connors, PD, Rosow, CE. Pediatric evaluation of the bispectral index (BIS) monitor and correlation of BIS with end-tidal sevoflurane concentration in infants and children. Anesth Analg 2000; 90: 872–877.CrossRefGoogle ScholarPubMed
23. Glass, PS, Bloom, M, Kearse, L, Rosow, C, Sebel, P, Manberg, P. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology 1997; 86: 836–847.CrossRefGoogle ScholarPubMed
24. Tosun, Z, Akin, A, Guler, G, Esmaoglu, A, Boyaci, A. Dexmedetomidine-ketamine and propofol-ketamine combinations for anesthesia in spontaneously breathing pediatric patients undergoing cardiac catheterization. J Cardiothorac Vasc Anesth 2006; 20: 515–519.CrossRefGoogle ScholarPubMed
25. Jobeir, A, Galal, MO, Bulbul, ZR, Solymar, L, Darwish, A, Schmaltz, AA. Use of low-dose ketamine and/or midazolam for pediatric cardiac catheterization: Is an anesthesiologist needed. Pediatr Cardiol 2003; 24: 236–243.Google ScholarPubMed
26. Auletta, JJ, O’Riordan, MA, Nieder, ML. Efficacy and safety of atropine-midazolam-ketamine in pediatric oncology patients. Curr Ther Res 1999; 60: 683–693.CrossRefGoogle Scholar
27. Auden, SM, Sobczyk, WL, Solinger, RE, Goldsmith, LJ. Oral ketamine/midazolam is superior to intramuscular meperidine, promethazine,and chlorpromazine for pediatric cardiac catheterization. Anesth Analg 2000; 90: 299–305.CrossRefGoogle ScholarPubMed