Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-27T23:47:48.642Z Has data issue: false hasContentIssue false
  • English
  • Français

Variation of bispectral index monitoring in paediatric patients undergoing propofol-remifentanil anaesthesia

Published online by Cambridge University Press:  01 October 2008

J. S. Liu ,
J. M. Zhang  and
Y. Yue
J. S. Liu
Affiliation:
Capital Medical University, Beijing Tongren Hospital, Department of Anesthesiology, Beijing, China
J. M. Zhang
Affiliation:
Capital Medical University, Beijing Children’s Hospital, Department of Anesthesiology, Beijing, China
Y. Yue*
Affiliation:
Capital Medical University, Beijing Chaoyang Hospital, Department of Anesthesiology, Beijing, China
*
Correspondence to: Yun Yue, Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China. E-mail: yueyun@hotmail.com; Tel: +86 10 85231643; Fax: +86 10 65077808
Get access

Summary

Background and objective

The technology of bispectral index monitoring is based on an algorithm developed from adults. This study was conducted to investigate the difference in bispectral index monitoring between paediatric and adult patients under intravenous anaesthesia.

Methods

In all, 68 patients undergoing elective surgery were divided into three groups as follows: Group A (younger children, n = 20, 3 yr ⩽yr ⩽ 5 yr), Group B (older children, n = 20, 6 yr ⩽yr ⩽12 yr), Group C (adults, n = 28, 25 yr ⩽yr ⩽50 yr). All patients were induced by plasma target-controlled infusion of propofol till loss of consciousness (loss of response to verbal commands and eyelash reflex). The plasma concentration (Cppropofol) and effect-site concentration (Cepropofol) of propofol and bispectral index values were compared at loss of consciousness and regaining of consciousness. During the operation, remifentanil was infused at a fixed rate of 0.25μg kg−1 min−1, and the minute average bispectral index values of three groups were also compared at different stable concentrations of propofol (Cepropofol = Cppropofol = 2, 3, 4 and 5 μg mL−1, respectively).

Results

At loss of consciousness and regaining of consciousness, the bispectral index values in Group A (loss of consciousness: 74.7 ± 6.3, regaining of consciousness: 81.1 ± 10.5) were significantly higher than those in Group C (loss of consciousness: 68.6 ± 9.4, regaining of consciousness: 74.5 ± 6.0) (P < 0.01). There was no statistical difference between Cppropofol in all groups at loss of consciousness and regaining of consciousness. The Cepropofol at loss of consciousness in Group A (3.57 ± 0.60 μg mL−1) and B (3.25 ± 0.44 μg mL−1) were significantly higher than those in Group C (2.15 ± 0.86 μg mL−1) (P < 0.01). At the same stable concentrations of propofol, the bispectral index values in Group A and B were significantly higher than those in Group C, and the bispectral index values in Group A were also significantly higher than those in Group B (P < 0.01). The Cepropofol when bispectral index ⩽ 40 in Group A, B, C were approximately at 6, 5 and 3 μg mL−1, respectively.

Conclusions

At loss of consciousness and regaining of consciousness, the bispectral index values of younger children group are significantly higher than those of adults. At the same stable concentrations of propofol, the bispectral index values are significantly different between children and adults. This study suggests that there is deviation when the adult algorithm of bispectral index monitoring is applied in paediatric patients under intravenous anaesthesia.

Keywords

CHILDCHILD PRESCHOOLBISPECTRAL INDEXPROPOFOLREMIFENTANILANAESTHESIA INTRAVENOUS
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 10 , October 2008 , pp. 821 - 825
Copyright
Copyright © European Society of Anaesthesiology 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Song, D, van Vlymen, J, White, PF. Is the bispectral index useful in predicting fast-track eligibility after ambulatory anesthesia with propofol and desflurane? Anesth Analg 1998; 87: 1245–1248.CrossRefGoogle ScholarPubMed
2.Gan, TJ, Glass, PS, Winsor, A et al. Bispectral index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anesthesia. BIS Utility Study Group. Anesthesiology 1997; 87: 808–815.CrossRefGoogle ScholarPubMed
3.Myles, PS, Leslie, K, McNeil, J et al. Bispectral index monitoring to prevent awareness during anaesthesia: The B-Aware randomized controlled trial. Lancet 2004; 363: 1757–1763.CrossRefGoogle Scholar
4.Mizrahi, EM. Avoiding the pitfalls of EEG interpretation in childhood epilepsy. Epilepsia 1996; 37: S41–S51.CrossRefGoogle ScholarPubMed
5.Eeg-Olofsson, O, Petersen, I, Sellden, U. The development of the electroencephalogram in normal children from the age of 1 through 15 years: paroxysmal activity. Neuropadiatrie 1971; 2: 375–404.CrossRefGoogle ScholarPubMed
6.Marsh, B, White, M, Morton, N et al. Pharmacokinetic model driven infusion of propofol in children. Br J Anaesth 1991; 67: 41–48.CrossRefGoogle ScholarPubMed
7.Kataria, BK, Ved, SA, Nicodemus, HF et al. The pharmacokinetics of propofol in children using three different data analysis approaches. Anesthesiology 1994; 80: 104–122.CrossRefGoogle ScholarPubMed
8.Drummond, JC. Monitoring depth of anesthesia: with emphasis on the application of the bispectral index and the middle latency auditory evoked response to the prevention of recall. Anesthesiology 2000; 93: 876–882.CrossRefGoogle Scholar
9.Kissin, I. Depth of anesthesia and bispectral index monitoring. Anesth Analg 2000; 90: 1114–1117.CrossRefGoogle ScholarPubMed
10.Todd, MM. EEGs, EEG processing, and the bispectral index. Anesthesiology 1998; 89: 815–817.CrossRefGoogle ScholarPubMed
11.Sleigh, JW, Donovan, J. Comparison of bispectral index, 95% spectral edge frequency and approximate entropy of the EEG, with changes in heart rate variability during induction of general anaesthesia. Br J Anaesth 1999; 82: 666–671.CrossRefGoogle ScholarPubMed
12.Johansen, JW, Sebel, P. Development and clinical application of electroencephalographic bispectrum monitoring. Anesthesiology 2000; 93: 1336–1344.CrossRefGoogle ScholarPubMed
13.Doi, M, Gajraj, RJ, Mantzaridis, H, Kenny, GN. Relationship between calculated blood concentration of propofol and electrophysiological variables during emergence from anaesthesia: comparison of bispectral index, spectral edge frequency, median frequency and auditory evoked potential index. Br J Anaesth 1997; 78: 180–184.CrossRefGoogle ScholarPubMed
14.Liu, J, Singh, H, White, PF. Electroencephalographic bispectral index correlates with intraoperative recall and depth of propofol-induced sedation. Anesth Analg 1997; 84: 185–189.CrossRefGoogle ScholarPubMed
15.Strachan, AN, Edwards, ND. Randomized placebo-controlled trial to assess the effect of remifentanil and propofol on bispectral index and sedation. Br J Anaesth 2000; 84: 489–490.CrossRefGoogle ScholarPubMed
16.Powers, KS, Nazarian, EB, Tapyrik, SA et al. Bispectral index as a guide for titration of propofol during procedural sedation among children. Pediatrics 2005; 115: 1666–1674.CrossRefGoogle ScholarPubMed
17.Whyte, SD, Booker, PD. Bispectral index during isoflurane anesthesia in pediatric patients. Anesth Analg 2004; 98: 1644–1649.CrossRefGoogle ScholarPubMed
18.McDermott, NB, VanSickle, T, Motas, D et al. Validation of the bispectral index monitor during conscious and deep sedation in children. Anesth Analg 2003; 97: 39–43.CrossRefGoogle ScholarPubMed
19.Davidson, AJ, Czarnecki, C. The bispectral index in children: comparing isoflurane and halothane. Br J Anaesth 2004; 92: 14–17.CrossRefGoogle ScholarPubMed
20.Fletcher, JE, Hinn, AR, Heard, CM et al. The effects of isoflurane and deflurane titrated to a bispectral index of 60 on the cortical somatosensory evoked potential during pediatric scoliosis surgery. Anesth Analg 2005; 100: 1797–1803.CrossRefGoogle Scholar
21.Kim, HS, Oh, AY, Kim, CS et al. Correlation of bispectral index with end-tidal sevoflurane concentration and age in infants and children. Br J Anaesth 2005; 95: 362–366.CrossRefGoogle ScholarPubMed
22.Malviya, S, Voepel-Lewis, T, Tait, AR. A comparison of observational and objective measures to differentiate depth of sedation in children birth to 18 years of age. Anesth Analg 2005; 102: 389–394.CrossRefGoogle Scholar
23.Flaishon, R, Windsor, A, Sigl, J et al. Recovery of consciousness after thiopental or propofol: bispectral index and the isolated forearm technique. Anesthesiology 1997; 86: 613–619.CrossRefGoogle ScholarPubMed
24.Glass, PS, Bloom, M, Kearse, L et al. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology 1997; 86: 836–847.CrossRefGoogle ScholarPubMed
25.Kerssens, C, Klein, J, Bonke, B. Awareness: monitoring versus remembering what happened. Anesthesiology 2003; 99: 570–575.CrossRefGoogle ScholarPubMed
26.Park, HJ, Kim, YL, Kim, CS et al. Changes of bispectral index during recovery from general anesthesia with 2% propofol and remifentanil in children. Paediatr Anaesth 2007; 17: 353–357.CrossRefGoogle ScholarPubMed
27.Rampil, IJ. A primer for EEG signal processing in anesthesia. Anesthesiology 1998; 89: 980–1002.CrossRefGoogle ScholarPubMed
28.Schultz, A, Grouven, U, Zander, I et al. Age-related effects in the EEG during propofol anaesthesia. Acta Anaesthesiol Scand 2004; 48: 27–34.CrossRefGoogle ScholarPubMed