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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
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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

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