Bispectral Analysis During Pediatric Procedural Sedation

• Published in: Pediatric emergency care Vol. 21; no. 1; pp. 6 - 11
• Main Authors: Overly, Frank L, Wright, Robert O, Connor, Francis A, Fontaine, Brian, Jay, Greg, Linakis, James G
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-01-2005; Lippincott Williams & Wilkins
• Subjects: Adolescent; Algorithms; Analgesics - administration & dosage; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Child; Child, Preschool; Electroencephalography; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Humans; Hypnotics and Sedatives - administration & dosage; Hypnotics. Sedatives; Intensive care medicine; Ketamine - administration & dosage; Medical sciences; Methohexital - administration & dosage; Midazolam - administration & dosage; Monitoring, Physiologic - methods; Neuropharmacology; Pharmacology. Drug treatments; Propofol - administration & dosage; Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Signal Processing, Computer-Assisted; Human; Pediatrics; Intensive care; Sedation; Child; Resuscitation
• ISSN: 0749-5161; 1535-1815
• DOI: 10.1097/01.pec.0000150981.88733.d8

OBJECTIVE:Bispectral analysis (BIS) is a technology using EEG information from a forehead electrode to calculate an index (0-100; 0 = coma, 90-100 = awake). Our objective was to determine the degree of agreement between sedation scales and BIS values in pediatric patients undergoing sedation.
METHODS:Patients ages 2 to 17 years, undergoing procedural sedation, were enrolled. Sedation was performed in the customary manner with the addition of BIS monitoring and assessment of a clinical sedation scalethe Observer's Assessment of Alertness/Sedation (OAA/S), every 5 minutes during the sedation procedure. Clinical scales were performed by an investigator blinded to the BIS index. The association between a clinical scale and BIS scores was analyzed using longitudinal regression analysis.
RESULTS:We enrolled 47 subjects; 55% were sedated with ketamine and midazolam and the remaining 45% received methohexital, propofol or midazolam and a narcotic. The results of the regression analysis demonstrated a highly significant association between the OAA/S score and BIS value (β = 5.0, 95% CI 4.3 to 5.7, P < 0.0001). Patients were divided into 2 groups, those sedated with ketamine and those sedated with nonketamine medications. The association between OAA/S score and BIS value was not statistically significant for the ketamine population (β = 0.809, 95% CI −0.1 to 1.7, P = 0.09), but remained significant for the nonketamine subjects (β = 8.6, 95% CI 7.7 to 9.4, P < 0.0001).
CONCLUSIONS:The OAA/S sedation scale predicts the BIS value for pediatric patients undergoing procedural sedation when sedated with certain medications, excluding ketamine.