A Comparison of Observational and Objective Measures to Differentiate Depth of Sedation in Children from Birth to 18 Years of Age

Malviya, Shobha; Voepel‐Lewis, Terri; Tait, Alan R.

doi:10.1213/01.ane.0000184045.01780.73

Cited by 71 publications

(45 citation statements)

References 23 publications

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“…A variety of sedation scoring systems have been developed to measure the depth of sedation for both research and clinical settings. The more commonly used scales include the University of Michigan Sedation Scale ( UMSS ), 9,10 the Observer's Assessment of Alertness/Sedation (OAA/S ), 11 the Ramsay Sedation Score, 12 and the Houpt Scale. 13 These sedation scales have limitations in clinical practice because of observer variance in the subjective assessment and the disruptive effect of stimuli that need to be given to assess the depth of sedation.…”

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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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confidence: 99%

Bispectral Index Monitoring of Sedation Depth in Pediatric Dental Patients

Haberland

Baker

Liu³

2011

Anesthesia Progress

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“…All demographics and hospitalization details, including pain and sedation scores every 4 hours and daily opioid administration (measured in morphine equivalents), were recorded through review of the electronic medical record (EMR). Pain scores that had been recorded using either the Numeric Rating Scale (NRS) or the Wong-Backer Faces Scale, and sedation scores that had been assessed utilizing The University of Michigan Sedation Scale (UMMS) were documented during the chart review [21,22]. Comorbidities such as history of asthma, priapism, kidney disease, or avascular necrosis, were also recorded from the EMR.…”

Section: Research Design and Data Sourcesmentioning

confidence: 99%

Low-dose Ketamine for Children and Adolescents with Acute Sickle Cell Disease Related Pain: A Single Center Experience

Neri¹,

Pestieau

Young³

et al. 2014

J Anesth Clin Res

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Background: Opioids are the mainstay of therapy for painful vasoocclusive episodes (VOEs) in sickle cell disease (SCD). Based on limited studies, low-dose ketamine could be a useful adjuvant analgesic for refractory SCD pain, but its safety and efficacy has not been evaluated in pediatric SCD. Procedure:Using retrospective chart review we recorded and compared characteristics of hospitalizations of 33 children with SCD hospitalized with VOE who were treated with low-dose ketamine and opioid PCA vs. a paired hospitalization where the same patients received opioid PCA without ketamine. We seek to 1) describe a single center experience using adjuvant low-dose ketamine with opioid PCA for sickle cell related pain, 2) retrospectively explore the safety and efficacy of adjuvant low-dose ketamine for pain management, and 3) determine ketamine's effect on opioid consumption in children and adolescents hospitalized with VOE. Results:During hospitalizations where patients received ketamine, pain scores and opioid use were higher (6.48 vs. 5.99; p=0.002 and 0.040 mg/kg/h vs. 0.032 mg/kg/h; p=0.004 respectively) compared to hospitalizations without ketamine. In 3 patients, ketamine was discontinued due to temporary and reversible psychotomimetic effects. There were no additional short term side effects of ketamine.Conclusions: Low-dose ketamine has an acceptable short-term safety profile for patients with SCD hospitalized for VOE. Lack of an opioid sparing effect of ketamine likely represents use of low-dose ketamine for patients presenting with more severe VOE pain. Prospective randomized studies of adjuvant low-dose ketamine for SCD pain are warranted to determine efficacy and long-term safety.

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“…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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A Comparison of Observational and Objective Measures to Differentiate Depth of Sedation in Children from Birth to 18 Years of Age

Cited by 71 publications

References 23 publications

Bispectral Index Monitoring of Sedation Depth in Pediatric Dental Patients

Bispectral Index Monitoring of Sedation Depth in Pediatric Dental Patients

Low-dose Ketamine for Children and Adolescents with Acute Sickle Cell Disease Related Pain: A Single Center Experience

Monitoring sedation in the critically ill child

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