Analysis of electroencephalogram-derived indexes for anesthetic depth monitoring in pediatric patients with intellectual disability undergoing dental surgery

Abstract

BackgroundPatients with intellectual disability (ID) often require general anesthesia during oral procedures. Anesthetic depth monitoring in these patients can be difficult due to their already altered mental state prior to anesthesia. In this study, the utility of electroencephalographic indexes to reflect anesthetic depth was evaluated in pediatric patients with ID.MethodsSeventeen patients (mean age, 9.6 ± 2.9 years) scheduled for dental procedures were enrolled in this study. After anesthesia induction with propofol or sevoflurane, a bilateral sensor was placed on the patient's forehead and the bispectral index (BIS) was recorded. Anesthesia was maintained with sevoflurane, which was adjusted according to the clinical signs by an anesthesiologist blinded to the BIS value. The index performance was accessed by correlation (with the end-tidal sevoflurane [EtSevo] concentration) and prediction probability (with a clinical scale of anesthesia). The asymmetry of the electroencephalogram between the left and right sides was also analyzed.ResultsThe BIS had good correlation and prediction probabilities (above 0.5) in the majority of patients; however, BIS was not correlated with EtSevo or the clinical scale of anesthesia in patients with Lennox-Gastaut, West syndrome, cerebral palsy, and epilepsy. BIS showed better correlations than SEF95 and TP. No significant differences were observed between the left- and right-side indexes.ConclusionBIS may be able to reflect sevoflurane anesthetic depth in patients with some types of ID; however, more research is required to better define the neurological conditions and/or degrees of disability that may allow anesthesiologists to use the BIS.

Countering the poor oral health of people with intellectual and developmental disability: a scoping literature review

“…Mechanical tooth cleaning can be effective in improving OH for people with ID. Sakaguchi et al, 2011 (Japan) [46]RCTInvestigate use of propofol sedation using Bispectral Index (BIS)-guided target-controlled pump infusion (TCI) in dental patients with ID when compared to manual controlIntervention group: n = 20 (male n = 12; female n = 8) and Manual control group: n = 20 (male n = 15; female n = 5).The BIS-TCI group had significantly reduced doses of propofol and shortened recovery times. BIS-TCI can reduce the dose and length of sedation for people with ID. Silva et al, 2018 (Portugal) [47]Observational studyAnalyse the utility of Bispectral Index (BIS) for anaesthetic depth monitoring in paediatric dental patients with IDD.17 patients with ID (female n = 7, male n = 10).The BIS correlated with end-tidal sedative concentration and had good prediction probability except in patients with Lennox-Gastaut, West syndrome, cerebral palsy and epilepsy. BIS may be able to reflect anaesthetic depth in patients with some types of ID. Vaessen, Schouten, van der Hoeve & Knape, 2017 (The Netherlands) [48]Retrospective studyEvaluate safety and effectiveness of propofol sedation by trained nonmedical sedation practitioners in dental patients with ID in an office-based setting.Participants a with ID; mild ( n = 21); moderate ( n = 56) and severe ( n = 47).Propofol sedation was effective, allowing a sufficient sedation level without moderate or severe complications.…”

“…The other six studies provided insights into the factors that could affect dental routines and treatment procedures for people with IDD, including one that examined the appropriateness of implementing GA in dental treatment [41], four that focussed on the depth of sedation or GA administered [42, 44, 46, 47], as well as one retrospective study on the feasibility of propofol sedation for dental care [48].…”

“…The study by Vaessen et al [48] evaluated the safety and effectiveness of propofol sedation during dental treatment ( n = 124); propofol sedation is effective providing its flexibility in addressing individual patient needs in combination with low-dose propofol [48]. Silva et al [47] found that bispectral index (BIS) detected by a bilateral sensor placed on patient’s forehead may be able to reflect anaesthetic depth in patients undergoing dental treatment under GA. Despite the relatively small sample size, monitoring of BIS could potentially benefit some patients with IDD considering the difficulties faced by dentists in interpreting clinical signs of their neurological conditions under anaesthesia.…”

Anästhesie bei Kindern und Jugendlichen mit Behinderung

“…Trotzdem nutzen Kinderanästhesisten diese bei geistig behinderten Kindern fast ebenso häufig wie bei nicht behinderten Kindern (43 vs. 45 %) [9]. Die Werte korrelieren gut mit den klinischen Zeichen der Narkosetiefe und der endexspiratorischen Narkosegas-Konzentration [10]. Bei gleicher Sevofluran-Konzentration sind die Werte aber signifikant niedriger als bei nicht behinderten Patienten.…”

Brain areas modulation in consciousness during sevoflurane anesthesia

“…EEG is commonly used to evaluate the state of consciousness under anesthesia more accurately in many surgical contexts, as well as in experimental settings measuring the activity of brain areas in model animal organisms during sevoflurane anesthesia. Typically, this is achieved through a series of monitoring indicators derived from EEG, such as bispectral index, 95% spectral edge frequency, median frequency, and entropy index (Silva et al, 2018 ). In addition, the righting reflex (RR) is the most commonly used behavioral indicator in sevoflurane experimental settings to assess animal consciousness, with the loss of the righting reflex (LORR) and the recovery of the righting reflex (RORR) representing LOC and ROC, respectively (Gao and Calderon, 2020 ).…”