Bilateral Bis Assessment of Sedation in Paediatric Intensive Care – Two case Reports

Abstract

The notes of these neonates were reviewed for the following information: birth weight, gestational age, co-existing congenital anomalies, preoperative respiratory function, operation duration, postoperative analgesia, ICU admission and duration of stay in ICU. Results: Thirty-five TOF repairs were identified. One neonate was excluded as he had concomitant abdominal surgery. Of the 34 remaining, 30 sets of notes were reviewed. The outcome for these neonates is shown in the diagram. Of the 10 neonates who did not receive an epidural, a reason was found in eight cases: three were already ventilated, two had abnormal coagulation, two had coexisting congenital heart disease and one had recurrent apnoeas. Only three of the 20 neonates with an epidural required postoperative ventilation, one for metabolic acidosis, one for lung collapse and one for inadequate respiratory effort. All three remained on ICU for <24 h. The median PICU stay for those neonates who did not receive an epidural was 4 days (range 2-11 days). The group who received epidural analgesia was more mature (38.7 weeks c.f. 35.3 weeks gestational age) and heavier (2.9 kg c.f. 2.3 kg) than the group who did not. The mean operative time (including bronchoscopy and surgery) was 2.8 h in the epidural group and 3.3 h in the nonepidural group.Conclusion: Mature neonates presenting for TOF repair can be managed with epidural analgesia, usually removing the need for postoperative ventilation and an ICU bed. There is a group of smaller, less mature neonates that did not receive epidural analgesia, we cannot determine from this audit whether any of these would have benefited from epidural analgesia.Reference 1 Bosenberg AT, Wiersma R, Hadley GP. Esophageal atresia: caudo-thoracic epidural anesthesia reduces the need for postoperative ventilatory support.

Clinically relevant asymmetry of bispectral index during recovery from anaesthesia for ear-nose-throat surgery in adults and children

“…The maximum duration of these asymmetries was < 5 min. The median (IQR [range]) number of intra-operative BIS asymmetries per patient with BIS asymmetry was 3 (2-5 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]). The median (IQR [range]) number of intra-operative BIS asymmetries per hour of surgery in these patients was 1.5 (1.1-2.4 [0.3-5.1]).…”

“…However, no studies focussed on this relationship have been performed. Handedness and cerebral hemisphere dominance may not be fully developed in small children and brain structures determining handedness and cerebral hemisphere dominance may not be involved in the generation of EEG components determining BIS values [3–8].…”

“…Usually the electroencephalogram (EEG) for the calculation of BIS is obtained unilaterally from the frontolateral skull and this method assumed that the EEG characteristics are equal for both sides. However, obtaining bilateral BIS from sedated patients on the intensive care unit and from children during general anaesthesia revealed laterality differences predominantly during light sedation and during arousal after external stimulation [3–6]. Recently, electrodes and monitors for bilateral measurement of BIS have become available.…”

Bispectral Index asymmetry and COMFORT score in paediatric intensive care patients

“…Recently, one of the authors (C.A.M.) who presented initial data from our study at an international forum 12 reported the occurrence of BIS asymmetry in children sedated in PICU.…”