Bispectral Index Monitoring of Sedation Depth in Pediatric Dental Patients

Abstract

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.

The effects of bispectral index monitoring on hemodynamics and recovery profile in developmentally delayed pediatric patients undergoing dental surgery

“…The studies conducted both in pediatric and adult patients undergoing sedation for dental rehabilitation show a significant relationship between BIS scores and sedation scale scores .…”

“…t-1, basal; t-2, after induction; t-3, after intubation; t-4, at the start of surgery; t-5, 10 min; t-6, 20 min; t-7, 30 min; t-8, at the end of surgery; t-9, after extubation; t-10, during eye opening in response to verbal stimulus or painful pinching. show a significant relationship between BIS scores and sedation scale scores (18)(19)(20)(21). Bispectral Index Scale monitoring has a favorable effect on the recovery profile, and is also known to prevent intraoperative awareness (1), which can result in posttraumatic stress disorder, behavioral disorders, and development of undesired phobias (22).…”

Sedation monitoring during open muscle biopsy in children by Comfort Score and Bispectral Index – a prospective analysis

“… found a BIS of approximately 65 correlating with deep sedation; Haberland et al . defined children with a BIS <70 as deeply sedated and unarousable. Powers et al .…”

¿Existe un valor de índice biespectral adecuado para endoscopias digestivas altas en respiración espontánea en el paciente pediátrico?

“…Dicho índice tiene un valor de 0 a 100 (0 indica coma profundo y 100 vigilia normal). El uso de este método no invasivo de cuantificación de la actividad del córtex cerebral se ha extendido ampliamente [3][4][5][6][7][8] . La revisión Cochrane del 2007 concluye que el BIS disminuye los episodios de despertar intraoperatorio y el tiempo de recuperación anestésica 2 .…”

“…Los valores del BIS «ideales» para una anestesia general se establecen en el rango 45-55; sin embargo, para los procedimientos en respiración espontánea hay pocos trabajos [4][5][6][7][8] . Debido a este motivo se plantea un estudio para tratar de predecir un valor del índice biespectral (BIS ® ) lo menos bajo posible que permita la realización de la técnica invasiva.…”