Can Bispectral Index aid laryngeal mask placement in children?

Lim, S.I.; Chambers, Neil; Somerville, Nicola

doi:10.1111/j.1460-9592.2006.02005.x

Cited by 5 publications

(4 citation statements)

References 31 publications

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“…However, BIS results may not reliably reduce airway complications during LMA placement. 27 In our study, the total consumption and awakening effect-site concentration of propofol were not significantly different between the “awake” and “deep” groups. Moreover, no patients reported during the postoperative visit that they had been conscious during LMA removal with a propofol concentration of 2.0 μg/mL.…”

Section: Discussioncontrasting

confidence: 46%

Removal of Laryngeal Mask Airway in Adults Under Target-Controlled, Propofol–Fentanyl Infusion Anesthesia

Huang

Hung

Lu³

2016

Medicine

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After emergence from anesthesia, the incidence and severity of adverse airway effects caused by the laryngeal mask airway (LMA) can vary, depending on when the device was removed; nonetheless, reports differ regarding the exact optimal timing of LMA removal. The purpose of this study was to compare the rate of adverse events between 2 groups: those whose LMA was removed under general anesthesia (“deep” group) or under target-controlled infusion (TCI) of propofol (“awake” group).Institutional Review Board approval and written informed consent were obtained; 124 patients were then randomly allocated into either the “awake” group or the “deep” group. Anesthesia was induced and maintained using TCI of propofol, as well as intravenous fentanyl. In the “deep” group, the LMA was removed after surgery while the patients were deeply anesthetized using a target effect-site propofol concentration of 2 μg/mL, whereas in the “awake” group, the device was removed while the patients followed verbal instructions. The incidence of the following adverse events was recorded: coughing, straining, bronchospasm, laryngospasm, clenching, breath holding, gross purposeful movement, airway obstruction, retching, vomiting, and oxygen desaturation. If any such event occurred, the LMA removal was considered a failure. Airway hyperreactivity was recorded and graded – based on the severity of cough, breath holding, and oxygen desaturation.The failure rate was higher in the “awake” group (15/61; 24.6%) than in the “deep” group (5/60; 8.3%). Airway hyperreactivity was mild (score, <3) in both groups.Removal of the LMA under deep anesthesia using a target-controlled, effect-site propofol concentration of 2 μg/mL may be safer and more successful than removal when patients are fully awake after surgery.

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Section: Discussioncontrasting

confidence: 46%

Removal of Laryngeal Mask Airway in Adults Under Target-Controlled, Propofol–Fentanyl Infusion Anesthesia

Huang

Hung

Lu³

2016

Medicine

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“…In one study, BIS was a poor predictor of complications associated with laryngeal mask airway insertion, while another provided weak and indirect evidence suggesting BIS may be a predictor of complications at laryngeal mask airway removal [55,56].…”

Section: Do They Improve Outcomes In Children?mentioning

confidence: 99%

Monitoring the anaesthetic depth in children – an update

Davidson

2007

Current Opinion in Anaesthesiology

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“…Furthermore, it has been proven that the BIS value is a poor predictor of complications during insertion and removal of devices for securing breathing passageways (8,9). The study performed by Schwartz, with the patient group of 240 children, assessing the BIS monitoring in children in the course of maintenance stage of GA (20) showed a significant variability and surprisingly high values of BIS in a large proportion of paediatric patients; data obtained in the study suggest, that BIS monitor is not a reliable monitor of GA depth.…”

Section: Discussionmentioning

confidence: 99%

“…Contrary to the adult population, laryngospasm presents a potentially significant complication of too shallow anaesthesia in children (7). Several studies have presented poor and indirect evidence about the BIS value being a poor and indirect predictor of complications in the course of placement and removal of the laryngeal mask (8,9). Perioperative awareness may result in significant psychological complications in the post-operative period (e.g.…”

Section: Introductionmentioning

confidence: 99%

Monitoring the Depth of General Anaesthesia with Bis Monitor in the Course of Surgical Procedure in Children Shortens the Period of Recovery from General Anaesthesia

Divák

Frelich

Dragula

et al. 2016

Acta Medica Martiniana

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Monitoring the depth of general anaesthesia (GA) enables the anaesthetist to reach the optimal depth of GA, and thus prevent the occurrence of too deep or too shallow anaesthesia, together with all associated consequences. Anaesthesia, which is too shallow, increases the risk of perioperative awareness. In adult patients, the incidence of perioperative awareness is 0.1-0.2 % for the total number of GA procedures,in paediatric population, the clinical studies present the incidence of up to 5 % (1973), 0.8 % (2005) for the total number of GA procedures. Perioperative awareness is a serious complication, with possible psychological consequences for the patients, including post-traumatic stress disorder.BIS monitoring is one of the possibilities how to assess the depth of GA. This technique is based on the assessment of EEG curve, when individual parameters of the EEG signal are, using mathematical methods, transformed into a dimensionless number, so-called bispectral index (BIS), the value of which is expressed on the scale from 0 to 100, and which reflects the depth of general anaesthesia.This prospective randomized clinical trial has proven, on a group of 101 children that the use of BIS monitor in the course of GA shortens the period of recovery from general anaesthesia, however, it does not decrease the consumption of inhalation anaesthetics when compared to GA performed without BIS monitoring. The results of the study confirmed the importance of monitoring the depth of GA in patients with intravenous administration of Propofol. The authors have observed an inverse linear relation between the values of BIS and MAC (minimum alveolar concentration).

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Can Bispectral Index aid laryngeal mask placement in children?

Abstract: Bispectral Index Score appears, from this study, not to be a useful tool to help predict complications of LMA placement or to help reduce airway complications during LMA placement. Other markers may be more useful predictors of adverse airway events.

Cited by 5 publications

References 31 publications

Removal of Laryngeal Mask Airway in Adults Under Target-Controlled, Propofol–Fentanyl Infusion Anesthesia

Removal of Laryngeal Mask Airway in Adults Under Target-Controlled, Propofol–Fentanyl Infusion Anesthesia

Monitoring the anaesthetic depth in children – an update

Monitoring the Depth of General Anaesthesia with Bis Monitor in the Course of Surgical Procedure in Children Shortens the Period of Recovery from General Anaesthesia

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