Sedation monitoring of children by the Bispectral Index in the pediatric intensive care unit

Abstract

The Bispectral Index correlates well with the Ramsay score in the normal sedated child. The Ramsay score and bedside nurse assessment are inadequate for monitoring the depth of sedation in paralyzed children. The Bispectral Index is a useful adjunct in assessing sedation in a paralyzed patient.

A review of the utility of EEG depth of anaesthesia monitors in the paediatric intensive care environment

“…Fourteen articles evaluating DoAM in the PIC population were identified and included for review (Aneja et al 2003;Berkenbosch et al 2002;Courtman et al 2003;Crain et al 2002;Froom et al 2008;Lamas et al 2008a;Lamas et al 2008b;Lamas et al 2009a;Lamas et al 2009b;Prins et al 2007;Tobias and Grindstaff 2005;Triltsch et al 2005;Trope et al 2005;Twite et al 2005). Most studies were prospective, and observational studies, apart from Trope and collegues (2005), who undertook a retrospective chart review.…”

“…Eight studies investigated COMFORT (Courtman et al 2003;Crain et al 2002;Froom et al 2008;Lamas et al 2008a;Lamas et al 2009b;Triltsch et al 2005;Twite et al 2005). Five studies investigated RSS (Aneja et al 2003;Berkenbosch et al 2002;Lamas et al 2008a;Lamas et al 2008b;Lamas et al 2009b). One study investigated the Tracheal Suctioning Score together with the Paediatric Intensive Care Sedation Score (Berkenbosch et al 2002).…”

“…In addition, DoAMs were assessed in a variety of clinical situations. Studies examined the applicability of DoAMs during the care of sedated PIC patients without NMB (Berkenbosch et al 2002;Crain et al 2002;Triltsch et al 2005;Twite et al 2005) and with NMB (Aneja et al 2003;Lamas et al 2008a;Tobias and Grindstaff 2005;Trope et al 2005). Other studies compared postoperative cardiac and non cardiac patients (Lamas et al 2009b), patients receiving a variety of stimuli (Lamas et al 2008b), peri-physiotherapy (Froom et al 2008), peri-endotracheal suction (Courtman et al 2003) and children during barbiturate coma (Prins et al 2007).…”

“…Five studies did not report the BIS software version used (Aneja et al 2003;Berkenbosch et al 2002;Crain et al 2002;Tobias and Grindstaff 2005;Trope et al 2005).…”

“…Thus have an inherent limitation for patients receiving neuromuscular blockade (NMB) (Tobias 2005). Electroencephalogram (EEG) analysis, using commercially available depth of anaesthesia monitors (DoAM), may provide an objective method to assess children's sedation in PIC (Aneja et al 2003). …”