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

Sargın, Mehmet; Uluer, Mehmet Selçuk; Özmen, Sadık

doi:10.1111/pan.12692

Cited by 15 publications

(8 citation statements)

References 23 publications

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“…In line with other investigations, bispectral monitoring was used efficiently and effectively in mentally retarded patients ( 31 , 32 ), and could have a positive effect upon the recovery profile in developmentally delayed pediatric patients ( 32 ).…”

Section: Discussionsupporting

confidence: 64%

Hemodynamic and ventilatory changes in pediatric patients with special needs: A comparative clinical study

Pérez‐García¹,

Ruiz‐Roca²,

Añez³

et al. 2022

J Clin Exp Dent

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Background Very limited data are available on the hemodynamic and ventilatory changes during sedation and general anesthesia using bispectral index (BIS) monitoring in intellectually disabled children. The purpose was to determine the hemodynamic and ventilatory changes after propofol and sevoflurane administration in children with special needs (CSN) versus healthy children (HC) during dental treatment. Material and Methods Forty pediatric patients needing dental treatment were allocated into two groups: children without systemic disease (healthy children [HC]) and mentally disabled children (children with special needs [CSN]). Sevoflurane in oxygen (100% oxygen, 5 l/min) and continuous propofol infusion (target-controlled infusion [TCI], 2 µg/ml) were used as sedative agents, and 2% lidocaine with 1:80,000 adrenaline was used as local anesthesia in both groups. Heart rate (HR), oxygen saturation (SaO2), respiratory rate (RR), exhaled carbon dioxide (CO2), blood pressure (BP) and bispectral monitoring (BIS) values were recorded during the entire dental treatment procedure. Results A statistically significant decrease in systolic BP, diastolic BP and RR was observed, with no significant differences between the healthy and disabled groups. In contrast, the HR and BIS values were lower in the CSN group than in the healthy patients ( p ≤ 0.05). Conclusions Patients with special needs had lower HR and BIS values than healthy patients, while BP, SaO2 and exhaled CO2 showed similar results in both groups. Key words: Bispectral index, hemodynamic changes, ventilatory changes, pediatric patients, special needs.

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Section: Discussionsupporting

confidence: 64%

Hemodynamic and ventilatory changes in pediatric patients with special needs: A comparative clinical study

Pérez‐García¹,

Ruiz‐Roca²,

Añez³

et al. 2022

J Clin Exp Dent

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“…The associations between anesthesia depth and death and myocardial infarction or postoperative cognitive decline and long-term survival have been studied, but the available evidence is inconclusive. 17 , 18 …”

Section: Discussionmentioning

confidence: 99%

An investigation into the effect of depth of anesthesia on postoperative pain in laparoscopic cholecystectomy surgery: a double-blind clinical trial

Faiz

Siamdoust

Rahimzadeh

et al. 2017

JPR

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Backgrounds and objectiveSome studies have shown that deeper anesthesia is more effective on postoperative analgesia and reduces the need for sedative drugs. This study sought to investigate the effect of depth of anesthesia on postoperative pain in laparoscopic cholecystectomy.Materials and methodsIn this double-blind clinical trial, 60 patients undergoing laparoscopic cholecystectomy were randomly divided into two groups: low bispectral index (L-BIS=35–44) and high bispectral index (H-BIS=45–55). Anesthesia protocol was the same for both groups (propofol and remifentanil). The pain intensity (at rest and during cough) was evaluated based on the visual analog scale scores in recovery and at 8, 16 and 24 hours after surgery.ResultsThe mean pain score was significantly lower in patients in the L-BIS group at all examined times at rest and during cough than that in the H-BIS group. The number of patients in need of additional sedative drug in the H-BIS group in recovery was significantly more than that in the L-BIS group (27 vs 18 patients, P=0.007). The incidence of nausea in the recovery room 8 hours after the surgery was significantly less in the L-BIS group than that in the H-BIS group, while at 16 and 24 hours, no case of nausea was reported in the two groups.ConclusionGiven the results of this study, it seems that general anesthesia with propofol and remifentanil with L-BIS causes less need for additional analgesic drug and less nausea and vomiting compared to anesthesia with H-BIS.

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“…Similarly, children with developmental delay or cerebral palsy are known to have a lower MAC to volatile anesthetic agents, 99 require less propofol to maintain a given hypnotic state, 65 and frequently have delayed emergence from general anesthesia. 66,100 Moreover, children with neurological disorders are often on neuropsychiatric medications such as antiepileptics, which may enhance or inhibit liver metabolism of anesthetic drugs, making anesthetic requirements even less predictable. EEG monitoring provides an important window into the brain states of these patients whose anesthetic requirements may differ from NT children, though not always in a predictable manner, and allows precise titration of anesthetic doses to meet their unique needs.…”

Section: Childrenmentioning

confidence: 99%

A Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children

Bong

Balanza

Khoo

et al. 2022

Anesthesia &Amp; Analgesia

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The major therapeutic end points of general anesthesia include hypnosis, amnesia, and immobility. There is a complex relationship between general anesthesia, responsiveness, hemodynamic stability, and reaction to noxious stimuli. This complexity is compounded in pediatric anesthesia, where clinicians manage children from a wide range of ages, developmental stages, and body sizes, with their concomitant differences in physiology and pharmacology. This renders anesthetic requirements difficult to predict based solely on a child’s age, body weight, and vital signs. Electroencephalogram (EEG) monitoring provides a window into children’s brain states and may be useful in guiding clinical anesthesia management. However, many clinicians are unfamiliar with EEG monitoring in children. Young children’s EEGs differ substantially from those of older children and adults, and there is a lack of evidence-based guidance on how and when to use the EEG for anesthesia care in children. This narrative review begins by summarizing what is known about EEG monitoring in pediatric anesthesia care. A key knowledge gap in the literature relates to a lack of practical information illustrating the utility of the EEG in clinical management. To address this gap, this narrative review illustrates how the EEG spectrogram can be used to visualize, in real time, brain responses to anesthetic drugs in relation to hemodynamic stability, surgical stimulation, and other interventions such as cardiopulmonary bypass. This review discusses anesthetic management principles in a variety of clinical scenarios, including infants, children with altered conscious levels, children with atypical neurodevelopment, children with hemodynamic instability, children undergoing total intravenous anesthesia, and those undergoing cardiopulmonary bypass. Each scenario is accompanied by practical illustrations of how the EEG can be visualized to help titrate anesthetic dosage to avoid undersedation or oversedation when patients experience hypotension or other physiological challenges, when surgical stimulation increases, and when a child’s anesthetic requirements are otherwise less predictable. Overall, this review illustrates how well-established clinical management principles in children can be significantly complemented by the addition of EEG monitoring, thus enabling personalized anesthesia care to enhance patient safety and experience.

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

Abstract: In conclusion, results suggest that routine BIS monitoring may be beneficial due to its favorable effects on the recovery profile in developmentally delayed pediatric patients.

Cited by 15 publications

References 23 publications

Hemodynamic and ventilatory changes in pediatric patients with special needs: A comparative clinical study

Hemodynamic and ventilatory changes in pediatric patients with special needs: A comparative clinical study

An investigation into the effect of depth of anesthesia on postoperative pain in laparoscopic cholecystectomy surgery: a double-blind clinical trial

A Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children

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