The Influence of BIS Monitoring on Sedative Dose in Pediatric Patients Undergoing Open Muscle Biopsies – a Randomized Controlled Trial

Tschiedel, Eva; Müller, Oliver; Marina, Adela Della; Felderhoff-Müser, Ursula; Dohna-Schwake, Christian

doi:10.1055/s-0043-119692

Cited by 5 publications

(3 citation statements)

References 26 publications

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“…However, the quality of the examination and the frequency of complications during flexible bronchoscopy in children mainly depend on coughing frequency and sedation quality. For procedural sedation, the use of propofol and remifentanil (among others) is common and proven to be safe and effective 4–7 . They were applied safely in combination in pediatric patients 8,9 .…”

Section: Introductionmentioning

confidence: 99%

Sedation for bronchoscopy in children: A prospective randomized double‐blinded trial

Tschiedel

Eckerland

Felderhoff‐Mueser

et al. 2020

Pediatric Pulmonology

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Introduction In pediatric patients, flexible bronchoscopy requires deep sedation. Different sedation regimes are common, but only some of them include opioids. Due to their antitussive effect, the use of short‐acting opioids may be beneficial for this particular indication, but additional respiratory depression may lead to an increase in adverse events. Here, we systematically compared sedation regimes in children undergoing flexible bronchoscopy with either propofol alone, or a combination of propofol and remifentanil. The primary outcome parameter was the frequency of coughing episodes during the intervention. Secondary outcome parameters were frequency and types of complications, patient satisfaction, examiner satisfaction, and recovery time after finishing the sedation. Methods Fifty children aged 1–17 years undergoing flexible bronchoscopy under deep sedation with propofol were randomly assigned to two groups: PR receiving propofol and remifentanil and PP receiving propofol only. Sedation depth was predefined as Comfort Score 10–13. Results We found significantly less coughing episodes ([med (IQR)] PR: 0.73 (0.28–2.45)/min; PP: 1.98 (1.26–3.12)/min; p = .010) and shorter recovery time in Group PR (PR: 13.5 (8–17.5) min; PP: 21.0 (14–27) min; p = .011). Examiner's satisfaction was higher in Group PR (PR: 10 (8–10); PP: 9 (7–9); p = .012). The number of adverse events, patient satisfaction, and required propofol dose during the intervention did not differ between groups. Conclusion We suggest the combination of propofol with remifentanil instead of using propofol alone in pediatric procedural sedation for flexible bronchoscopy.

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Section: Introductionmentioning

confidence: 99%

Sedation for bronchoscopy in children: A prospective randomized double‐blinded trial

Tschiedel

Eckerland

Felderhoff‐Mueser

et al. 2020

Pediatric Pulmonology

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“…Apparative methods for indirect brain monitoring in the pediatric intensive care unit (PICU) include measurement of cerebral tissue oxygenation, cerebral blood flow, and cerebral metabolic state. Monitoring of electrical activity is possible by bispectral index (BIS-) monitoring and conventional continuous electroencephalography (cEEG) (1, 2). However, each technique has its limitations regarding duration, accuracy, availability, or easy applicability.…”

Section: Introductionmentioning

confidence: 99%

Amplitude-Integrated EEG for Neurological Assessment and Seizure Detection in a German Pediatric Intensive Care Unit

et al. 2019

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Objective: The aim of our study was to assess the use of aEEG in our pediatric intensive care unit (PICU), indications for neuromonitoring and its findings, utility for seizure detection, and associations with outcome. Design: We retrospectively analyzed non-neonates who were treated in our PICU and received amplitude-integrated EEG (aEEG). Patients: 27 patients aged between 29 days and 10 0/12 years (median 7.3 months) were included, who received a total of 35 aEEGS. Measurements: aEEG tracings were assessed for background (BG) pattern and its evolution, seizures, and side differences using a visual classification (Hellström-Westas). Clinical data were collected from patients' histories and analyzed for correlation with aEEG findings. Main results: While rare in early years, there was an increase in use over time. Most aEEGs were conducted because of (suspected) seizures or for management of antiepileptic treatment. aEEG had low sensitivity but high specificity for recognition of pathological BG pattern with reference to conventional EEG. Worsening of BG pattern or failure to improve was associated with death. Seizure detection rates by aEEG were higher than by clinical observation, especially for identification of non-convulsive epileptic state (ES). Side differences in aEEG were rare, but if present, they were associated with unilateral brain injury. Conclusions: aEEG is useful for the detection of seizures and ES in pediatric intensive care patients. Abnormal BG pattern and poor evolution of BG are negatively associated with survival. aEEG is a potential supplement to conventional EEG, facilitating long-term surveillance of cerebral function when continuous full-channel EEG is not available. Further investigation is needed.

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“…Their validation and performance have been assessed, with good reliability of the CS and RS [ 3 , 5 , 6 ]. Even though the CS was originally developed for sedated patients treated in the pediatric intensive care unit (PICU) and not for procedural sedation, it has been used for measuring sedation depth during procedural sedation in the PICU performed by pediatric intensivists [ 7 , 8 , 9 , 10 , 11 ]. The UMSS is a simple scoring tool and has recently shown good interrater agreement for light levels of sedation, but showed less agreement during deeper stages of sedation [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Correlation of Comfort Score and Narcotrend Index during Procedural Sedation with Midazolam and Propofol in Children

Bruns,

Joist,

Joist

et al. 2024

JCM

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Background/Objectives: Precise assessment of hypnotic depth in children during procedural sedation with preserved spontaneous breathing is challenging. The Narcotrendindex (NI) offers uninterrupted information by continuous electrocortical monitoring without the need to apply a stimulus with the risk of assessment-induced arousal. This study aimed to explore the correlation between NI and the Comfort Scale (CS) during procedural sedation with midazolam and propofol and to identify an NI target range for deep sedation. Methods: A prospective observational study was conducted on 176 children (6 months to 17.9 years) undergoing procedural sedation with midazolam premedication and continuous propofol infusion. Statistical analyses included Pearson correlation of NI and CS values, logistic regression, and receiver operating curves. Results: Median NI values varied with CS and age. The correlation coefficient between CS and NI was 0.50 and slightly higher in procedure-specific subgroup analyses. The optimal NI cut-off for deep sedation was between 50 and 60 depending on the analyzed subgroup and displayed high positive predictive values for sufficient sedation throughout. Conclusion: Our study found a moderate correlation between NI and CS, demonstrating reliable identification of adequately sedated patients.

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The Influence of BIS Monitoring on Sedative Dose in Pediatric Patients Undergoing Open Muscle Biopsies – a Randomized Controlled Trial

Abstract: For children undergoing minor surgical procedures under analgosedation, BIS monitoring does not affect the sedative dose, the time until eye opening or the frequency of complications.

Cited by 5 publications

References 26 publications

Sedation for bronchoscopy in children: A prospective randomized double‐blinded trial

Sedation for bronchoscopy in children: A prospective randomized double‐blinded trial

Amplitude-Integrated EEG for Neurological Assessment and Seizure Detection in a German Pediatric Intensive Care Unit

Correlation of Comfort Score and Narcotrend Index during Procedural Sedation with Midazolam and Propofol in Children

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