The relationship between age and minimum alveolar concentration of sevoflurane for maintaining bispectral index below 50 in children

Tokuwaka, Junko; Satsumae, Tsuyoshi; Mizutani, Taro; Yamada, Kumiko; Inomata, Shinichi; Tanaka, Makoto

doi:10.1111/anae.12890

Cited by 19 publications

(18 citation statements)

References 15 publications

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“…As compared to infants, children of 5‐12 years needed higher doses of rocuronium for achieving similar conditions of tracheal intubation. Although anesthetic requirement tends to decrease in upgrowing children, those aged 5‐12 years, on a mg/kg basis, need more of all nondepolarizing NMBAs than do infants or adolescents for a given degree of neuromuscular block . Developmental changes at neuromuscular synapses between 5 and 12 years are likely to increase margin of safety for the relay of motor nerve signals to muscle, requiring higher amounts of nondepolarizing NMBAs to effectively block transmission .…”

Section: Discussionmentioning

confidence: 99%

Neuromuscular‐blocking agents for tracheal intubation in pediatric patients (0‐12 years): A systematic review and meta‐analysis

Vanlinthout

Geniets

Driessen

et al. 2020

Pediatric Anesthesia

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Background:The benefit of using neuromuscular-blocking agents to facilitate tracheal intubation in pediatric patients remains unclear due to variations in design, treatments, and results among trials. By combining the available evidence, we aimed to establish whether scientific findings are consistent and can be generalized across various populations, settings, and treatments. Methods:A systematic search for randomized controlled trials, related to the use of neuromuscular-blocking agents for tracheal intubation in American Society of Anesthesiologists class I-II participants (0-12 years), was performed. We considered all randomized controlled trials that studied whether intubation conditions and hemodynamics obtained by using neuromuscular-blocking agents were equivalent to those that were achieved without neuromuscular-blocking agents. We combined the outcomes in Review Manager 5.3 (RevMan, The Cochrane Collaboration) by pairwise random-effects meta-analysis using a risk ratio (RR) for intubation conditions and mean difference for hemodynamic values (mean [95% Confidence Intervals]).Heterogeneity among trials was explored using sensitivity analyses. Results:We identified 22 eligible randomized controlled trials with 1651 participants.Overall, the use of a neuromuscular-blocking agent was associated with a clinically important increase in the likelihood of both excellent (RR = 1.41 [1.19-1.68], I 2 = 76%) and acceptable (RR = 1.13 [1.07-1.19], I 2 = 68%) intubating conditions. There is strong evidence that both unacceptable intubation conditions (RR = 0.35 [0.22-0.46], I 2 = 23%) and failed first intubation attempts (RR = 0.25 [0.14-0.42], I 2 = 0%) were less likely to occur when a neuromuscular-blocking agent was used compared with when it was not. Higher systolic or mean arterial pressures (mean difference = 13.3 [9.1-17.5] mm Hg, I 2 = 69%) and heart rates (mean difference = 15.9 [11.0-20.8] beats/ min, I 2 = 75%) as well as a lower incidence of arrhythmias were observed when tracheal intubation was facilitated by neuromuscular-blocking agents. Conclusion:The use of a neuromuscular-blocking agent during light-to-moderate depth of anesthesia can improve the quality as well as the success rate of tracheal intubation and is associated with better hemodynamic stability during induction of anesthesia. S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Vanlinthout LE, Geniets B, Driessen JJ, et al. Neuromuscular-blocking agents for tracheal intubation in pediatric patients: A systematic review and meta-analysis.

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Section: Discussionmentioning

confidence: 99%

Neuromuscular‐blocking agents for tracheal intubation in pediatric patients (0‐12 years): A systematic review and meta‐analysis

Vanlinthout

Geniets

Driessen

et al. 2020

Pediatric Anesthesia

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“…A previous study reported that BIS-based methods are not reliable for assessing the depth of sevo urane anesthesia in children under 2 years of age. [18] Additional research has revealed that the performance of BIS or entropy improves as age increases. [19] In the present study, all patients were over 3 years of age (mean age: 9.7 years), allowing us to avoid this limitation.…”

Section: Discussionmentioning

confidence: 99%

Comparison of bispectral index and patient state index during sevoflurane anesthesia in children: a prospective observational study

Jang

Kim

et al. 2020

Preprint

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Background: Cortical electroencephalography (EEG)-based devices are used to monitor the depth of anesthesia. In this study, we compared the values of bispectral index (BIS) and patient state index (PSI) during sevoflurane anesthesia in children. The ability/accuracy of BIS and PSI to predict the maintenance and recovery state of anesthesia was evaluated based on prediction probability (Pk) values and the secondary outcomes were agreement and correlation of two monitors.Methods: Fifty children (3-12 years old) were enrolled and the patients received sevoflurane anesthesia with remifentanil. Before the induction of anesthesia, BIS and PSI sensors were simultaneously placed on the forehead, and data were collected until the end of anesthesia. Maintenance state was defined as the period following intubation until the cessation of sevoflurane, while recovery state was defined as the period following the cessation of sevoflurane until awake. The prediction probability (Pk), agreement or correlation of BIS and PSI in different anesthesia state were calculated.Results: Anesthesia reduced mean BIS and PSI values. Pk of BIS (95% Confidential Interval (CI) [0.78-0.91])) and PSI (95% CI [0.82-0.91]) for anesthesia were 0.85 and 0.87, respectively. Agreement was 0.79 for recovery state and 0.73 for maintenance state.Conclusions: Pk values were comparable for BIS and PSI. Agreement between BIS and PSI measurements in the same state was relatively good. Therefore, these monitors are appropriate for monitoring for different state of anesthesia in pediatric population.Trial Registry Number: Clinical Trials.gov NCT03792334.

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“…Tokuwaka et al [12] stated that under sevoflurane anesthesia, BIS values are unreliable in children age < 2 years when assessing the depth of anesthesia. Wodey et al [13] reported that the BIS values ranged from 20 to 74 (median 40) under 1.0 MAC of sevoflurane in children, and the EEG and BIS measured appeared to be strongly correlated with age.…”

Section: Discussionmentioning

confidence: 99%

Analyzing Electroencephalography (EEG) Waves Provides a Reliable Tool to Assess the Depth of Sevoflurane Anesthesia in Pediatric Patients

et al. 2019

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Background Studies have reported that BIS is unreliable in children because its algorithm provides misleading information about the actual depth of anesthesia. Raw EEG analysis provides direct neurophysiologic measurement of cerebral activity. The relationship between age and EEG has rarely been reported, thus the aim of the present study was to compare raw electroencephalography (EEG) among different age groups of surgical patients under general anesthesia with 1.0 MAC sevoflurane. Material/Methods We enrolled 135 patients aged 0–80 years old (ASA physical status I or II) undergoing surgery, who were divided into 6 groups: 1–12 months old (group 1), 1–3 years old (group 2), 3–6 years old (group 3), 6–18 years old (group 4), 18–65 years old (group 5), and 65–80 years old (group 6). Different raw EEG waves (alpha, delta, and theta) were compared for all subjects. Results The BIS values in groups 1 to 6 were 52.2±12.7, 55.0±8.0, 44.5±7.3, 43.8±7.3, 44.2±6.2, and 49.1±6.2 respectively. Compared with groups 1 and 2 (52.2±12.7, 55.0±8.0), BIS values of groups 3, 4, and 5 (44.5±7.3, 43.8±7.3, 44.2±6.2, respectively) were lower ( P <0.05). Theta frequency was observed in the 6 groups. The EEG frequencies in groups 1 to 6 were 6.0 (5.5–6.0), 6.0 (5.5–6.0), 6.0 (5.5–6.0), 6.0 (6.0–7.0), 6.3 (6.0–7.0), and 6.0 (5.1–6.0), respectively. Compared with group 6, EEG frequencies in groups 4 and 5 were higher ( P <0.05). BIS value was significantly correlated with EEG frequency (R 2 =0.063, P <0.01). Conclusions Analyzing raw EEG waves provides more accurate judgement of depth of anesthesia, especially in pediatric cases in which monitors often provide misleading values.

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The relationship between age and minimum alveolar concentration of sevoflurane for maintaining bispectral index below 50 in children

Cited by 19 publications

References 15 publications

Neuromuscular‐blocking agents for tracheal intubation in pediatric patients (0‐12 years): A systematic review and meta‐analysis

Neuromuscular‐blocking agents for tracheal intubation in pediatric patients (0‐12 years): A systematic review and meta‐analysis

Comparison of bispectral index and patient state index during sevoflurane anesthesia in children: a prospective observational study

Analyzing Electroencephalography (EEG) Waves Provides a Reliable Tool to Assess the Depth of Sevoflurane Anesthesia in Pediatric Patients

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