The utility of bispectral index monitoring for sedated patients treated with low-dose remifentanil

Kato, Takao; Koitabashi, Toshiya; Ouchi, Takashi; Serita, Ryohei

doi:10.1007/s10877-012-9379-4

Cited by 9 publications

(8 citation statements)

References 21 publications

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“…Patients with lower remifentanil infusion rates showed an increase in heart rate, mean arterial pressure, and BIS index during intubation, which stand in line with the observations made by Iselin-Chaves et al [ 38 ], who described an inverse correlation between BIS index variability and level of analgesia. In contrast to that, Kato et al [ 39 ] calculated clearly a better correlation between the RASS Score and the BIS index when low-dose remifentanil was administered in addition to propofol. In this study, high variable BIS index values were observed at almost the same serum concentrations of sufentanil (Fig.…”

Section: Discussionmentioning

confidence: 84%

Monitoring of sedation depth in intensive care unit by therapeutic drug monitoring? A prospective observation study of medical intensive care patients

et al. 2018

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BackgroundAnalgosedation is a cornerstone therapy for mechanically ventilated patients in intensive care units (ICU). To avoid inadequate sedation and its complications, monitoring of analgosedation is of great importance. The aim of this study was to investigate whether monitoring of analgosedative drug concentrations (midazolam and sufentanil) might be beneficial to optimize analgosedation and whether drug serum concentrations correlate with the results of subjective (Richmond Agitation-Sedation Scale [RASS]/Ramsay Sedation Scale) and objective (bispectral (BIS) index) monitoring procedures.MethodsForty-nine intubated, ventilated, and analgosedated critically ill patients treated in ICU were clinically evaluated concerning the depth of sedation using RASS Score, Ramsay Score, and BIS index twice a day. Serum concentrations of midazolam and sufentanil were determined in blood samples drawn at the same time. Clinical and laboratory data were statistically analyzed for correlations using the Spearman’s rank correlation coefficient rho (ρ).ResultsAverage age of the population was 57.8 ± 16.0 years, 61% of the patients were males. Most frequent causes for ICU treatments were sepsis (22%), pneumonia (22%), or a combination of both (25%). Serum concentrations of midazolam correlated weakly with RASS (ρ = − 0.467) and Ramsay Scores (ρ = 0.476). Serum concentrations of sufentanil correlated weakly with RASS (ρ = − 0.312) and Ramsay Scores (ρ = 0.295). Correlations between BIS index and serum concentrations of midazolam (ρ = − 0.252) and sufentanil (ρ = − 0.166) were low.ConclusionCorrelations between drug serum concentrations and clinical or neurophysiological monitoring procedures were weak. This might be due to intersubject variability, polypharmacy with drug-drug interactions, and complex metabolism, which can be altered in critically ill patients. Therapeutic drug monitoring is not beneficial to determine depth of sedation in ICU patients.Electronic supplementary materialThe online version of this article (10.1186/s40560-018-0331-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 84%

Monitoring of sedation depth in intensive care unit by therapeutic drug monitoring? A prospective observation study of medical intensive care patients

et al. 2018

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“…Assumption of the correlation between BIS and OAA/S was estimated to be 0.7, as reported previously. 17 We also sought to detect the effect size of correlation with 5% a-error and 80% statistical power. Thus, we calculated that 15 patients were needed for each group, with an estimated dropout rate of 10%.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of the bispectral index and Observer’s Assessment of Alertness/Sedation Scale in monitoring sedation during spinal anesthesia: A randomized clinical trial

et al. 2019

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Objective The bispectral index (BIS) has been used to monitor sedation during spinal anesthesia. We evaluated the correlation between BIS and the Observer’s Assessment of Alertness/Sedation Scale (OAA/S) in patients sedated with dexmedetomidine, propofol, or midazolam. Methods This prospective, randomized study included 46 patients scheduled for knee arthroplasty under spinal anesthesia with sedation. The patients were randomized to receive sedation with dexmedetomidine (n = 15), propofol (n = 15), or midazolam (n = 16). Correlation between BIS and OAA/S was assessed during sedation in the three groups. Results A linear correlation was observed between BIS and OAA/S, and there was no significant difference in BIS score between the groups during mild to moderate sedation status (OAA/S 3–5). During deep sedation (OAA/S 1–2), the BIS score in the midazolam group was significantly higher than that in the propofol and dexmedetomidine groups (74.4 ± 11.9 vs 67.7 ± 9.5 vs 62.6 ± 12.2). Conclusions BIS values differed at the same level of sedation between different sedative agents. Objective sedation scores should therefore be used in combination with BIS values for the assessment of sedation levels during spinal anesthesia.

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“…In the remifentanil group BIS and RASS was found to be correlated with each other, but no correlation was found between the two in the other group (18). We also evaluated patients using remifentanil infusion to achieve sedation in our study, and found a correlation between RASS and BIS.…”

Section: Resultsmentioning

confidence: 68%

Correlation between Ramsay Sedation Scale and Richmond Agitation-Sedation Scale with Bispectral Index Monıtoring in the Intensive Care Unit

2018

ARC Journal of Anesthesiology

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Background: Achieving appropriate sedation levels in mechanically ventilated patients is very crucial in intensive care units. Reaching and keeping appropriate level of sedation in these patients is a common problem.. By reaching appropriate sedation and analgesia, comfort and easier adoption to weaning is aimed. For adequate and appropriate sedation, monitoring the sedation level is needed. Different scoring techniques are used for this purpose. Our aim is to compare Bispectral index (BIS) monitoring, which is an objective method, with subjective clinical sedation scales, and to investigate the correlation between them. Methods: Data of patients, whom sedation and mechanical ventilation were performed in postoperative period, were analysed retrospectively. All patients with comorbidities which cause altered brain function and who needed inotropic drugs were excluded from the study. Richmond Sedation Scale (RSS) levels were held between +2-+3, and Richmond Agitation Sedation Scale (RASS), BIS and hemodynamic parameters were recorded in every hour for 6 hours. Results: A negative correlation between BIS and clinical sedation scales was observed in patients who had superficial sedation. RASS levels ranged from 0 to "-3", and average BIS value was 75. The average BIS value at RAMSAY

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The utility of bispectral index monitoring for sedated patients treated with low-dose remifentanil

Cited by 9 publications

References 21 publications

Monitoring of sedation depth in intensive care unit by therapeutic drug monitoring? A prospective observation study of medical intensive care patients

Monitoring of sedation depth in intensive care unit by therapeutic drug monitoring? A prospective observation study of medical intensive care patients

Efficacy of the bispectral index and Observer’s Assessment of Alertness/Sedation Scale in monitoring sedation during spinal anesthesia: A randomized clinical trial

Correlation between Ramsay Sedation Scale and Richmond Agitation-Sedation Scale with Bispectral Index Monıtoring in the Intensive Care Unit

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