Bispectral Index System (BIS) monitoring reduces time to discharge in children requiring intramuscular sedation and general anesthesia for outpatient dental rehabilitation.
OBJECTIVE
Pediatric patients who receive both intramuscular (i.m.) sedation and general anesthesia (GA) for oral rehabilitation occasionally experience prolonged sedation and delayed discharge. The Bispectral Index System (BIS) is an EEG monitor that measures the level of sedation. The authors compared discharge times of patients who had BIS monitoring to those who did not to determine if the use of BIS speeded discharge.


METHODS
After IRB approval, 20 children were enrolled. BIS was monitored continuously from admission until discharge. Each child received ketamine, midazolam, and glycopyrrolate i.m. Once sedated, the patient was transferred to the operating room, monitored, and i.v. access was established. GA proceeded with sevoflurane, rocuronium, and fentanyl. Randomly, in half the patients, the anesthesiologist knew and maintained the BIS at GA level of sedation by adjusting sevoflurane. In the rest, the anesthesiologist did not know BIS. Time from turning of sevoflurane to discharge was noted and compared.


RESULTS
Patients where the BIS was known and used were discharged 60+/-13 minutes after the end of GA. Patients where BIS was unknown were discharged 90+/-11 minutes after the end of GA (P<.001).


CONCLUSIONS
Based on the data, the authors recommend the use of BIS to facilitate faster discharge of pediatric patients who require i.m. sedation and GA for oral rehabilitation.
Messieha
Z S
ZS
Department of Anesthesiology, University of Illinois-Chicago, Chicago, Ill, USA. messieha@uic.edu
Ananda
R C
RC
Hoffman
W E
WE
Punwani
I C
IC
Koenig
H M
HM
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage; D000293:Adolescent; D000553:Ambulatory Care; D000762:Anesthesia Recovery Period; D000766:Anesthesia, Dental; D000768:Anesthesia, General; D000778:Anesthetics, Dissociative / Q000008:administration & dosage; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007273:Injections, Intramuscular; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D009065:Mouth Rehabilitation; D010351:Patient Discharge; D012815:Signal Processing, Computer-Assisted; D013997:Time Factors
D000759:Adjuvants, Anesthesia; D000778:Anesthetics, Dissociative; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives