Bispectral analysis during pediatric procedural sedation.
OBJECTIVE
Bispectral analysis (BIS) is a technology using EEG information from a forehead electrode to calculate an index (0-100; 0 = coma, 90-100 = awake). Our objective was to determine the degree of agreement between sedation scales and BIS values in pediatric patients undergoing sedation.


METHODS
Patients ages 2 to 17 years, undergoing procedural sedation, were enrolled. Sedation was performed in the customary manner with the addition of BIS monitoring and assessment of a clinical sedation scale: the Observer's Assessment of Alertness/Sedation (OAA/S), every 5 minutes during the sedation procedure. Clinical scales were performed by an investigator blinded to the BIS index. The association between a clinical scale and BIS scores was analyzed using longitudinal regression analysis.


RESULTS
We enrolled 47 subjects; 55% were sedated with ketamine and midazolam and the remaining 45% received methohexital, propofol or midazolam and a narcotic. The results of the regression analysis demonstrated a highly significant association between the OAA/S score and BIS value (beta = 5.0, 95% CI 4.3 to 5.7, P < 0.0001). Patients were divided into 2 groups, those sedated with ketamine and those sedated with nonketamine medications. The association between OAA/S score and BIS value was not statistically significant for the ketamine population (beta = 0.809, 95% CI -0.1 to 1.7, P = 0.09), but remained significant for the nonketamine subjects (beta = 8.6, 95% CI 7.7 to 9.4, P < 0.0001).


CONCLUSIONS
The OAA/S sedation scale predicts the BIS value for pediatric patients undergoing procedural sedation when sedated with certain medications, excluding ketamine.
Overly
Frank L
FL
Department of Pediatrics, Rhode Island Hospital, Providence, RI 02903, USA. foverly@lifespan.org
Wright
Robert O
RO
Connor
Francis A
FA
Fontaine
Brian
B
Jay
Greg
G
Linakis
James G
JG
D000293:Adolescent; D000465:Algorithms; D000700:Analgesics / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007649:Ketamine / Q000008:administration & dosage; D008723:Methohexital / Q000008:administration & dosage; D008874:Midazolam / Q000008:administration & dosage; D008991:Monitoring, Physiologic / Q000379:methods*; D015742:Propofol / Q000008:administration & dosage; D012815:Signal Processing, Computer-Assisted
D000700:Analgesics; D006993:Hypnotics and Sedatives; D007649:Ketamine; D008723:Methohexital; D008874:Midazolam; D015742:Propofol