Bispectral analysis during deep sedation of pediatric oral surgery patients.
OBJECTIVE
Bispectral (BIS) analysis uses electroencephalogram information from a forehead electrode to calculate an index score (0 to 100; 0 = coma; 90 to 100 = awake). This index score correlates with the level of alertness in anesthetized patients. Classically, sedation has been monitored with clinical sedation scales such as the Observers Assessment of Alertness Sedation Scale (OAA/S), Modified Ramsey Scale, or a Visual Analog Scale (VAS). Our objective was to determine the correlation between clinical sedation scales and BIS index in pediatric patients undergoing sedation in an outpatient oral surgery setting.


METHODS
Prospective cohort study of patients aged 2 to 17 years undergoing sedation in an outpatient oral surgery office. Sedation was performed in the customary manner with the addition of BIS monitoring. Three clinical sedation scores (OAA/S: 5 to 1; 5 = awake, 1 = unresponsive; Modified Ramsey: 1 to 6; 1-2 = awake, 6 = unresponsive; VAS: 0 to 10; 0 = awake, 10 = unresponsive) were assigned every 5 minutes by an investigator blinded to the BIS index. Data were analyzed using a repeated measures linear regression model.


RESULTS
Sixteen subjects undergoing oral surgery, ages 4.5 years to 17 years, were enrolled, mean age 12.6 years +/- 4.3 years (standard deviation). Patients received methohexital in addition to 1 or more of the following: nitrous oxide, fentanyl, or midazolam. The results of the longitudinal regression analysis showed a highly significant association between the sedation scales and the BIS index.


CONCLUSIONS
The BIS monitor may be a useful adjunct in monitoring pediatric patients receiving sedation in the outpatient setting.
Overly
Frank L
FL
Emergency Medicine and Pediatrics, Rhode Island Hospital, Brown Medical School, Providence, Rhode Island, RI 02903, USA. foverly@lifespan.org
Wright
Robert O
RO
Connor
Francis A
FA
Jay
Gregory D
GD
Linakis
James G
JG
D000293:Adolescent; D000556:Ambulatory Surgical Procedures; D000766:Anesthesia, Dental / Q000379:methods*; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016292:Procedural Sedation; D003243:Consciousness / Q000187:drug effects; D004569:Electroencephalography / Q000187:drug effects*; D005260:Female; D005283:Fentanyl / Q000494:pharmacology; D006801:Humans; D008297:Male; D008723:Methohexital / Q000494:pharmacology; D008874:Midazolam / Q000494:pharmacology; D016343:Monitoring, Intraoperative / Q000379:methods*; D009609:Nitrous Oxide / Q000494:pharmacology; D019647:Oral Surgical Procedures; D011446:Prospective Studies; D012815:Signal Processing, Computer-Assisted; D016037:Single-Blind Method
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008723:Methohexital; D009609:Nitrous Oxide; D008874:Midazolam; D005283:Fentanyl