title: Value of bispectral index monitor in differentiating between moderate and deep Ramsay Sedation Scores in children.
abstract: BACKGROUND
  Pediatric patients who undergo diagnostic radiological imaging studies routinely require moderate or deep sedation to a Ramsay Sedation Score (RSS) of 4 or 5, respectively. The correlation between moderate and deep RSS and bispectral index (BIS) in children has never been validated. This study was designed to determine whether the BIS values correlate with RSS of children sedated for diagnostic imaging studies.
  
  
  METHODS
  After Institutional Review Board approval, data were prospectively collected on all children receiving pentobarbital alone for computed tomography or magnetic resonance imaging. On arrival in the recovery room, any child assigned a Ramsay score of 4 or 5 was subsequently monitored with the BIS. Receiver-operating characteristic (ROC) analysis was used to evaluate the discriminative ability of BIS in differentiating depth of anesthesia.
  
  
  RESULTS
  A total of 86 children over 1 year of age were enrolled. Children with Ramsay 4 (moderate) and Ramsay 5 (deep) sedation scores showed no significant difference in age or pentobarbital dose (mg.kg(-1)). BIS values followed a normal Gaussian-shaped distribution for both Ramsay scores. There was no significant difference in mean BIS values between the Ramsay groups (P = 0.64). There was a wide variation in BIS values (range of 31-90), which demonstrates that the BIS monitor does not correlate with the clinically assigned RSS depth of anesthesia in children. The ROC curve for BIS is equivalent to a line of nondiscrimination.
  
  
  CONCLUSIONS
  BIS has limited ability to distinguish between moderate and deep Ramsay sedation levels in children who receive pentobarbital sedation for diagnostic imaging studies.
authors.affiliation: Departments of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA. keira.mason@childrens.harvard.edu
authors.forename: Keira P
authors.initials: KP
authors.lastname: Mason
authors.forename: Edward
authors.initials: E
authors.lastname: Michna
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Patricia E
authors.initials: PE
authors.lastname: Burrows
authors.forename: Michele A
authors.initials: MA
authors.lastname: Pirich
authors.forename: Maureen
authors.initials: M
authors.lastname: Carrier
authors.forename: Paulette J
authors.initials: PJ
authors.lastname: Fontaine
authors.forename: Navil F
authors.initials: NF
authors.lastname: Sethna
mesh_terms: D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000145:classification*; D004311:Double-Blind Method; D004569:Electroencephalography / Q000187:drug effects*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000494:pharmacology; D008279:Magnetic Resonance Imaging; D008297:Male; D010424:Pentobarbital / Q000008:administration & dosage* / Q000494:pharmacology; D011446:Prospective Studies; D012372:ROC Curve; D012107:Research Design; D014057:Tomography, X-Ray Computed
chemical_list: D006993:Hypnotics and Sedatives; D010424:Pentobarbital