title: The relationship between bispectral index and endtidal concentration of sevoflurane during anesthesia and recovery in spontaneously ventilating children.
abstract: BACKGROUND
  Global inverse correlation between BIS (bispectral index) and depth of anesthesia using sevoflurane has been documented in children in several studies under experimental conditions and in steady-state conditions during mechanically controlled ventilation. Because sevoflurane mask anesthesia combined with a peripheral nerve block is widely used in children, we studied the relationship between BIS and endtidal concentration of sevoflurane (PE(sevo)) under these conditions during surgery and emergence.
  
  
  METHODS
  In this prospective blinded study of 32 children, the relationship between BIS and PE(sevo) was studied during sevoflurane anesthesia via facemask combined with peripheral nerve block. The intraoperative phase was studied during steady-state conditions (fixed PE(sevo)) and the emergence phase was studied during fast alveolar washout (FAW). BIS and PE(sevo) data fitted using the E(max) model. Coefficients of variation of BIS and PE(sevo) during the two periods were compared.
  
  
  RESULTS
  Fit was adequate with the simple E(max) model. Intraoperative variation in BIS was large (28.4%), and larger than at awakening (28.4% vs 8%). At awakening, BIS varied less than PE(sevo) (8% vs 28.5%). No difference was found between children younger and those older than 5 years.
  
  
  CONCLUSIONS
  Caution is required for intraoperative titration based on BIS when spontaneous ventilation is maintained because of the wide variability compared with PE(sevo). During emergence using FAW, BIS varied significantly less than PE(sevo), but the clinical relevance of this point could be discussed during anesthesia without tracheal intubation.
authors.affiliation: Department of Anesthesiology, Purpan Hospital, University of Toulouse, Toulouse, France. kern.d@chu-toulouse.fr
authors.forename: Delphine
authors.initials: D
authors.lastname: Kern
authors.forename: Olivier
authors.initials: O
authors.lastname: Fourcade
authors.forename: Jean-Xavier
authors.initials: JX
authors.lastname: Mazoit
authors.forename: Vincent
authors.initials: V
authors.lastname: Minville
authors.forename: Clement
authors.initials: C
authors.lastname: Chassery
authors.forename: Gerald
authors.initials: G
authors.lastname: Chausseray
authors.forename: P
authors.initials: P
authors.lastname: Galinier
authors.forename: Kamran
authors.initials: K
authors.lastname: Samii
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D000762:Anesthesia Recovery Period; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography / Q000187:drug effects*; D006801:Humans; D007223:Infant; D008738:Methyl Ethers; D016343:Monitoring, Intraoperative / Q000379:methods; D009407:Nerve Block / Q000379:methods; D019370:Observation / Q000379:methods; D011446:Prospective Studies; D012119:Respiration / Q000187:drug effects; D000077149:Sevoflurane; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation*; D013990:Tidal Volume / Q000187:drug effects / Q000502:physiology
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane