Level of sedation evaluation with Cerebral State Index and A-Line Arx in children undergoing diagnostic procedures.
BACKGROUND
Monitoring of anesthesia depth is difficult clinically, particularly in children. The aim of this study was to assess the correlation existing between CSI (Cerebral State Index), or AAI (A-line ARX) and a clinical sedation scale such as UMSS (University of Michigan Sedation Scale), during deep sedation with propofol in children undergoing diagnostic procedures.


METHODS
Twenty ASA I and II children, scheduled to undergo deep sedation for magnetic resonance imaging (MRI) or Esophagogastroduodenoscopy (EGDS), were enrolled. The patients were randomly assigned to receive depth of anesthesia monitoring with CSI or AAI. The anesthetist administered repeated doses of propofol every 10 s to a UMSS score of 3-4. An attending anesthetist, not involved in drug administration, recorded time and doses of sedation medications, vital signs, UMSS score and CSI or AAI score. All the evaluations were recorded at awake state (baseline), every 10 s until an UMSS score of 3-4 and every 3 min until the children were awake.


RESULTS
We enrolled 13 males and seven females ranging in age from 8 months to 7 years. After induction of anesthesia CSI and AAI scores decreased and from the end of the procedure to emergence the two scores increased. The CSI data showed a strong correlation with the UMSS scores (r = -0.861; P < 0.0001); we found a similar correlation between the AAI data and the UMSS scores (r = -0.823; P < 0.0001).


CONCLUSIONS
Our study suggests that CSI and AAI may be two, real-time and objective tools to assess induction and emergence during propofol sedation in children undergoing EGDS and MRI.
Disma
Nicola
N
Department of Anesthesia and Intensive Care (Director Prof. A. Gullo), Policlinico University Hospital, Catania, Italy. nicoladisma@tin.it
Lauretta
Daniela
D
Palermo
Filippo
F
Sapienza
Danila
D
Ingelmo
Pablo Mauricio
PM
Astuto
Marinella
M
D000762:Anesthesia Recovery Period; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001921:Brain / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods*; D004334:Drug Administration Schedule; D004562:Electrocardiography / Q000379:methods; D004569:Electroencephalography / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005072:Evoked Potentials, Auditory / Q000187:drug effects*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D015742:Propofol / Q000008:administration & dosage; D013997:Time Factors
D018686:Anesthetics, Intravenous; D015742:Propofol