title: Bispectral analysis during procedural sedation in the pediatric emergency department.
abstract: OBJECTIVE
  Our primary objective was to determine the maximum depth of sedation achieved, as measured by the bispectral (BIS) index monitor, for pediatric patients undergoing procedural sedation in a pediatric emergency department.
  
  
  METHODS
  This prospective, blinded, observational study was conducted in a tertiary pediatric emergency department. Procedural sedation and analgesia were performed in the standard manner, with the addition of blinded BIS index monitoring. In addition, both the sedating physician and the procedural physician recorded their clinical impression of the maximum depth of sedation.
  
  
  RESULTS
  A convenience sample of 50 patients was enrolled. The median age was 9.2 years (range, 3-15 y). The mean nadir BIS index was 43.1 ± 17.4 (SD), with a 95% confidence interval from 37.8 to 48.4. This was significantly lower than the BIS index value that is considered to reflect general anesthesia (<60; P > 0.0001). Almost 80% of the analyzed patient sedations were classified as having achieved general anesthesia. When comparing the sedating physician and the procedural physician's clinical assessment of maximal depth of sedation with the nadir BIS index value, there was only slight agreement between the 2 groups (κ statistics, 0.19 and 0.057, respectively). Ninety-three percent of the sedating physicians and 88% of the procedural physicians underestimated the maximum depth of sedation of their patients.
  
  
  CONCLUSIONS
  This study suggests that most pediatric procedural sedation patients spend at least a period in a general anesthetic state. During most procedural sedation, the physicians involved are likely underestimating the maximal depth of sedation for their patients.
authors.affiliation: Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Carmen
authors.initials: C
authors.lastname: Gamble
authors.forename: Jon
authors.initials: J
authors.lastname: Gamble
authors.forename: Rob
authors.initials: R
authors.lastname: Seal
authors.forename: R Bruce
authors.initials: RB
authors.lastname: Wright
authors.forename: Samina
authors.initials: S
authors.lastname: Ali
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods*; D056805:Consciousness Monitors; D004569:Electroencephalography; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D011446:Prospective Studies; D016037:Single-Blind Method
chemical_list: D006993:Hypnotics and Sedatives