title: Sedation monitoring during open muscle biopsy in children by Comfort Score and Bispectral Index - a prospective analysis.
abstract: BACKGROUND
  Open muscle biopsies in children are generally performed under general anesthesia. Alternatively, deep sedation and analgesia may be required.
  
  
  OBJECTIVE
  The aim of our study was to compare the Bispectral Index (BIS) and Comfort Score (CS) with respect to their clinical significance for sedation/analgesia in children undergoing open muscle biopsy.
  
  
  METHODS
  Thirty pediatric patients subjected to open muscle biopsy for diagnosis of their underlying disease were prospectively enrolled. Sedation/analgesia was performed in all patients using remifentanil and propofol. The patients were simultaneously monitored using the CS and BIS.
  
  
  RESULTS
  All sedations and muscle biopsies were performed uneventfully. The CS and BIS were significantly correlated (R = 0.589; P < 0.01). Receiver operating characteristic (ROC) analysis revealed an area under the curve (AUC) of 0.918 with a maximum cut-off point of BIS 70.5 (sensitivity 0.9; specificity 0.785) for adequate sedation. Sensitivity of 100% was achieved at BIS 60. Accordingly, all patients with BIS ≤60 had CS within the target range of 10-14. The BIS showed substantial intra- and interindividual variability (30 points and 58 points, respectively) during sedation, whereas CS varied only within close ranges during sedation. In 25 patients, sedatives were reduced according to low BIS values (<60). No unintended anesthesia awareness was noted during the study period.
  
  
  CONCLUSIONS
  Bispectral Index provides an additional helpful tool to guide sedation/analgesia in minor surgical procedures in children. BIS values ≤60 correlated with sufficient depth of sedation and prevented unintended awareness. Additionally, BIS measurement allowed for distinct regulation of depth of sedation without prolonged sedation/analgesia due to unintended overdose.
authors.affiliation: Department of Pediatrics 1, University Hospital Essen, Essen, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Tschiedel
authors.forename: Oliver
authors.initials: O
authors.lastname: Müller
authors.forename: Ulrike
authors.initials: U
authors.lastname: Schara
authors.forename: Ursula
authors.initials: U
authors.lastname: Felderhoff-Müser
authors.forename: Christian
authors.initials: C
authors.lastname: Dohna-Schwake
mesh_terms: D000293:Adolescent; D000698:Analgesia; D018686:Anesthetics, Intravenous; D019540:Area Under Curve; D001706:Biopsy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D056805:Consciousness Monitors; D054810:Deep Sedation; D005260:Female; D006801:Humans; D007223:Infant; D058926:Intraoperative Awareness / Q000453:epidemiology; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D018482:Muscle, Skeletal / Q000473:pathology*; D009468:Neuromuscular Diseases / Q000175:diagnosis / Q000473:pathology; D010880:Piperidines; D015742:Propofol; D011446:Prospective Studies; D012372:ROC Curve; D000077208:Remifentanil
chemical_list: D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol
keywords: Bispectral Index; Comfort Score; muscle biopsy; pediatric; sedation