Usefulness of bispectral index and patient state index during sevoflurane anesthesia in children: A prospective observational study

Young-Eun Jang, Eun-Hee Kim, Ji-Hyun Lee, Jin-Tae Kim, Hee-Soo Kim, Young-Eun Jang, Eun-Hee Kim, Ji-Hyun Lee, Jin-Tae Kim, Hee-Soo Kim

Abstract

Cortical electroencephalography-based devices are used to monitor the depth of anesthesia. In this study, we evaluated the values of bispectral index (BIS) and patient state index (PSI) during sevoflurane anesthesia in children. The ability/accuracy of BIS and PSI to predict the maintenance and recovery state of anesthesia was evaluated based on prediction probability (Pk) values and the secondary outcomes were agreement and correlation of 2 monitors. Fifty children (3-12 years old) were enrolled and the patients received sevoflurane anesthesia with remifentanil followed by propofol administration. Before the induction of anesthesia, BIS and PSI sensors were simultaneously placed on the forehead, and data were collected until the end of anesthesia. Maintenance state was defined as the period following intubation until the cessation of sevoflurane, while recovery state was defined as the period following the cessation of sevoflurane until awake. Pk, agreement or correlation of BIS and PSI in different anesthesia state were calculated. Anesthesia reduced mean BIS and PSI values. Pk of BIS (95% confidential interval [CI]: 0.78-0.91) and PSI (95% CI: 0.82-0.91) for anesthesia were 0.85 and 0.87, respectively. Agreement was 0.79 for recovery state and 0.73 for maintenance state. Pk values were comparable for BIS and PSI. Agreement between BIS and PSI measurements in the same state was relatively good. Therefore, these monitors are appropriate for monitoring for different state of anesthesia in pediatric population.

Trial registration: ClinicalTrials.gov NCT03792334.

Conflict of interest statement

The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the article.

Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

Figures

Figure 1.
Figure 1.
Plots of BIS and PSI against inspiratory sevoflurane concentration (A, B) or expiratory sevoflurane concentration (C, D) during the study period. Comparing to the inspiratory sevoflurane concentration, same values of BIS or PSI had a narrow expiratory sevoflurane concentration. BIS = bispectral index; PSI = patient state index.

References

    1. Oliveira CR, Bernardo WM, Nunes VM. Benefit of general anesthesia monitored by bispectral index compared with monitoring guided only by clinical parameters. Systematic review and meta-analysis. Braz J Anesthesiol. 2017;67:72–84.
    1. Louvet N, Rigouzzo A, Sabourdin N, et al. . Bispectral index under propofol anesthesia in children: a comparative randomized study between TIVA and TCI. Paediatr Anaesth. 2016;26:899–908.
    1. Chhabra A, Subramaniam R, Srivastava A, et al. . Spectral entropy monitoring for adults and children undergoing general anaesthesia. Cochrane Database Syst Rev. 2016;3:CD010135.
    1. Kreuer S, Wilhelm W. The Narcotrend monitor. Best Pract Res Clin Anaesthesiol. 2006;20:111–9.
    1. Cho SH, Kim SS, Hyun DM, et al. . Comparison between cerebral state index and bispectral index during desflurane anesthesia. Korean J Anesthesiol. 2018;71:447–52.
    1. Revuelta M, Paniagua P, Campos JM, et al. . Validation of the index of consciousness during sevoflurane and remifentanil anaesthesia: a comparison with the bispectral index and the cerebral state index. Br J Anaesth. 2008;101:653–8.
    1. Melia U, Gabarron E, Agusti M, et al. . Comparison of the qCON and qNOX indices for the assessment of unconsciousness level and noxious stimulation response during surgery. J Clin Monit Comput. 2017;31:1273–81.
    1. Liao WW, Wang JJ, Wu GJ, et al. . The effect of cerebral monitoring on recovery after sevoflurane anesthesia in ambulatory setting in children: a comparison among bispectral index, A-line autoregressive index, and standard practice. J Chin Med Assoc. 2011;74:28–36.
    1. Shoushtarian M, McGlade DP, Delacretaz LJ, et al. . Evaluation of the brain anaesthesia response monitor during anaesthesia for cardiac surgery: a double-blind, randomised controlled trial using two doses of fentanyl. J Clin Monit Comput. 2016;30:833–44.
    1. Lee KH, Kim YH, Sung YJ, et al. . The Patient State Index is well balanced for propofol sedation. Hippokratia. 2015;19:235–8.
    1. Drover D, Ortega HR. Patient state index. Best Pract Res Clin Anaesthesiol. 2006;20:121–8.
    1. Vanluchene AL, Struys MM, Heyse BE, et al. . Spectral entropy measurement of patient responsiveness during propofol and remifentanil. A comparison with the bispectral index. Br J Anaesth. 2004;93:645–54.
    1. Tiefenthaler W, Colvin J, Steger B, et al. . How Bispectral index compares to spectral entropy of the EEG and A-line ARX index in the same patient. Open Med (Wars). 2018;13:583–96.
    1. Kang E, Lee KH, Park JH. Comparison of two methods of anesthesia using patient state index: propofol versus sevoflurane during interventional neuroradiology procedure. Anesth Pain Med. 2019;9:e87518.
    1. Yhim HB, Yoon SH, Jang YE, et al. . Effects of benzydamine hydrochloride on postoperative sore throat after extubation in children: a randomized controlled trial. BMC Anesthesiol. 2020;20:77.
    1. Lee HC, Ryu HG, Park Y, et al. . Data driven investigation of Bispectral index algorithm. Sci Rep. 2019;9:13769.
    1. Smith WD, Dutton RC, Smith NT. Measuring the performance of anesthetic depth indicators. Anesthesiology. 1996;84:38–51.
    1. Jun MR, Yoo JH, Park SY, et al. . Assessment of phase-lag entropy, a new measure of electroencephalographic signals, for propofol-induced sedation. Korean J Anesthesiol. 2019;72:351–6.
    1. Soehle M, Kuech M, Grube M, et al. . Patient state index vs bispectral index as measures of the electroencephalographic effects of propofol. Br J Anaesth. 2010;105:172–8.
    1. Tokuwaka J, Satsumae T, Mizutani T, et al. . The relationship between age and minimum alveolar concentration of sevoflurane for maintaining bispectral index below 50 in children. Anaesthesia. 2015;70:318–22.
    1. Sciusco A, Standing JF, Sheng Y, et al. . Effect of age on the performance of bispectral and entropy indices during sevoflurane pediatric anesthesia: a pharmacometric study. Paediatr Anaesth. 2017;27:399–408.
    1. Rigouzzo A, Khoy-Ear L, Laude D, et al. . EEG profiles during general anesthesia in children: a comparative study between sevoflurane and propofol. Paediatr Anaesth. 2019;29:250–7.
    1. Blusse van Oud-Alblas HJ, Peters JW, de Leeuw TG, et al. . Comparison of bispectral index and composite auditory evoked potential index for monitoring depth of hypnosis in children. Anesthesiology. 2008;108:851–7.
    1. Liu PP, Wu C, Wu JZ, et al. . The prediction probabilities for emergence from sevoflurane anesthesia in children: a comparison of the perfusion index and the bispectral index. Paediatr Anaesth. 2018;28:281–6.
    1. Koch S, Stegherr AM, Morgeli R, et al. . Electroencephalogram dynamics in children during different levels of anaesthetic depth. Clin Neurophysiol. 2017;128:2014–21.
    1. Liu JS, Zhang JM, Yue Y. Variation of bispectral index monitoring in paediatric patients undergoing propofol-remifentanil anaesthesia. Eur J Anaesthesiol. 2008;25:821–5.
    1. Taivainen T, Klockars J, Hiller A, et al. . The performance of Bispectral Index in children during equi-MAC halothane vs. sevoflurane anaesthesia. Eur J Anaesthesiol. 2008;25:933–9.

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