Bispectral index monitoring in pediatric anesthesia

Anesthetic management guided by bispectral index monitoring has been demonstrated to facilitate earlier recovery in adults. Recent preliminary data also suggest that titration of drugs to achieve a specific bispectral index value may reduce the incidence of intraoperative awareness in high-risk adults. It is unclear, however, if this technology will benefit children as it is based on an algorithm developed from adults. This article reviews the literature on the use of the bispectral index monitor in children.

In recent studies, bispectral index scores were shown to correlate well with sedation scores during conscious and deep sedation in pediatric patients, and also with end-tidal concentrations of inhalation agents in children, although bispectral index values may differ with equipotent doses of different agents. Other studies have shown that titrating anesthetic agents to a specific bispectral index value during general anesthesia in the pediatric age group is associated with the use of lower amounts of anesthetic agents and faster recovery from anesthesia in children over 2 years old. However, the utility of bispectral index monitoring in infants, particularly those less than 6 months old, is questionable, as there is little correlation between bispectral index values and other measures of the depth of anesthesia in this subset of patients.

Bispectral index monitoring may be used to guide anesthetic administration in older children, but its use as a tool for guiding sedation in the younger pediatric patient needs further investigation. It may be necessary to develop a different bispectral index algorithm for children in the younger age groups.