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Published on: January 23, 2017
Bispectral index and middle latency auditory evoked potentials in children younger than two-years-old
Adelaida Lamas1, Jesús López-Herce, Luis Sancho
1Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Insights
The bispectral index (BIS), midlatency auditory evoked potentials (MLAEP), and modified Ramsay score (RS) correlate well in sedated children. However, their agreement is poor, indicating limited clinical utility for monitoring depth of sedation.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
- Neuroscience
Background:
- Assessing depth of sedation in pediatric patients is crucial for safe anesthesia and intensive care.
- The bispectral index (BIS), midlatency auditory evoked potentials (MLAEP), and modified Ramsay score (RS) are commonly used monitoring tools.
- Limited data exists on the correlation and agreement of these measures in non-pharmacologically sedated healthy children.
Purpose of the Study:
- To analyze the correlation and agreement between BIS, MLAEP, and RS.
- To evaluate these indices in healthy children younger than 2 years during wakefulness and natural sleep.
- To determine their utility in monitoring sedation levels without pharmacological intervention.
Main Methods:
- A study involving 53 healthy children under 2 years of age.
- Simultaneous evaluation using BIS, MLAEP, and modified RS.
- Statistical analysis including Spearman Rank Correlation and Cohen's Kappa tests to assess correlation and agreement.
Main Results:
- Moderate-to-good correlation was found among BIS, MLAEP, and RS (P = 0.01).
- Correlation coefficients ranged from r = -0.504 to r = -0.624.
- Agreement between the methods was poor to fair (kappa values ranging from 0.270 to 0.409).
- Lower correlations were observed in infants aged 1-6 months.
- Higher BIS values were noted in infants younger than 1 month compared to older infants during sleep.
Conclusions:
- BIS, MLAEP, and RS demonstrate good correlation in children under 2 years not receiving sedation.
- The level of agreement between these monitoring methods is poor.
- Clinical application for precise sedation monitoring may be limited due to poor agreement.
Background:
We analyzed the values of the bispectral index (BIS) and midlatency auditory evoked potentials (MLAEP) and their correlation with the modified Ramsay score (RS) during wakefulness and natural sleep in healthy children without pharmacological sedation.
Methods:
Fifty-three healthy children younger than 2-yr-old were studied. Children were evaluated simultaneously using the modified RS, the BIS, and MLAEPs. Each patient was studied only once. The correlation and agreement were studied. The correlation among the three methods was determined using the Spearman Rank Correlation test and the agreement among the methods was assessed using by Cohen's Kappa test.
Results:
There was a moderate-to-good correlation (r) among the three methods (P = 0.01): BIS and MLAEP (r = 0.574), BIS and RS (r = -0.504), and MLAEP and RS (r = -0.624). However, the level of agreement (kappa) was only poor to fair: BIS and MLAEP (kappa = 0.392), BIS and RS (kappa = 0.270), and MLAEP and RS (kappa = 0.409). All the correlations were lower in children between 1 and 6 mo-of-age. When the children were asleep (RS: 3-5), the BIS values were higher in children younger than 1 mo-of-age than in children older than 6 mo-of-age (P after Bonferroni correction = 0.028).
Conclusions:
The BIS, MLAEP, and RS have a good correlation in children younger than 2 yr not receiving pharmacological sedation, though the level of agreement was poor.
