Performance of BIS in children using the paediatric BIS Quattro sensor
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1Department of Anaesthesia and Pain Management, Royal Children's Hospital Melbourne, Victoria, Australia.
Insights
The Bispectral Index (BIS) monitor effectively assesses anaesthesia depth in children aged one to 13 years. BIS values below 50 reliably indicate that wakefulness is unlikely during anaesthesia emergence.
Area of Science:
- Anesthesiology
- Neuroscience
- Pediatric Medicine
Background:
- The Bispectral Index (BIS) is a widely used electroencephalogram-derived monitor for assessing anaesthesia depth.
- Previous research on BIS performance in children utilized earlier device versions, necessitating updated evaluations.
Purpose of the Study:
- To compare the performance of the BIS paediatric Quattro sensor across diverse pediatric age groups.
- To evaluate the reliability of BIS monitoring in children aged one to 13 years during anaesthesia emergence.
Main Methods:
- One hundred eighty children (one to 13 years) were enrolled.
- BIS values were recorded during emergence from anaesthesia, with wakefulness assessed concurrently.
- Children were stratified into four age groups (one-three, three-six, six-nine, nine-13 years) for analysis using receiver operating characteristic curves.
Main Results:
- Good quality BIS data was obtained from 161 children.
- Areas under the curve (AUC) for detecting wakefulness ranged from 0.80 (one-three years) to 0.95 (nine-13 years).
- No statistically significant difference in BIS performance was found across the age groups (ANOVA, P=0.26).
Conclusions:
- The BIS paediatric Quattro sensor demonstrates consistent performance in assessing anaesthesia depth across pediatric age groups from one to 13 years.
- A BIS value of 50 or greater showed 100% sensitivity for detecting wakefulness when all age groups were combined.
- Maintaining a BIS value below 50 is suggested as a reliable indicator that wakefulness is unlikely during anaesthesia emergence in children.
Abstract:
The Bispectral Index (BIS) is one of the most frequently used electroencephalogram-derived depth of anaesthesia monitors. Previous studies in children have suggested BIS performs well in older children, however these studies have used earlier versions of the BIS device. The aim of this study was to compare the performance of BIS over different age groups using the BIS paediatric Quattro sensor (Aspect Medical Systems, Norwood, MA, U.S.A.). One hundred and eighty children between one and 13 years were enrolled. At a predetermined time during emergence from anaesthesia, wakefulness was assessed and BIS recorded. For analysis, children were divided into four groups (one to three, three to six, six to nine and nine to 13 years) and for each age group a receiver operating characteristic curve was generated. Areas under the curve were compared across age groups. Good quality BIS data was available in 161 children. The areas under the curves for each age group were: one to three years 0.80, three to six years 0.88, six to nine years 0.85 and nine to 13 years 0.95. Although the area was least in the youngest age group and greatest in the oldest age group, there was no evidence for a difference when tested with ANOVA (P=0.26). When combining all age groups taking a BIS value of 50 or greater provided 100% sensitivity to detect wakefulness. This study found no evidence for any substantial difference in performance between ages one and 13 years. If BIS is used in children to detect wakefulness occurring with lightening of anaesthesia, then this study suggests that if the BIS is maintained below 50 then wakefulness is unlikely to have occurred.
