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Lower bispectral index values in children who are intellectually disabled
Abraham J Valkenburg1, Tom G de Leeuw, Dick Tibboel
1Departments of Pediatric Surgery, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands. a.valkenburg@erasmusmc.nl
Insights
Intellectually disabled children show lower bispectral index (BIS) values during anesthesia. Anesthesiologists must be aware of this to avoid misinterpreting consciousness levels in these children.
Area of Science:
- Anesthesiology
- Neuroscience
- Pediatrics
Background:
- Limited data exist on bispectral index (BIS) monitoring in intellectually disabled children.
- Factors like epilepsy, brain pathology, or medications may affect BIS readings.
- This study addresses the lack of information on BIS use in this population.
Purpose of the Study:
- To compare BIS values at four anesthesia stages between intellectually disabled children and controls.
- To evaluate BIS's ability to differentiate consciousness states in both groups.
Main Methods:
- Included 18 intellectually disabled children and 35 controls (aged 2-13 years).
- Recorded BIS values, key anesthetic events, and vital signs.
- Assessed BIS performance using receiver operating characteristic curves.
Main Results:
- Intellectually disabled children had significantly lower BIS values in awake, intraoperative, and emergence states.
- BIS monitor showed comparable discriminative properties for consciousness between groups.
- Optimal BIS cutoff for consciousness discrimination was 28 points lower in the disabled group.
Conclusions:
- Anesthesiologists should anticipate lower BIS values in intellectually disabled children.
- There's a risk of misinterpreting consciousness due to altered BIS values.
- Further multicenter research is needed to establish optimal BIS monitoring protocols for this population.
Background:
Very few data are available on the use of bispectral index (BIS) monitoring in children who are intellectually disabled. Epileptiform electroencephalogram activity, underlying cerebral pathology, or anticonvulsant/spasmolytic therapy might influence BIS monitoring. Our aim in this exploratory study was to first compare BIS values at 4 different stages of anesthesia between intellectually disabled children and controls. Our second aim was to investigate the discriminative properties of BIS between consciousness and unconsciousness for intellectually disabled children and for controls.
Methods:
Eighteen intellectually disabled children and 35 control children, aged 2-13 yr, were included. BIS values, landmark events, and standard monitoring values of vital functions were recorded throughout the whole procedure. The performance of BIS in distinguishing between a conscious and unconscious state was assessed from receiver operating characteristic curves.
Results:
Median (interquartile range) BIS values for the intellectually disabled group were significantly lower than those for controls in the awake state (72 [48-77] vs 97 [84-98], P < 0.001), during stable intraoperative anesthesia (34 [21-45] vs 43 [33-52], P = 0.02), and during return of consciousness (59 [36-68] vs 73 [64-78], P = 0.009). The discriminative properties of the BIS monitor for the state of consciousness were comparable between the 2 groups according to the receiver operating characteristic curves. Nevertheless, the optimal cutoff BIS value for discrimination between conscious and unconscious state was 28 points lower for the intellectually disabled group.
Conclusions:
We advise anesthesiologists to be alert to possible lower BIS values in intellectually disabled children. There is a risk that they will inadvertently misinterpret the state of consciousness in intellectually disabled children. New multicenter studies must find the optimal manner of evaluating (un)consciousness in intellectually disabled patients with documented and confirmed specific etiologies of their intellectual disability.
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