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[Is there an appropriate bispectral index for upper gastrointestinal endoscopy in spontaneous breathing in the
F J Alados-Arboledas1, M P Millán-Bueno2, J F Expósito-Montes1
1Unidad de Cuidados Intensivos Pediátricos, UGC de Pediatría, Complejo Hospitalario de Jaén, Jaén, España.
Insights
Bispectral index (BIS) levels below 59 effectively predict successful pediatric upper gastrointestinal endoscopy (UGE) during spontaneous breathing. This finding helps optimize anesthetic depth for safer, more efficient procedures in children.
Area of Science:
- Pediatric Anesthesiology
- Gastroenterology
- Medical Device Technology
Background:
- Establishing appropriate anesthetic depth for pediatric upper gastrointestinal endoscopy (UGE) under spontaneous breathing is challenging.
- Current bispectral index (BIS) values for optimal sedation in this population are not well-defined.
Purpose of the Study:
- To determine a specific BIS level that indicates adequate anesthesia for pediatric UGE without gag reflex or motor response.
- To identify a less profound BIS level for safer spontaneous breathing during UGE in children.
Main Methods:
- A prospective study involving 61 pediatric patients (12-167 months) undergoing diagnostic UGE.
- Anesthetic protocol using propofol, with stepwise BIS level adjustments (60-69, 50-59, 45-49) until successful UGE.
- Monitoring of vital signs, Ramsay scale, and BIS values; logistic regression analysis to predict UGE success.
Main Results:
- The effective BIS level for successful UGE was 56.41±4.63.
- Propofol dose: 4.86±1.21 mg/kg; induction time: 11.07±2.69 minutes.
- No significant difference in effective BIS between younger and older children.
Conclusions:
- BIS levels below 59 are predictive of successful pediatric UGE.
- The study demonstrated 72.13% sensitivity and 88.06% specificity for BIS < 59 in predicting UGE success.
- This provides a guideline for optimizing anesthesia in pediatric spontaneous breathing endoscopy.
Objective:
The bispectral index (BIS) values that predict appropriate anesthetic level to perform an upper gastrointestinal endoscopy in spontaneous breathing are not well established in Pediatrics. The objective of this study is to determine whether it is possible to find an appropriate, less profound, BIS level in the pediatric patient that would enable an upper gastrointestinal endoscopy (UGE) to be performed in spontaneous breathing without causing gag reflex or motor response.
Material And Method:
A prospective study was designed and included 61 patients from 12-167 months old, and an ASAI-II who needed a diagnostic UGE. The study was conducted from October 2011 to March 2013.
Intervention:
UGE performed with an anesthetic protocol using propofol. The vital signs measured were heart and respiratory rate, pulse oximetry, non-invasive blood pressure. The sedation level score (Ramsay scale) and BIS values were also measured. The first attempt was performed at BIS level 60-69, and this was not feasible, then the anesthetic was deepened and a second attempt made at BIS level 50-59. If this was still not possible a deeper anesthetic level was then achieved and a third attempt made at BIS level 45-49. Variables of interest were: effective BIS level (eBIS), BIS level at which UGE was performed without gag reflex or motor response; propofol total dose (mgkg(-1)), induction time (time from onset of sedation to effective start of UGE). A logistic regression analysis was performed to obtain an equation to estimate the possibility of UGE success.
Results:
The distribution of the patient was: male 40%, female 60%, with 11 (18%) patients under 36 months. The statistical values are expressed as mean and standard deviation, with following results; age (months): 95.9±45.86; weight (kg): 30.5±14.68; effective BIS: 56.41±4.63; induction time (minutes): 11.07±2.69; total propofol dose (per kg): 4.86±1.21. An additional intra-procedure propofol bolus was given in 38 patients (62%), with 7/38 of them (18%) due to movement, and 31/38 (82%) due to BIS level increase. No statistical differences were found in effective BIS level between older and younger patients.
Conclusions:
According to the results, BIS levels below 59 predict UGE success, with 72.13% sensitivity and 88.06% specificity in the pediatric population studied.
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