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The Use of Bispectral Index Monitoring Does Not Change Intraoperative Exposure to Volatile Anesthetics in Children
Cornelius A Sullivan1, Chinyere Egbuta2, Raymond S Park2
1Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Insights
Bispectral Index (BIS) monitoring did not change sevoflurane exposure in children undergoing surgery. Recovery times and agitation scores remained similar between groups, indicating no significant impact on patient outcomes.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Neuroscience
Background:
- Volatile anesthetics like sevoflurane raise concerns about long-term neurocognitive effects in children.
- Understanding factors influencing anesthetic exposure is crucial for pediatric patient safety.
Purpose of the Study:
- To investigate if Bispectral Index (BIS) monitoring affects sevoflurane delivery and exposure in pediatric patients.
- To evaluate the impact of BIS monitoring on postoperative recovery and agitation.
Main Methods:
- Prospective randomized trial involving healthy ambulatory day surgery patients aged 2-12 years.
- Two groups: one with anesthesiologists viewing BIS values, the other without.
- All patients received sevoflurane general anesthesia.
Main Results:
- No statistically significant difference in mean end-tidal sevoflurane levels between groups (1.8 in both).
- No significant differences in recovery room duration, time to discharge criteria, or Pediatric Agitation Emergence Delirium (PAED) and Face, Legs, Activity, Cry, Consolability (FLACC) scores.
- Intraoperative BIS monitoring did not alter sevoflurane administration or recovery profiles.
Conclusions:
- Intraoperative Bispectral Index (BIS) monitoring does not significantly alter sevoflurane exposure in healthy ambulatory children.
- BIS monitoring does not impact discharge readiness or the postoperative recovery profile in this pediatric population.
Abstract:
The exposure of infants and children to volatile anesthetics, such as sevoflurane, has been a topic of concern with respect to the potential risk for long term neurocognitive effects. The primary objective of this study was to determine whether the perioperative utilization of Bispectral Index (BIS) monitoring alters the sevoflurane delivery and exposure to children. This is a prospective randomized trial of two groups of healthy ambulatory day surgery patients (2 to 12 years). The patients in both groups had the BIS applied soon after the induction of general anesthesia, but only the anesthesiologists in the group randomized to BIS visible were able to see the BIS values. All of the patients received general anesthesia with sevoflurane. This study found no difference in the overall exposure to sevoflurane between both groups (mean end-tidal sevoflurane level of 1.8 in both groups, P = 084). The duration of time in the recovery room, the time to meet discharge criteria, the Pediatric Agitation Emergence Delirium (PAED) scores and the Face, Legs, Activity, Cry, Consolability (FLACC) scores were not statistically different between the groups. The application and utilization of intraoperative BIS monitoring does not alter the sevoflurane administration nor the discharge readiness nor the recovery profile in healthy ambulatory children.
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