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BIS Guided Titration of Sevoflurane in Pediatric Patients Undergoing Elective Surgery: A Randomized Controlled Trial
T Wesley Templeton1, Gijo Alex2, Jean D Eloy3
1Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Insights
Bispectral Index (BIS) monitoring in children 4-18 years old reduced sevoflurane use during anesthesia. While BIS guidance lowered anesthetic concentration, it did not significantly alter recovery times or quality.
Area of Science:
- Anesthesiology
- Neuroscience
- Pediatric Medicine
Background:
- Processed electroencephalogram (EEG) monitoring, such as the Bispectral Index (BIS), may optimize anesthesia administration in pediatric patients.
- Utilizing BIS monitoring could potentially reduce the overall amount of anesthetic agents required while ensuring adequate anesthetic depth.
- This study investigates the efficacy of BIS monitoring in guiding sevoflurane administration in children.
Purpose of the Study:
- To evaluate if using a BIS monitor to guide sevoflurane administration reduces the average end-tidal sevoflurane concentration in pediatric patients aged 4-18 years.
- To compare anesthetic requirements and recovery profiles between BIS-guided and standard anesthesia care in children.
Main Methods:
- Pediatric patients aged 4-18 years were randomized into two groups: BIS-guided anesthesia and a control group.
- Sevoflurane was the primary maintenance anesthetic; the BIS-guided group targeted a BIS value of 45-60, while the control group was blinded to BIS values.
- The primary outcome was the mean end-tidal sevoflurane concentration; secondary outcomes included recovery assessments (time to discharge, readiness, and quality).
Main Results:
- A total of 180 participants were randomized, with 84 in the BIS group and 86 in the control group.
- The BIS-guided group demonstrated a lower average end-tidal sevoflurane concentration across all age groups compared to the control group.
- No significant differences were observed in recovery outcomes, including time to discharge, readiness, or quality of recovery, between the two groups.
Conclusions:
- BIS-guided anesthesia resulted in a lower average end-tidal sevoflurane concentration in pediatric patients compared to standard care.
- Despite reduced sevoflurane use, BIS monitoring did not lead to significant differences in the recovery profile of pediatric patients.
- The Bispectral Index is a valuable tool for titrating general anesthesia and optimizing sevoflurane administration in children.
Background:
In pediatric patients, the use of processed EEG monitoring may reduce the amount of anesthesia administered while maintaining adequate depth of anesthesia.
Aims:
The primary aim of this study was to evaluate whether use of a BIS monitor to guide sevoflurane administration might reduce the average end tidal sevoflurane concentration used in children 4-18 years of age.
Methods:
Participants in three age groups (4-8, 9-12, and 13-18 years) were randomized to either the BIS guided group or the control group. Use of sevoflurane as the primary maintenance anesthetic was the only requirement in both arms. In the BIS guided group, sevoflurane was titrated to achieve a target BIS value of 45-60 during the maintenance period. In the control arm, clinicians were blinded to the BIS value. Primary outcome was mean end-tidal sevoflurane concentration during maintenance phase of anesthesia. Secondary assessments included time to discharge and the readiness and quality of recovery as assessed by the Pediatric Anesthesia Emergence Delirium scale, the modified Aldrete Score, and the Wong-Baker FACES scale. An intention-to-treat analysis was used to analyze and compare groups.
Results:
A total of 180 participants were randomized. Following randomization, 10 participants did not undergo any study procedures, leaving 84 participants in the BIS guided group and 86 participants in the control group. Across all age groups, the average end-tidal sevoflurane concentration was less in the BIS guided group compared to control (4-8 years: 2.2% ± 0.3% vs. 2.4% ± 0.4%, -0.3% [-0.4%, -0.1%]; 9-12 years: 1.7% ± 0.5% vs. 2.1% ± 0.6%, -0.4% [-0.7%, -0.1%]; 13-18 years: 1.6% ± 0.4% vs. 1.9% ± 0.5%, -0.3% [-0.5%, -0.1%]). No differences in recovery outcomes between treatment groups were observed.
Conclusions:
In pediatric participants, the BIS guided group reported a lower average end-tidal sevoflurane concentration compared to control, though no significant differences in recovery profile were noted.
Clinical Implications:
The Bispectral Index (BIS) is a processed EEG tool that can be used to titrate general anesthesia to achieve desired anesthetic depth. Brain monitoring with BIS resulted in lower average end-tidal sevoflurane concentrations in children aged 4-18 years undergoing general anesthesia.
Trial Registration:
ClinicalTrials.gov identifier: NCT04810481.
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