The Influence of BIS Monitoring on Sedative Dose in Pediatric Patients Undergoing Open Muscle Biopsies – a Randomized Controlled Trial

Abstract

Background The use of Propofol and Remifentanil for analgosedation in children is common and safe. For sedation monitoring clinical scores as Comfort Score (CS) as well as bispectral index (BIS) are frequently applied. The impact of BIS for sedation monitoring in pediatric patients is still under debate. This prospective study aims to investigate whether dual sedation monitoring of CS and BIS compared with monitoring of CS alone during muscle biopsies in children can reduce sedative doses, reduce awakening time and prevent complications.

Methods 50 pediatric patients requiring sedation for open muscle biopsy were prospectively enrolled. Analgosedation was performed with remifentanil and propofol. Patients were randomly assigned to 2 groups: In 25 patients, sedation was monitored using CS alone, and in 25 patients CS and BIS monitoring were simultaneously applied. The primary outcome was the propofol dose applied during muscle biopsy. Secondary outcome parameters were recovery time and the frequency of complications.

Results The median CS during the intervention in both groups was equal (11, P=1.000). The median BIS in group 2 was 59. No complications occurred in either group. There was no difference in propofol dose in either group (8.4 vs. 7.2 mg/kg/h; P=0.58) and no difference in the duration until eye opening (9 vs. 11 min; P=0.081).

Conclusion For children undergoing minor surgical procedures under analgosedation, BIS monitoring does not affect the sedative dose, the time until eye opening or the frequency of complications.

Zusammenfassung

Hintergrund Zur Analgosedierung von Kindern hat sich eine Medikamentenkombination aus Propofol und Remifentanil bewährt. Zum Sedierungsmonitoring sind sowohl klinische Scores wie der Comfort Score (CS) als auch der bispektrale Index (BIS) üblich. Die Bedeutung von BIS zum Sedierungsmonitoring bei Kindern ist nach wie vor nicht eindeutig und Gegenstand wissenschaftlicher Diskussionen. Ziel der vorliegenden prospektiven Studie ist es zu untersuchen, ob bei pädiatrischen Patienten das kombinierte Sedierungsmonitoring mit CS und BIS verglichen mit einem alleinigen Monitoring mittels CS während offener Muskelbiopsien zu einer Reduktion der Sedativadosis, einer verkürzten Aufwachzeit und einer Reduktion der Häufigkeit von Komplikationen führt.

Methoden 50 pädiatrische Patienten, die während offener Muskelbiopsien Propofol und Remifentanil zur Analgosedierung erhielten, wurden untersucht und dazu in 2 Gruppen randomisiert: Bei 25 Patienten wurde die Analgosedierung mittels CS allein, bei 25 mittels CS und zusätzlichem BIS Monitoring überwacht. Primärer Outcome Parameter war die benötigte Propofoldosis während des Eingriffs. Sekundäre outcome parameter waren Aufwachzeit und Häufigkeit von Komplikationen.

Ergebnisse Der mediane CS während des Eingriffs war in beiden Gruppen gleich (11, P=1,000). Der mediane BIS in Gruppe 2 war 59. In beiden Gruppen kam es zu keinerlei Komplikationen. Es gab keinen Unterschied in der applizierten Propofoldosis (8,4 vs. 7,2 mg/kg/h; P=0,081) und in der Aufwachzeit zwischen beiden Gruppen (9 vs. 11 min; P=0,081).

Schlussfolgerung Für die Analgosedierung während kleiner chirurgischer Eingriffe bei pädiatrischen Patienten hat das zusätzliche Sedierungsmonitoring mittels BIS keinen Einfluss auf die verwendete Sedativadosis, die Aufwachzeit oder die Häufigkeit von Komplikationen.

Key words

sedation monitoring - pediatric - bispectral index - comfort score - muscle biopsy

Schlüsselwörter

Sedierungsmonitoring - pädiatrisch - bispektraler Index - Comfort Score - Muskelbiopsie

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