Korean J Anesthesiol.  2019 Dec;72(6):592-598. 10.4097/kja.19129.

Validity of bispectral index monitoring during deep sedation in children with spastic cerebral palsy undergoing injection of botulinum toxin

• Jung SM
• Lee E
• Park SJ

• KMID: 2465729
• DOI: http://doi.org/10.4097/kja.19129

Abstract

BACKGROUND
This prospective study aimed to determine whether the bispectral index (BIS) is a valid objective tool for differentiating adequate from inadequate deep sedation in spontaneously breathing children with cerebral palsy (CP).
METHODS
Propofol was titrated to increase the level of sedation with a continuous infusion of remifentanil at a rate of 0.05 μg/kg/min while maintaining spontaneous ventilation in 22 children with spastic CP, aged 3-18 years. The depth of sedation was assessed using the University of Michigan Sedation Scale (UMSS) and the Modified Observer's Assessment of Alertness and Sedation (MOAAS) scale. Receiver operating characteristic curve analysis was performed to determine the cutoff BIS values for deep sedation, defined as a UMSS score of 3-4 and a MOAAS score of 0-1.
RESULTS
The BIS values significantly changed with the increase in the level of sedation across both the UMSS and MOAAS scores (P < 0.001). The BIS values correlated with the UMSS (r = −0.795, P < 0.001) and MOAAS (r = 0.815, P < 0.001) scores. The cutoff BIS value to detect adequate deep sedation in children with CP was 61.5 (UMSS score: sensitivity 0.860, specificity 0.814; MOAAS score: sensitivity 0.794, specificity 0.811).
CONCLUSIONS
The BIS value strongly correlates with the clinical sedation scales, such as the UMSS and MOAAS, during deep sedation in children with CP. Therefore, BIS monitoring can be used as a valid tool for assessing the level of propofol sedation in spontaneously breathing children with CP undergoing a botulinum toxin injection.

Keyword

Botulinum toxins; Cerebral palsy; Consciousness monitor; Deep sedation; Pediatric; Propofol

MeSH Terms

Botulinum Toxins*
Cerebral Palsy*
Child*
Consciousness Monitors*
Deep Sedation*
Humans
Michigan
Muscle Spasticity*
Propofol
Prospective Studies
Respiration
ROC Curve
Sensitivity and Specificity
Ventilation
Weights and Measures
Botulinum Toxins
Propofol