Anesth Pain Med.  2022 Jan;17(1):44-51. 10.17085/apm.21065.

Verification of the performance of the Bispectral Index as a hypnotic depth indicator during dexmedetomidine sedation

• Ki S
• Lee D
• Lee W
• Cho K
• Han Y
• Lee J

• KMID: 2526526
• DOI: http://doi.org/10.17085/apm.21065

Abstract

Background
Differences in the effects of propofol and dexmedetomidine sedation on electroencephalogram patterns have been reported previously. However, the reliability of the Bispectral Index (BIS) value for assessing the sedation caused by dexmedetomidine remains debatable. The purpose of this study is to evaluate the correlation between the BIS value and the Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) scale in patients sedated with dexmedetomidine.
Methods
Forty-two patients (age range, 20–80 years) who were scheduled for elective surgery under spinal anesthesia were enrolled in this study. Spinal anesthesia was performed using 0.5% bupivacaine, which was followed by dexmedetomidine infusion (loading dose, 0.5–1 μg/kg for 10 min; maintenance dose, 0.3–0.6 μg/kg/h). The MOAA/S score was used to evaluate the level of sedation, and the Vital Recorder program was used to collect data (vital signs and BIS values).
Results
A total of 215082 MOAA/S scores and BIS data pairs were analyzed. The baseline variability of the BIS value was 7.024%, and the decrease in the BIS value was associated with a decrease in the MOAA/S score. The correlation coefficient and prediction probability between the two measurements were 0.566 (P < 0.0001) and 0.636, respectively. The mean ± standard deviation values of the BIS were 87.22 ± 7.06, 75.85 ± 9.81, and 68.29 ± 12.65 when the MOAA/S scores were 5, 3, and 1, respectively. Furthermore, the cut-off BIS values in the receiver operating characteristic analysis at MOAA/S scores of 5, 3, and 1 were 82, 79, and 73, respectively.
Conclusion
The BIS values were significantly correlated with the MOAA/S scores. Thus, the BIS along with the clinical sedation scale might prove useful in assessing the hypnotic depth of a patient during sedation with dexmedetomidine.

Keyword

Anesthesia, spinal; Consciousness monitors; Dexmedetomidine; Hypnotics and sedatives

Figure

• 

  Fig. 1. The data preparation process for analysis. (A) Original MOAA/S data, which were manually recorded, and original BIS data, which were automatically recorded by a computer, were merged based on the time recorded. (B) Example of data pairs used in the analysis. MOAA/S: Modified Observer’s Assessment of Alert/Sedation scale, BIS: bispectral index.

• 

  Fig. 2. Change in blood pressure (BP) and heart rate (HR) during the study periods, including the dexmedetomidine sedation period. (A) The period before dexmedetomidine administration (baseline). (B) During the loading dose infusion period. (C) During the maintenance dose infusion period. (D) The period after the end of the dexmedetomidine infusion. The red line represents the mean and standard deviation, and the gray point represents the value of each participant. SBP: systolic BP, DBP: diastolic BP, MBP: mean BP.

• 

  Fig. 3. The Bispectral index (BIS) value and Modified Observer’s Assessment of Alert/Sedation (MOAA/S) score. The line in the center of the box represents the median value, the whiskers indicate the 5 to 95 percentiles, and the plus sign (“+”) represents the mean value. *P < 0.05 vs. an MOAA/S score of 5; independent t-test.

• 

  Fig. 4. Receiver operating characteristic (ROC) analysis, which was obtained from the association between the MOAA/S score and the BIS value. (A) The cut-off value (up) and ROC curve (down) when the MOAA/S score was 5. (B) The cut-off value (up) and ROC curve (down) when the score was 3. (C) The cut-off value (up) and ROC curve (down) when the MOAA/S score was 1. BIS: Bispectral index, MOAA/S: Modified Observer’s Assessment of Alert/Sedation scale.

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