BIS Guided Titration of Sevoflurane in Pediatric Patients Undergoing Elective Surgery: A Randomized Controlled Trial.

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Pediatric Anesthesia Pub Date : 2025-04-01 Epub Date: 2025-01-04 DOI:10.1111/pan.15057

T Wesley Templeton, Gijo Alex, Jean D Eloy, Lindsay Stollings, Richard J Ing, Eric C Cheon, Kumar Belani, Ilan Breskin, Peter S Sebel, Brad M Taicher

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引用次数: 0

Abstract

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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BIS引导下儿科择期手术患者七氟醚滴定：一项随机对照试验。

背景：在儿科患者中，使用经过处理的脑电图监测可以在保持足够麻醉深度的同时减少麻醉剂量。目的：本研究的主要目的是评估使用BIS监测仪指导七氟醚给药是否可以降低4-18岁儿童使用的七氟醚平均终潮浓度。方法：将3个年龄组（4-8岁、9-12岁和13-18岁）的参与者随机分为BIS引导组和对照组。使用七氟醚作为主要维持麻醉剂是双臂的唯一要求。在BIS引导组中，在维持期间滴定七氟醚以达到目标BIS值45-60。在对照组中，临床医生对BIS值不知情。主要观察指标为麻醉维持期平均七氟醚潮汐末浓度。二次评估包括出院时间、准备情况和恢复质量，采用小儿麻醉紧急谵妄量表、改良Aldrete评分和Wong-Baker FACES量表进行评估。意向治疗分析用于分析和比较各组。结果：共有180名参与者被随机化。随机分组后，10名参与者未接受任何研究程序，剩下84名参与者为BIS指导组，86名参与者为对照组。在所有年龄组中，BIS引导组的平均潮末七氟醚浓度低于对照组(4-8岁：2.2%±0.3% vs. 2.4%±0.4%,-0.3% [-0.4%,-0.1%]；9 - 12年:1.7%±0.5%比2.1%±0.6%,-0.4% (-0.7%,-0.1%);13-18年:1.6%±0.4%比1.9%±0.5%、-0.3%(-0.5%,-0.1%))。治疗组间康复结果无差异。结论：在儿童参与者中，BIS引导组报告的平均潮末七氟醚浓度低于对照组，尽管在恢复情况上没有显著差异。临床意义：双谱指数（BIS）是一种经过处理的脑电图工具，可用于滴定全身麻醉以达到所需的麻醉深度。在接受全身麻醉的4-18岁儿童中，BIS脑监测结果显示七氟醚平均潮末浓度较低。试验注册：ClinicalTrials.gov标识符：NCT04810481。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Anesthesia 医学-麻醉学

CiteScore

3.20

自引率

11.80%

发文量

222

审稿时长

3-8 weeks

期刊介绍： Devoted to the dissemination of research of interest and importance to practising anesthetists everywhere, the scientific and clinical content of Pediatric Anesthesia covers a wide selection of medical disciplines in all areas relevant to paediatric anaesthesia, pain management and peri-operative medicine. The International Editorial Board is supported by the Editorial Advisory Board and a team of Senior Advisors, to ensure that the journal is publishing the best work from the front line of research in the field. The journal publishes high-quality, relevant scientific and clinical research papers, reviews, commentaries, pro-con debates, historical vignettes, correspondence, case presentations and book reviews.