Malviya Shobha, Voepel-Lewis Terri, Tait Alan R, Watcha Mehernoor F, Sadhasivam Senthilkumar, Friesen Robert H
Section of Pediatrics, Department of Anesthesiology, University of Michigan Health Systems, F3900 Box 0211, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0211, USA.
Pediatrics. 2007 Sep;120(3):e461-70. doi: 10.1542/peds.2006-2577.
This study evaluated age- and sedative agent-related differences in bispectral index across observed sedation levels in a large sample of children < 18 years of age.
With institutional review board approval and waiver of consent, data from 4 independently conducted studies were combined in a secondary analysis of 3373 observations from 248 children aged 1 month to 18 years. In these studies, bispectral index values of sedated children were recorded in a blinded fashion, and sedation depth was scored using the University of Michigan Sedation Scale (UMSS). Bispectral index was evaluated across UMSS scores for several age groups and during use of each sedative agent (with/without opioids).
There was a moderate inverse correlation between bispectral index and UMSS for all age groups. There were significant differences in bispectral index across UMSS and between each sedation level except UMSS 3 to 4 in all the age groups and UMSS 0 to 1 in infants. The mean bispectral index and the cutoff values on the receiver-operating-characteristic curve for mild, moderate, and deep sedation were significantly lower in infants < or = 6 months compared with older children at each sedation level. Bispectral index was reasonably sensitive and specific in differentiating mild (UMSS 0-1) from deeper (UMSS 3-4) levels of sedation but poorly differentiated between moderate and deep levels of sedation in all age groups. There was a moderate correlation between bispectral index and UMSS during the use of chloral hydrate, pentobarbital, propofol, and midazolam but poor correlation during ketamine or opioid use. Bispectral index values were significantly lower during deep sedation with propofol and pentobarbital compared with midazolam and chloral hydrate.
Our findings suggest that, although bispectral index may differentiate light from deep sedation in most children, bispectral index must be interpreted cautiously in sedated children, with particular consideration given to patient age and use of sedative agents.
本研究评估了18岁以下儿童大样本中，不同年龄及镇静药物相关的脑电双频指数（bispectral index，BIS）在观察到的镇静水平上的差异。
经机构审查委员会批准并豁免知情同意书，将4项独立开展研究的数据合并，对248名年龄从1个月至18岁儿童的3373次观察结果进行二次分析。在这些研究中，以盲法记录镇静儿童的脑电双频指数值，并使用密歇根大学镇静评分量表（UMSS）对镇静深度进行评分。针对几个年龄组以及每种镇静药物（使用/未使用阿片类药物）的情况，根据UMSS评分评估脑电双频指数。
所有年龄组的脑电双频指数与UMSS之间均存在中度负相关。在所有年龄组以及婴儿的UMSS 0至1阶段，除UMSS 3至4外，各UMSS评分之间以及各镇静水平之间的脑电双频指数均存在显著差异。在每个镇静水平下，与年龄较大儿童相比，≤6个月的婴儿的平均脑电双频指数以及用于区分轻度、中度和深度镇静的受试者工作特征曲线上的临界值均显著更低。脑电双频指数在区分轻度（UMSS 0 - 1）与深度（UMSS 3 - 4）镇静水平方面具有合理的敏感性和特异性，但在所有年龄组中区分中度与深度镇静水平的能力较差。在使用水合氯醛、戊巴比妥、丙泊酚和咪达唑仑期间，脑电双频指数与UMSS之间存在中度相关性，但在使用氯胺酮或阿片类药物期间相关性较差。与咪达唑仑和水合氯醛相比，使用丙泊酚和戊巴比妥进行深度镇静时脑电双频指数值显著更低。
我们的研究结果表明，虽然脑电双频指数可能在大多数儿童中区分浅镇静与深镇静，但在镇静儿童中解读脑电双频指数时必须谨慎，尤其要考虑患者年龄和镇静药物的使用情况。
