Sciusco Alberto, Standing Joseph F, Sheng Yucheng, Raimondo Pasquale, Cinnella Gilda, Dambrosio Michele
Ospedali Riuniti, Department of Anesthesia and Intensive Care, University of Foggia, Foggia, Italy.
Institute of Child Health, University College London (UCL), London, UK.
Paediatr Anaesth. 2017 Apr;27(4):399-408. doi: 10.1111/pan.13086. Epub 2017 Feb 17.
Bispectral index (BIS) and entropy monitors have been proposed for use in children, but research has not supported their validity for infants. However, effective monitoring of young children may be even more important than for adults, to aid appropriate anesthetic dosing and reduce the chance of adverse consequences. This prospective study aimed to investigate the relationships between age and the predictive performance of BIS and entropy monitors in measuring the anesthetic drug effects within a pediatric surgery setting.
We concurrently recorded BIS and entropy (SE/RE) in 48 children aged 1 month-12 years, undergoing general anesthesia with sevoflurane and fentanyl. Nonlinear mixed effects modeling was used to characterize the concentration-response relationship independently between the three monitor indicators with sevoflurane. The model's goodness-of-fit was assessed by prediction-corrected visual predictive checks. Model fit with age was evaluated using absolute conditional individual weighted residuals (|CIWRES|). The ability of BIS and entropy monitors to describe the effect of anesthesia was compared with prediction probabilities (P ) in different age groups. Intraoperative and awakening values were compared in the age groups. The correlation between BIS and entropy was also calculated.
|CIWRES| vs age showed an increasing trend in the model's accuracy for all three indicators. P probabilities were similar for all three indicators within each age group, though lower in infants. The linear correlations between BIS and entropy in different age groups were lower for infants. Infants also tended to have lower values during surgery and at awakening than older children, while toddlers had higher values.
Performance of both monitors improves as age increases. Our results suggest a need for the development of new monitor algorithms or calibration to better account for the age-specific EEG dynamics of younger patients.
双频谱指数（BIS）监测仪和熵指数监测仪已被提议用于儿童，但研究并不支持其在婴儿中的有效性。然而，有效监测幼儿可能比监测成人更为重要，有助于合理使用麻醉药物剂量并降低出现不良后果的几率。这项前瞻性研究旨在调查在儿科手术环境中，年龄与BIS和熵指数监测仪测量麻醉药物效果的预测性能之间的关系。
我们同时记录了48名年龄在1个月至12岁之间、接受七氟醚和芬太尼全身麻醉的儿童的BIS和熵指数（SE/RE）。使用非线性混合效应模型来独立描述三种监测指标与七氟醚之间的浓度-反应关系。通过预测校正的视觉预测检查来评估模型的拟合优度。使用绝对条件个体加权残差（|CIWRES|）评估模型与年龄的拟合情况。将BIS和熵指数监测仪描述麻醉效果的能力与不同年龄组的预测概率（P）进行比较。比较各年龄组术中及苏醒时的值。还计算了BIS与熵指数之间的相关性。
|CIWRES|与年龄的关系表明，所有三种指标的模型准确性均呈上升趋势。各年龄组内所有三种指标的P概率相似，不过婴儿组的概率较低。不同年龄组中，婴儿的BIS与熵指数之间的线性相关性较低。婴儿在手术期间和苏醒时的值也往往低于大龄儿童，而学步儿童的值则较高。
随着年龄增长，两种监测仪的性能均有所提高。我们的结果表明，需要开发新的监测算法或进行校准，以更好地考虑年轻患者特定年龄的脑电图动态变化。
