Templeton T Wesley, Alex Gijo, Eloy Jean D, Stollings Lindsay, Ing Richard J, Cheon Eric C, Belani Kumar, Breskin Ilan, Sebel Peter S, Taicher Brad M
Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
UT Southwestern Medical Center, Children's Health Dallas, Dallas, Texas, USA.
Paediatr Anaesth. 2025 Apr;35(4):277-286. doi: 10.1111/pan.15057. Epub 2025 Jan 4.
In pediatric patients, the use of processed EEG monitoring may reduce the amount of anesthesia administered while maintaining adequate depth of anesthesia.
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.
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.
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.
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.
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.
ClinicalTrials.gov identifier: NCT04810481.
在儿科患者中，使用处理后的脑电图监测可能会减少麻醉药物的用量，同时维持足够的麻醉深度。
本研究的主要目的是评估使用脑电双频指数（BIS）监测仪指导七氟醚给药是否可以降低4至18岁儿童使用的平均呼气末七氟醚浓度。
将三个年龄组（4至8岁、9至12岁和13至18岁）的参与者随机分为BIS指导组或对照组。两组的唯一要求都是使用七氟醚作为主要维持麻醉剂。在BIS指导组中，在维持期将七氟醚滴定至目标BIS值为45至60。在对照组中，临床医生对BIS值不知情。主要结局是麻醉维持期的平均呼气末七氟醚浓度。次要评估包括出院时间以及通过小儿麻醉苏醒谵妄量表、改良的Aldrete评分和Wong-Baker面部表情量表评估的恢复准备情况和恢复质量。采用意向性分析来分析和比较组间差异。
共有180名参与者被随机分组。随机分组后，10名参与者未接受任何研究程序，BIS指导组剩下84名参与者，对照组剩下86名参与者。在所有年龄组中，BIS指导组的平均呼气末七氟醚浓度低于对照组（4至8岁：2.2%±0.3%对2.4%±0.4%，-0.3%[-0.4%，-0.1%]；9至12岁：1.7%±0.5%对2.1%±0.6%，-0.4%[-0.7%，-0.1%]；13至18岁：1.6%±0.4%对1.9%±0.5%，-0.3%[-0.5%，-0.1%]）。未观察到治疗组之间恢复结局的差异。
在儿科参与者中，BIS指导组报告的平均呼气末七氟醚浓度低于对照组，尽管在恢复情况方面未发现显著差异。
脑电双频指数（BIS）是一种处理后的脑电图工具，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至18岁儿童中，使用BIS进行脑监测可降低平均呼气末七氟醚浓度。
ClinicalTrials.gov标识符：NCT04810481。
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