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The performance of Bispectral Index in children during equi-MAC halothane vs. sevoflurane anaesthesia

Published online by Cambridge University Press:  01 November 2008

T. Taivainen ,
J. Klockars ,
A. Hiller ,
J. Wennervirta ,
M. J. van Gils  and
P. Suominen
T. Taivainen*
Affiliation:
Helsinki University Hospital, Hospital for Children and Adolescents, Department of Anaesthesiology and Intensive Care Medicine, Tampere, Finland
J. Klockars
Affiliation:
Helsinki University Hospital, Hospital for Children and Adolescents, Department of Anaesthesiology and Intensive Care Medicine, Tampere, Finland
A. Hiller
Affiliation:
Helsinki University Hospital, Hospital for Children and Adolescents, Department of Anaesthesiology and Intensive Care Medicine, Tampere, Finland
J. Wennervirta
Affiliation:
Helsinki University Hospital, Division of Anaesthesiology and Intensive Care Medicine, Intensive Care Units, Helsinki, Tampere, Finland
M. J. van Gils
Affiliation:
Helsinki University Hospital, VTT Information Technology Technical Research Centre of Finland, Tampere, Finland
P. Suominen
Affiliation:
Helsinki University Hospital, Hospital for Children and Adolescents, Department of Anaesthesiology and Intensive Care Medicine, Tampere, Finland
*
Correspondence to: Tomi Taivainen, Department of Anaesthesiology and Intensive Care Medicine, Hospital for Children and Adolescents, PL 281, 00029 HUS, Finland. E-mail: [email protected]; Tel: +358 50 427 1382; Fax: +358 9 471 76711
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Summary

Background and objective

The reliability of the Bispectral Index for evaluating and monitoring the depth of general anaesthesia in children is not as great as for that in adults. Therefore we analysed Bispectral Index performance in children by comparing changes in Bispectral Index values during a standardized and equipotent anaesthetic regimen using either halothane or sevoflurane for the induction and maintenance of general anaesthesia. Special interest was focussed on excitation during induction, and whether it was associated with simultaneous changes in Bispectral Index scores.

Methods

Twenty children (3–15 yr, ASA I–II) scheduled for general surgery were randomly allocated to either halothane (10 patients) or sevoflurane group (10 patients). Anaesthesia was induced by 3% halothane or 7% sevoflurane, either agent administered with 50% N2O in oxygen for 5 min, the period from the beginning of induction until intubation. Thereafter, anaesthesia was maintained by the respective volatile agent at 1 MAC (minimum alveolar concentration; in addition to 70% N2O in oxygen) and supplemented with remifentanil infusion adjusted to maintain the heart rate and mean arterial pressure to within 20% of the baseline values. Excitation at induction was defined as involuntary muscular movements.

Results

Sevoflurane induction produced a more rapid depression in Bispectral Index than halothane, the mean difference being greatest (47 Bispectral Index score) at 105 s. Excitation occurred in three patients during sevoflurane induction, which coincided with increases in Bispectral Index values in two of the three patients. During the maintenance phase at 1 MAC, the Bispectral Index (mean ± SD) was 57±7 for halothane and 47±9 for sevoflurane (P < 0.05). The remifentanil doses did not differ between both groups.

Conclusion

In children, halothane anaesthesia was associated with higher Bispectral Index values than sevoflurane when administered at 1 MAC. Large individual variation in Bispectral Index occurred within both groups. Due to these limitations, one should be cautious when interpreting paediatric Bispectral Index data.

Keywords

ANAESTHESIA INHALATIONALCHILDCHILD PRESCHOOLHALOTHANESEVOFLURANEBISPECTRAL INDEX
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 11 , November 2008 , pp. 933 - 939
Copyright
Copyright © European Society of Anaesthesiology 2008

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References

1.Denman, WT, Swanson, EL, Rosow, W, Ezbicki, K, Connors, P, Rosow, CE. Pediatric evaluation of the bispectral index (BIS) Monitor and correlation of BIS with end-tidal sevoflurane concentration in infants and children. Anesth Analg 2000; 90: 872–877.CrossRefGoogle ScholarPubMed
2.McCann, ME, Bacsik, J, Davidson, A, Auble, S, Sullivan, L, Laussen, P. The correlation of bispectral index with end-tidal sevoflurane concentration and haemodynamic parameters in preschoolers. Paediatr Anaesth 2002; 12: 519–525.CrossRefGoogle Scholar
3.Davidson, AJ, Huang, GH, Rebmann, CS, Ellery, C. Performance of entropy and bispectral index as measures of anaesthesia effect in children of different ages. Br J Anaesth 2005; 95: 674–679.CrossRefGoogle ScholarPubMed
4.Klockars, JGM, Hiller, A, Ranta, S, Talja, P, van Gils, MJ, Taivainen, T. Spectral entropy as a measure of hypnosis in children. Anesthesiology 2006; 104: 708–717.Google Scholar
5.Kim, HS, Oh, AY, Kim, CS, Kim, SD, Seo, KS, Kim, JH. Correlation of bispectral index with end-tidal sevoflurane concentration and age in infants and children. Br J Anaesth 2005; 95: 362–366.Google Scholar
6.Wodey, E, Tirel, O, Bansard, JY et al. Impact of age on both BIS values and EEG bispectrum during anaesthesia with sevoflurane. Br J Anaesth 2005; 94: 810–820.CrossRefGoogle ScholarPubMed
7.Kern, D, Fourcade, O, Maxoit, J-X et al. The relationship between bispectral index and endtidal concentration of sevoflurane during anesthesia and recovery in spontaneously ventilating children. Paediatr Anaesth 2007; 17: 249–254.Google Scholar
8.Lerman, J. Inhalation agents in pediatric anaesthesia – an update. Curr Opin Anaesthesiol 2007; 20: 221–226.Google Scholar
9.Morray, JP, Geiduschek, J, Ramamoorthy, C et al. Anesthesia-related cardiac arrest in children: Initial findings of the pediatric perioperative cardiac arrest (POCA) registry. Anesthesiology 2000; 93: 6–14.CrossRefGoogle ScholarPubMed
10.Constant, I, Leport, Y, Richard, P, Moutard, M-L, Murat, I. Agitation and changes of Bispectral Index™ and electroencephalographic-derived variables during sevoflurane induction in children: clonidine premedication reduces agitation compared with midazolam. Br J Anaesth 2004; 92: 504–511.Google Scholar
11.Sarner, JB, Levine, M, Davis, P et al. Clinical characteristics of sevoflurane in children: a comparison with halothane. Anesthesiology 1995; 82: 38–46.CrossRefGoogle ScholarPubMed
12.Constant, I, Dubois, M-C, Piat, V, Moutard, M-L, McCue, M, Murat, I. Changes in electroencephalogram and autonomic cardiovascular activity during induction of anesthesia with sevoflurane compared with halothane in children. Anesthesiology 1999; 91: 1604–1615.CrossRefGoogle ScholarPubMed
13.Haga, S, Shima, T, Momose, K, Andoh, K, Hashimoto, Y. Anesthetic induction of children with high concentrations of sevoflurane. Masui 1992; 41: 1951–1955.Google Scholar
14.Adachi, M, Ikemoto, Y, Kubo, K, Takuma, C. Seizure-like movements during induction of anaesthesia with sevoflurane. Br J Anaesth 1992; 68: 214–215.Google Scholar
15.Gregory, GA, Eger, EIII, Munson, ES. The relationship between age and halothane requirements in humans. Anesthesiology 1969; 30: 488–491.Google Scholar
16.Lerman, J, Sikich, N, Kleinman, S, Yentis, S. The pharmacology of sevoflurane in infants and children. Anesthesiology 1994; 80: 814–824.Google Scholar
17.Meakin, GH, Meretoja, OA, Perkins, R et al. Tracheal intubating conditions and pharmacodynamics following cisatracurium in infants and children undergoing halothane and thiopental-fentanyl anesthesia. Paediatr Anaesth 2007; 17: 113–120.Google Scholar
18.Brice, DD, Hetherington, RR, Utting, JE. A simple study of awareness and dreaming during anaesthesia. Br J Anaesth 1970; 42: 535–542.Google Scholar
19.Edwards, JJ, Soto, RG, Bedford, RF. Bispectral Index™ values are higher during halothane vs. sevoflurane anesthesia in children, but not in infants. Acta Anaesthesiol Scand 2005; 49: 1084–1087.CrossRefGoogle Scholar
20.Niedermeyer, E. Maturation of the EEG: development of waking and sleep patterns, electroencephalography. In: Niedermeyer, E, Lopes da Silva, F, eds. Basic Principles, Clinical Applications and Related Fields, 2nd edn. Urban & Schwarzenberg: Munich-Baltimore, 1987: 133–158.Google Scholar
21.Davidson, AJ, Czarnecki, C. The bispectral index in children: comparing isoflurane and halothane. Br J Anaesth 2004; 92: 14–17.Google Scholar
22.Tirel, O, Wodey, E, Harris, R, Bansard, JY, Ecoffey, C, Senhadji, L. The impact of age on bispectral index values and EEG bispectrum during anaesthesia with desflurane and halothane in children. Br J Anaesth 2006; 96: 480–485.CrossRefGoogle ScholarPubMed