Skin lesions associated with BIS monitoring in pediatric patients undergoing cardiac surgery

Abstract

To the Editor: The appearance of skin lesions at the attachment site of the bispectral index (BIS) sensor (Aspect Medical Systems, Newton, MA) was reported in an adult patient undergoing general anesthesia [1]. The Zipprep technology (Aspect Medical Systems; compatible with Ag–AgCI electrodes printed on a polyester substrate with adhesive foam backing) is currently used for BIS sensors. Although skin lesions at the attachment site of the BIS pediatric sensor frequently occur, occasionally remaining for a long time in pediatric patients undergoing general anesthesia, we recently reported blisters, another type of skin lesion, at the site where the adhesive part around the central electrode of the BIS sensor was attached [2]. Because we use BIS monitoring to detect cerebral ischemia in pediatric patients undergoing cardiac surgery [3], we designed a prospective observational study to investigate the incidence of skin lesions associated with use of the BIS sensor in pediatric patients undergoing cardiac surgery at our hospital between February and June 2009. Approval of the Ethics Committee of our hospital was obtained. We defined skin lesions associated with the BIS sensor as punctiform redness with or without tiny bleeding spots corresponding with electrode tines observed immediately after the removal of the BIS sensor and up to at least 24 h thereafter. Skin lesions associated with the BIS sensor (Fig. 1) were observed in 11 (median age 7 months old; age range 2–46 months; 3 ventricular septal defect closures, 3 atrio-ventricular septal defect radical operations, 2 bidirectional Glenn procedures, 1 total cavo-pulmonary connection, 1 Rastelli operation, 1 modified Blalock–Taussig operation) of 15 pediatric patients undergoing cardiac surgery while BIS monitoring was used. In contrast, no skin lesions were observed in 787 adult patients in whom BIS monitoring was used during the same period. Skin lesions healed within 3 days in five of the pediatric patients and within 7 days in three patients post-surgery, but lasted for about 10 days post-surgery in three very young pediatric patients: a 2-month-old infant (height