Abstract
The exposure of infants and children to volatile anesthetics, such as sevoflurane, has been a topic of concern with respect to the potential risk for long term neurocognitive effects. The primary objective of this study was to determine whether the perioperative utilization of Bispectral Index (BIS) monitoring alters the sevoflurane delivery and exposure to children. This is a prospective randomized trial of two groups of healthy ambulatory day surgery patients (2 to 12 years). The patients in both groups had the BIS applied soon after the induction of general anesthesia, but only the anesthesiologists in the group randomized to BIS visible were able to see the BIS values. All of the patients received general anesthesia with sevoflurane. This study found no difference in the overall exposure to sevoflurane between both groups (mean end-tidal sevoflurane level of 1.8 in both groups, P = 084). The duration of time in the recovery room, the time to meet discharge criteria, the Pediatric Agitation Emergence Delirium (PAED) scores and the Face, Legs, Activity, Cry, Consolability (FLACC) scores were not statistically different between the groups. The application and utilization of intraoperative BIS monitoring does not alter the sevoflurane administration nor the discharge readiness nor the recovery profile in healthy ambulatory children.
Highlights
There is considerable interest and some concern over the potential risk of general anesthesia, volatile anesthetics in particular, on the developing brain [1,2,3,4]
The use of intraoperative Bispectral Index Monitor (BIS) monitoring for pediatric anesthesia is not a standard of care and is largely based on clinician preference
There is no consensus on the value of the BIS from studies which have examined its usefulness in the pediatric population
Summary
There is considerable interest and some concern over the potential risk of general anesthesia, volatile anesthetics in particular, on the developing brain [1,2,3,4]. This potential for neurocognitive effects led the Food and Drug Administration (FDA) to release a Safety Statement in 2017, approving label changes for general anesthetics in young children. The Bispectral Index Monitor (BIS) is a non-invasive monitor that translates electroencephalographic data from an adhesive applied to the forehead to numerical values. Various studies have been conducted to assess whether BIS monitoring can offer a reliable, objective evaluation of anesthetic depth in children, but to date, the results are inconclusive [6,7,8,9]
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