Correlation between bispectral index, end-tidal anaesthetic gas concentration and difference in inspired–end-tidal oxygen concentration as measures of anaesthetic depth in paediatric patients posted for short surgical procedures

Bispectral index (BIS) is used for monitoring anaesthetic depth with inhaled anaesthetic agents in the operating room but has not been evaluated as a monitor of sedation depth in the intensive care unit (ICU) setting with these agents. If BIS could predict sedation depth in ICU patients, patient disturbances could be reduced and oversedation avoided. Twenty ventilator-dependent ICU patients aged 27 to 80 years were randomised to sedation with isoflurane via the AnaConDa® or intravenous midazolam. BIS (A-2000 XP, version 3.12), electromyogram activity (EMG) and Signal Quality Index were measured continuously. Hourly clinical evaluation of sedation depth according to Bloomsbury Sedation Score (Bloomsbury) was performed. The median BIS value during a 10-minute interval prior to the clinical evaluation at the bedside was compared with Bloomsbury. Nurses performing the clinical sedation scoring were blinded to the BIS values. End-tidal isoflurane concentration was measured and compared with Bloomsbury. Correlation was poor between BIS and Bloomsbury in both groups (Spearman's rho 0.012 in the isoflurane group and -0.057 in the midazolam group). Strong correlation was found between BIS and EMG (Spearman's rho 0.74). Significant correlation was found between end-tidal isoflurane concentration and Bloomsbury (Spearman's rho 0.47). In conclusion, BIS XP does not reliably predict sedation depth as measured by clinical evaluation in non-paralysed ICU patients sedated with isoflurane or midazolam. EMG contributes significantly to BIS values in isoflurane or midazolam sedated, non-paralysed ICU patients. End-tidal isoflurane concentration appeared to be a better indicator of clinical sedation depth than BIS.

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Effects of education of paediatric patients undergoing elective surgical procedures on their anxiety - a systematic review

Journal of Clinical Nursing ◽

10.1111/jocn.12187 ◽

2013 ◽

Vol 23 (7-8) ◽

pp. 940-954 ◽

Cited By ~ 23

Author(s):

Panagiota Copanitsanou ◽

Kirsi Valkeapää

Keyword(s):

Systematic Review ◽

Surgical Procedures ◽

Elective Surgical Procedures ◽

Paediatric Patients

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Re-formation of absent anterior chamber by iris incision using a 20-gauge knife in eyes with advanced paediatric vitreoretinopathies

10.21203/rs.2.13586/v1 ◽

2019 ◽

Author(s):

Chunli Chen ◽

Tian Tian ◽

Peiquan Zhao ◽

Xiaorong Li

Keyword(s):

Postoperative Complications ◽

Prospective Study ◽

Anterior Chamber ◽

Surgical Procedures ◽

The Novel ◽

Paediatric Patients ◽

Initial Episode

Abstract Background To present the novel usage of iris incision in paediatric patients lacking an anterior chamber due to various advanced vitreoretinopathies.Methods Forty-one patients (41 eyes) were enrolled in this consecutive, prospective study. Iris incision was performed in all patients. The number of iris incision times, surgical procedures, and intraoperative and postoperative complications were collected. Patients were followed up for at least 6 months.Results Anterior chamber formation was achieved with only 1 initial episode of iris incision in 28 (68.3%) eyes, with 2 episodes in 11 (26.8%) eyes, and with 3 episodes in the remaining 2 (4.9%) eyes, which also underwent 1 episode of external SRF drainage. Except for iris incarceration, which occurred in 7 (17%) of the eyes during surgery, no other related complications were noted at the last follow-up.Conclusions This novel use of iris incision is effective, simple and safe in the management of an lost anterior chamber.

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Oxygen Flow, Inhalant Oxygen Concentration and CO_2 Gas Concentration in Mask at Oxygen Therapy

JAPANES JOURNAL OF MEDICAL INSTRUMENTATION ◽

10.4286/ikakikaigaku.46.1_17 ◽

1976 ◽

Vol 46 (1) ◽

pp. 17-24

Author(s):

T. MINOBE

Keyword(s):

Oxygen Concentration ◽

Oxygen Therapy ◽

Oxygen Flow ◽

Gas Concentration

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The Use of Bispectral Index Monitoring Does Not Change Intraoperative Exposure to Volatile Anesthetics in Children

Journal of Clinical Medicine ◽

10.3390/jcm9082437 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2437

Author(s):

Cornelius A. Sullivan ◽

Chinyere Egbuta ◽

Raymond S. Park ◽

Karina Lukovits ◽

David Cavanaugh ◽

...

Keyword(s):

General Anesthesia ◽

Bispectral Index ◽

Volatile Anesthetics ◽

Day Surgery ◽

Primary Objective ◽

Recovery Profile ◽

The Face ◽

End Tidal ◽

Discharge Criteria

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.

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Evaluation of estimates of alveolar gas exchange by using a tidally ventilated nonhomogenous lung model

Journal of Applied Physiology ◽

10.1152/jappl.1997.82.6.1963 ◽

1997 ◽

Vol 82 (6) ◽

pp. 1963-1971 ◽

Cited By ~ 18

Author(s):

Thierry Busso ◽

Peter A. Robbins

Keyword(s):

Gas Exchange ◽

Lung Model ◽

Gas Composition ◽

Breathing Patterns ◽

Alveolar Volume ◽

Gas Concentration ◽

Pulmonary Capillaries ◽

Partial Pressures ◽

End Tidal ◽

Alveolar Gas Exchange

Busso, Thierry, and Peter A. Robbins. Evaluation of estimates of alveolar gas exchange by using a tidally ventilated nonhomogenous lung model. J. Appl. Physiol. 82(6): 1963–1971, 1997.—The purpose of this study was to evaluate algorithms for estimating O2 and CO2 transfer at the pulmonary capillaries by use of a nine-compartment tidally ventilated lung model that incorporated inhomogeneities in ventilation-to-volume and ventilation-to-perfusion ratios. Breath-to-breath O2 and CO2 exchange at the capillary level and at the mouth were simulated by using realistic cyclical breathing patterns to drive the model, derived from 40-min recordings in six resting subjects. The SD of the breath-by-breath gas exchange at the mouth around the value at the pulmonary capillaries was 59.7 ± 25.5% for O2 and 22.3 ± 10.4% for CO2. Algorithms including corrections for changes in alveolar volume and for changes in alveolar gas composition improved the estimates of pulmonary exchange, reducing the SD to 20.8 ± 10.4% for O2 and 15.2 ± 5.8% for CO2. The remaining imprecision of the estimates arose almost entirely from using end-tidal measurements to estimate the breath-to-breath changes in end-expiratory alveolar gas concentration. The results led us to suggest an alternative method that does not use changes in end-tidal partial pressures as explicit estimates of the changes in alveolar gas concentration. The proposed method yielded significant improvements in estimation for the model data of this study.

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