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PEDIATRIC ANESTHESIA

A Comparison of Observational and Objective Measures to Differentiate Depth of Sedation in Children from Birth to 18 Years of Age

Department of Anesthesiology, Section of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan Medical Center, Ann Arbor, Michigan

Address correspondence and reprint requests to Shobha Malviya, MD, Department of Anesthesiology, Section of Pediatrics, F3900/Box 0211, C.S. Mott Children’s Hospital, University of Michigan Medical Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109–0211. Address e-mail to smalviya{at}umich.edu.

Several observational and objective methods are available to assess sedation depth; however, data regarding their accuracy in differentiating deep sedation are limited. In this study we compared 3 sedation tools in children from birth to 18 yr of age and determined their relative value in detecting deep levels of sedation. Bispectral index monitoring (BIS®), Modified Maintenance of Wakefulness Tests (MMWT), and the University of Michigan Sedation Scale (UMSS) were used to assess sedation. Three-hundred-twenty-seven observations were recorded in 39 children. The overall validity of each measure was supported by appropriate changes after sedation administration through the observation period. There were moderate to high correlations between UMSS and BIS (rho = –0.73) and UMSS and MMWT (rho = –0.59; P < 0.01). The correlation between BIS and MMWT was significant but low (r = 0.36; P < 0.01). Measures of exact agreement supported the reliability of the UMSS and MMWT across the sedation continuum. There were significant decreases in BIS across UMSS scores except from scores 2–3. ROC curves suggested that BIS 80 and MMWT 14 min were most sensitive in delineating deep sedation. Our findings demonstrate the overall validity of these observational and objective measures of sedation depth in children <18 yr of age but show ongoing limitations distinguishing moderate from deep sedation.

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