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PEDIATRIC ANESTHESIA

Bispectral Index During Isoflurane Anesthesia in Pediatric Patients

Jackson-Rees Department of Anesthesia, Royal Liverpool Children’s Hospital and the Liverpool University Department of Anesthesia, United Kingdom

Address correspondence and reprint requests to Simon D. Whyte, MB, Jackson-Rees Department of Anesthesia, Royal Liverpool Children’s Hospital, Eaton Rd., Liverpool, L12 2AP, United Kingdom. Address e-mail to sdwhyte{at}bigfoot.com

Bispectral index (BIS) was developed to monitor anesthetic depth in adults, but has been investigated for use in children, using sevoflurane. We examined the concentration-response relationship between BIS and isoflurane. Thirty children undergoing cardiac catheterization received continuous intraoperative BIS monitoring and had BIS values recorded at 6 steady-state end-tidal isoflurane (Et_Iso) concentrations between 1.5% and 0.5% and at first arousal. The mean (SD) values for BIS were as follows: 1.5%, 32.3 ± 11.7; 1.3%, 34.7 ± 12.5; 1.1%, 40.5 ± 13.3; 0.9%, 48.0 ± 13.7; 0.7%, 55.9 ± 14.4; and 0.5%, 61.8 ± 13.1. There was an inverse correlation between Et_Iso and BIS (r = –0.634; P < 0.01). There were significant differences (P < 0.0001) in mean BIS values between adjacent Et_Iso in all cases except 1.5% versus 1.3%. An inhibitory sigmoid E_max model best described the BIS-isoflurane concentration relationship, with an 50% effective dose of 0.85% (95% confidence interval, 0.72%–0.98%). The mean value of BIS at first arousal was 78.5 ± 12.3. The relationship between Et_Iso and BIS is qualitatively and quantitatively similar to that described for isoflurane in adults and sevoflurane in children. These results add to the body of evidence that BIS is adequately calibrated for use in children older than 1 yr.

IMPLICATIONS: This observational study of children undergoing cardiac catheterization characterizes the concentration-response relationship between bispectral index and isoflurane and demonstrates that bispectral index seems adequately calibrated for monitoring the depth of isoflurane anesthesia in pediatric patients.

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