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Efficacy of the bispectral index and Observer's Assessment of Alertness/Sedation Scale in monitoring sedation during spinal anesthesia: A randomized clinical trial.

ABSTRACT: OBJECTIVE:The bispectral index (BIS) has been used to monitor sedation during spinal anesthesia. We evaluated the correlation between BIS and the Observer's Assessment of Alertness/Sedation Scale (OAA/S) in patients sedated with dexmedetomidine, propofol, or midazolam. METHODS:This prospective, randomized study included 46 patients scheduled for knee arthroplasty under spinal anesthesia with sedation. The patients were randomized to receive sedation with dexmedetomidine (n?=?15), propofol (n?=?15), or midazolam (n?=?16). Correlation between BIS and OAA/S was assessed during sedation in the three groups. RESULTS:A linear correlation was observed between BIS and OAA/S, and there was no significant difference in BIS score between the groups during mild to moderate sedation status (OAA/S 3-5). During deep sedation (OAA/S 1-2), the BIS score in the midazolam group was significantly higher than that in the propofol and dexmedetomidine groups (74.4?±?11.9 vs 67.7?±? 9.5 vs 62.6?±?12.2). CONCLUSIONS:BIS values differed at the same level of sedation between different sedative agents. Objective sedation scores should therefore be used in combination with BIS values for the assessment of sedation levels during spinal anesthesia.

SUBMITTER: Lim TW

PROVIDER: S-EPMC7607532 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Efficacy of the bispectral index and Observer's Assessment of Alertness/Sedation Scale in monitoring sedation during spinal anesthesia: A randomized clinical trial.

Lim Tae Wan TW Choi Yi Hwa YH Kim Jong Yeop JY Choi Jong Bum JB Lee Soo Kyung SK Youn Eun Ji EJ Lee Jun Suck JS

The Journal of international medical research 20191225 4

<h4>Objective</h4>The bispectral index (BIS) has been used to monitor sedation during spinal anesthesia. We evaluated the correlation between BIS and the Observer's Assessment of Alertness/Sedation Scale (OAA/S) in patients sedated with dexmedetomidine, propofol, or midazolam.<h4>Methods</h4>This prospective, randomized study included 46 patients scheduled for knee arthroplasty under spinal anesthesia with sedation. The patients were randomized to receive sedation with dexmedetomidine (n = 15), ...[more]

PMID: 31875756

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Project description:BackgroundReducing depth of anesthesia and anesthetic exposure may help prevent delirium, but trials have been conflicting. Most studies were conducted under general anesthesia or in cognitively impaired patients. It is unclear whether reducing depth of anesthesia beyond levels consistent with general anesthesia reduces delirium in cognitively intact patients. The authors' objective was to determine whether a bundled approach to reduce anesthetic agent exposure as determined by Bispectral Index (BIS) values (spinal anesthesia with targeted sedation based on BIS values) compared with general anesthesia (masked BIS) reduces delirium.MethodsImportant eligibility criteria for this parallel-arm randomized trial were patients 65 yr or greater undergoing lumbar spine fusion. The intervention group received spinal anesthesia with targeted sedation to BIS greater than 60 to 70. The control group received general anesthesia (masked BIS). The primary outcome was delirium using the Confusion Assessment Method daily through postoperative day 3, with blinded assessment.ResultsThe median age of 217 patients in the analysis was 72 (interquartile range, 69 to 77). The median BIS value in the spinal anesthesia with targeted sedation based on BIS values group was 62 (interquartile range, 53 to 70) and in the general anesthesia with masked BIS values group was 45 (interquartile range, 41 to 50; P < 0.001). Incident delirium was not different in the spinal anesthesia with targeted sedation based on BIS values group (25.2% [28 of 111] vs. the general anesthesia with masked BIS values group (18.9% [20 of 106]; P = 0.259; relative risk, 1.22 [95% CI, 0.85 to 1.76]). In prespecified subgroup analyses, the effect of anesthetic strategy differed according to the Mini-Mental State Examination, but not the Charlson Comorbidity Index or age. Two strokes occurred among patients receiving spinal anesthesia and one death among patients receiving general anesthesia.ConclusionsSpinal anesthesia with targeted sedation based on BIS values compared with general anesthesia with masked BIS values did not reduce delirium after lumbar fusion.Editor’s perspective

Project description:BACKGROUND:It is unknown to what extent hypotension frequently observed following administration of propofol for induction of general anesthesia is caused by overdosing propofol. Unlike clinical signs, electroencephalon-based cerebral monitoring allows to detect and quantify an overdose of hypnotics. Therefore, we tested whether the use of an electroencephalon-based cerebral monitoring will cause less hypotension following induction with propofol. METHODS:Subjects were randomly assigned to a bispectral index (BIS)-guided (target range 40-60) or to a weight-related (2 mg.kg-?1) manual administration of propofol for induction of general anesthesia. The primary endpoint was the incidence of hypotension following the administration of propofol. Secondary endpoints included the degree of hypotension and correlations between BIS and drop in mean arterial pressure (MAP). Incidences were analyzed with Fisher's Exact-test. RESULTS:Of the 240 patients enrolled into this study, 235 predominantly non-geriatric (median 48 years, 25th - 75th percentile 35-61 years) patients without severe concomitant disease (88% American Society of Anesthesiology physical status 1-2) undergoing ear, nose and throat surgery, ophthalmic surgery, and dermatologic surgery were analyzed. Patients who were manually administered propofol guided by BIS (n?=?120) compared to those who were given propofol by weight (n?=?115) did not differ concerning the incidence of hypotension (44% vs. 45%; p?=?0.87). Study groups were also similar regarding the maximal drop in MAP compared to baseline (33% vs. 30%) and the proportion of hypotensive events related to all measurements (17% vs. 19%). Final propofol induction doses in BIS group and NON-BIS group were similar (1.93 mg/kg vs. 2 mg/kg). There was no linear correlation between BIS and the drop in MAP at all times (r?<?0.2 for all) except for a weak one at 6 min (r?=?0.221). CONCLUSION:Results of our study suggest that a BIS-guided compared to a weight-adjusted manual administration of propofol for induction of general anesthesia in non-geriatric patients will not lower the incidence and degree of arterial hypotension. TRIAL REGISTRATION:German Registry of Clinical Trials ( DRKS00010544 ), retrospectively registered on August 4, 2016.

Dataset Information

Efficacy of the bispectral index and Observer's Assessment of Alertness/Sedation Scale in monitoring sedation during spinal anesthesia: A randomized clinical trial.

Publications

Efficacy of the bispectral index and Observer's Assessment of Alertness/Sedation Scale in monitoring sedation during spinal anesthesia: A randomized clinical trial.

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