Document Detail


Depth of sedation using Cerebral State Index in infants undergoing spinal anesthesia.
MedLine Citation:
PMID:  19143957     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Infants are noted to frequently sleep during spinal anesthesia, with a concomitant fall in Bispectral Index. However, there are suggestions that EEG derived anesthesia depth monitors have inferior performance in infants. The aim of this study was to quantify the degree of sedation during spinal anesthesia in infants using another EEG derived measure of anesthesia effect--the Cerebral State Index (CSI). METHODS: Twelve infants, <52 weeks postconceptual menstrual age, scheduled for bilateral inguinal hernia repair under spinal anesthesia were enrolled. Patients received a standard anesthetic protocol with a subarachnoid dose of 1 mg x kg(-1) of levobupivacaine 0.5%. No premedication, sedatives, opioids or anticholinergics were administrated during the perioperative period and patients were left undisturbed during the surgical time, without tactile stimulation or loud auditory stimuli. CSI score (0-100) and bust suppression (BS) (0-100%) were continuously recorded during the surgical time and then statistically re-evaluated. RESULTS: In all patients the CSI fell during the procedure and there were significant levels of BS recorded by the CSI monitor. The BS occurred between 12 and 34 min after spinal anesthesia with the peak being at 30 min and mean onset time being 15 (2.6) min after spinal block. A statistical significant difference was found between the lowest mean CSI as well as the highest BS if compared with their baseline values. A negative correlation was found between CSI and BS. CONCLUSIONS: The degree of burst suppression detected by the CSI in our study supports the hypothesis that infants may have discontinuous patterns of EEG during spinal anesthesia similar to those seen during emergence from general anesthesia. Moreover, the limitations in the application of the adult algorithms to infant EEG may lead to an overestimation of the degree of sedation.
Authors:
Nicola Disma; Pietro Tuo; Marinella Astuto; Andrew J Davidson
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Publication Detail:
Type:  Journal Article     Date:  2008-11-25
Journal Detail:
Title:  Paediatric anaesthesia     Volume:  19     ISSN:  1460-9592     ISO Abbreviation:  Paediatr Anaesth     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-02-11     Completed Date:  2009-06-11     Revised Date:  2010-05-17    
Medline Journal Info:
Nlm Unique ID:  9206575     Medline TA:  Paediatr Anaesth     Country:  France    
Other Details:
Languages:  eng     Pagination:  133-7     Citation Subset:  IM    
Affiliation:
Anaesthesia and Intensive Care, Gaslini Children's Hospital, Genoa, Italy. nicoladisma@tin.it
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MeSH Terms
Descriptor/Qualifier:
Anesthesia, Spinal*
Anesthetics, Local / administration & dosage
Brain / physiology*
Bupivacaine / administration & dosage,  analogs & derivatives
Child, Preschool
Conscious Sedation / psychology,  standards*
Electroencephalography / drug effects*
Female
Humans
Infant
Male
Monitoring, Intraoperative / methods,  standards
Research Design
Chemical
Reg. No./Substance:
0/Anesthetics, Local; 0/levobupivacaine; 2180-92-9/Bupivacaine
Comments/Corrections
Comment In:
Paediatr Anaesth. 2010 Apr;20(4):368-9   [PMID:  20470343 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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