ABSTRACT
BACKGROUND: The Bispectral Index (BIS) monitor has been suggested as a potential tool to measure depth of sedation in paediatric intensive care unit (PICU) patients. The primary aim of our observational study was to assess the difference in BIS values between the left and right sides of the brain. Secondary aims were to compare BIS and COMFORT score and to assess change in BIS with tracheal suctioning. METHODS: Nineteen ventilated and sedated PICU patients had paediatric BIS sensors applied to either side of their forehead. Each patient underwent physiotherapy involving tracheal suctioning. Their BIS data and corresponding COMFORT score, assessment as by their respective nurses, were recorded before, during, and after physiotherapy. RESULTS: Seven patients underwent more than one physiotherapy session; therefore, 28 sets of data were collected. The mean BIS difference values (and 95% CI) between left BIS and right BIS for pre-, during, and post-physiotherapy periods were 9.2 (5.9-12.5), 15.8 (11.9-19.7), and 7.5 (5.2-9.7), respectively. Correlation between mean BIS, left brain BIS, and right brain BIS to COMFORT score was highly significant (P<0.001 for all three) during the pre- and post-physiotherapy period, but less so during the stimulated physiotherapy period (P=0.044, P=0.014, and P=0.253, respectively). CONCLUSIONS: A discrepancy between left and right brain BIS exists, especially when the patient is stimulated. COMFORT score and BIS correlate well between light and moderate sedation.
Subject(s)
Conscious Sedation , Electroencephalography/methods , Intensive Care Units, Pediatric , Child , Child, Preschool , Critical Care/methods , Dominance, Cerebral , Female , Health Status Indicators , Humans , Infant , Male , Monitoring, Physiologic/methods , Prospective Studies , Single-Blind MethodABSTRACT
The aim of this study was to determine the filtration performance of five commonly used paediatric breathing system filters following exposure to desflurane, isoflurane and sevoflurane. It has been suggested that oil may degrade the performance of filter material. Volatile anaesthetic vapours are organic and hence may affect the filtration performance of breathing system filters during anaesthesia. This has not been tested for various concentrations of volatile agent, type and duration of exposure. The filtration performance of the filters was measured following exposure to desflurane, isoflurane and sevoflurane at 1 and 2 minimum alveolar concentration (MAC) for 1 and 4 h. Penetration of particles through the Clear-Therm Micro, Clear-Therm Mini and Humid-Vent Filter Pedi increased by between 2.4 and 2.8 times after exposure to desflurane at 2 MAC for 4 h compared to that through unexposed filters (p < 0.0001 for all three filters). Further investigation is required to determine whether this reduction in filtration performance by desflurane is clinically significant.
