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The performance of Bispectral Index in children during equi-MAC halothane vs. sevoflurane anaesthesia

Published online by Cambridge University Press:  01 November 2008

T. Taivainen ,
J. Klockars ,
A. Hiller ,
J. Wennervirta ,
M. J. van Gils  and
P. Suominen
T. Taivainen*
Affiliation:
Helsinki University Hospital, Hospital for Children and Adolescents, Department of Anaesthesiology and Intensive Care Medicine, Tampere, Finland
J. Klockars
Affiliation:
Helsinki University Hospital, Hospital for Children and Adolescents, Department of Anaesthesiology and Intensive Care Medicine, Tampere, Finland
A. Hiller
Affiliation:
Helsinki University Hospital, Hospital for Children and Adolescents, Department of Anaesthesiology and Intensive Care Medicine, Tampere, Finland
J. Wennervirta
Affiliation:
Helsinki University Hospital, Division of Anaesthesiology and Intensive Care Medicine, Intensive Care Units, Helsinki, Tampere, Finland
M. J. van Gils
Affiliation:
Helsinki University Hospital, VTT Information Technology Technical Research Centre of Finland, Tampere, Finland
P. Suominen
Affiliation:
Helsinki University Hospital, Hospital for Children and Adolescents, Department of Anaesthesiology and Intensive Care Medicine, Tampere, Finland
*
Correspondence to: Tomi Taivainen, Department of Anaesthesiology and Intensive Care Medicine, Hospital for Children and Adolescents, PL 281, 00029 HUS, Finland. E-mail: tomi.taivainen@hus.fi; Tel: +358 50 427 1382; Fax: +358 9 471 76711
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Summary

Background and objective

The reliability of the Bispectral Index for evaluating and monitoring the depth of general anaesthesia in children is not as great as for that in adults. Therefore we analysed Bispectral Index performance in children by comparing changes in Bispectral Index values during a standardized and equipotent anaesthetic regimen using either halothane or sevoflurane for the induction and maintenance of general anaesthesia. Special interest was focussed on excitation during induction, and whether it was associated with simultaneous changes in Bispectral Index scores.

Methods

Twenty children (3–15 yr, ASA I–II) scheduled for general surgery were randomly allocated to either halothane (10 patients) or sevoflurane group (10 patients). Anaesthesia was induced by 3% halothane or 7% sevoflurane, either agent administered with 50% N2O in oxygen for 5 min, the period from the beginning of induction until intubation. Thereafter, anaesthesia was maintained by the respective volatile agent at 1 MAC (minimum alveolar concentration; in addition to 70% N2O in oxygen) and supplemented with remifentanil infusion adjusted to maintain the heart rate and mean arterial pressure to within 20% of the baseline values. Excitation at induction was defined as involuntary muscular movements.

Results

Sevoflurane induction produced a more rapid depression in Bispectral Index than halothane, the mean difference being greatest (47 Bispectral Index score) at 105 s. Excitation occurred in three patients during sevoflurane induction, which coincided with increases in Bispectral Index values in two of the three patients. During the maintenance phase at 1 MAC, the Bispectral Index (mean ± SD) was 57±7 for halothane and 47±9 for sevoflurane (P < 0.05). The remifentanil doses did not differ between both groups.

Conclusion

In children, halothane anaesthesia was associated with higher Bispectral Index values than sevoflurane when administered at 1 MAC. Large individual variation in Bispectral Index occurred within both groups. Due to these limitations, one should be cautious when interpreting paediatric Bispectral Index data.

Keywords

ANAESTHESIA INHALATIONALCHILDCHILD PRESCHOOLHALOTHANESEVOFLURANEBISPECTRAL INDEX
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 11 , November 2008 , pp. 933 - 939
Copyright
Copyright © European Society of Anaesthesiology 2008

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