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The Dynamic Relationship Between End-Tidal Sevoflurane Concentrations, Bispectral Index, and Cerebral State Index in Children

R. Fuentes, L. Cortinez, Michel Struys UGent, A. Delfino and H. Munoz (2008) ANESTHESIA AND ANALGESIA. 107(5). p.1573-1578
abstract
BACKGROUND: To guide anesthetic administration with electroencephalogram monitors in children, an adequate characterization of the anesthetic effect measured by these monitors in this population is needed. We sought to quantify and compare the dynamic profile of sevoflurane's effect measured with the cerebral state index (CST) and the bispectral index (BIS) in children. METHODS: Fifteen healthy children, aged 3-15 yr, scheduled to undergo minor surgery were prospectively studied. During the simultaneous recording of CST and % for 5 min and then decreased. BIS, the sevoflurane vaporizer was set at 6 vol End-tidal concentrations (C-ET) were measured. The C-ET-sevoflurane effect-site concentration equilibration and pharmacodynamics were modeled. Goodness of fit between models was compared. Data are typical value (coefficient of variation). RESULTS: Within the anesthetic depth range studied, the rate of change of sevoflurane's effect expressed as the effect-site equilibration half-life (t(1/2) k(e0)) was slower with the CST [2.0 (14) min] than with BIS [1.2 (53) min] (P < 0.05). The estimated baseline effect of BIS and CST before sevoflurane administration (E-0) was 84 (39) for CST and 87 (7) for BIS (NS). The sensitivity to sevoflurane hypnotic effect expressed in the C-50 [steady-state C-ET eliciting half of the maximum response (E-max)] was 2.1 (68) % with CST and 2.1. (16)% with BIS (NS). The E-max with CST 45 (0) was higher than that with BIS 27 (39) (P < 0.05). The population prediction error was significantly better for BIS (-0.7 +/- 26.9) than for CST (-3.0 +/- 178.6) (P < 0.05). CONCLUSIONS: In children, the t(1/2) k(e0) of sevoflurane and the pharmacodynamics of sevoflurane were quantified and the results were entirely dependent on the monitor used to measure its hypnotic effect. Within the anesthetic depth range studied, the rate of change of sevoflurane's effect was slower with the CST. To adequately guide sevoflurane administration with these monitors in children, these differences should be considered.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
PHARMACODYNAMICS, PERFORMANCE, INFANTS, BIS, AGE, EEG, PROPOFOL ANESTHESIA, CONTROLLED INFUSION
journal title
ANESTHESIA AND ANALGESIA
Anesth. Analg.
volume
107
issue
5
pages
1573 - 1578
publisher
LIPPINCOTT WILLIAMS & WILKINS,
place of publication
530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA
Web of Science type
Article
Web of Science id
000260397200018
JCR category
ANESTHESIOLOGY
JCR impact factor
2.59 (2008)
JCR rank
6/22 (2008)
JCR quartile
2 (2008)
ISSN
0003-2999
DOI
10.1213/ane.0b013e318181ef88
language
English
UGent publication?
yes
classification
A1
copyright statement
I have retained and own the full copyright for this publication
id
529117
handle
http://hdl.handle.net/1854/LU-529117
date created
2009-03-24 11:42:48
date last changed
2009-03-26 09:57:44
@article{529117,
  abstract     = {BACKGROUND: To guide anesthetic administration with electroencephalogram monitors in children, an adequate characterization of the anesthetic effect measured by these monitors in this population is needed. We sought to quantify and compare the dynamic profile of sevoflurane's effect measured with the cerebral state index (CST) and the bispectral index (BIS) in children.
METHODS: Fifteen healthy children, aged 3-15 yr, scheduled to undergo minor surgery were prospectively studied. During the simultaneous recording of CST and \% for 5 min and then decreased. BIS, the sevoflurane vaporizer was set at 6 vol End-tidal concentrations (C-ET) were measured. The C-ET-sevoflurane effect-site concentration equilibration and pharmacodynamics were modeled. Goodness of fit between models was compared. Data are typical value (coefficient of variation).

RESULTS: Within the anesthetic depth range studied, the rate of change of sevoflurane's effect expressed as the effect-site equilibration half-life (t(1/2) k(e0)) was slower with the CST [2.0 (14) min] than with BIS [1.2 (53) min] (P {\textlangle} 0.05). The estimated baseline effect of BIS and CST before sevoflurane administration (E-0) was 84 (39) for CST and 87 (7) for BIS (NS). The sensitivity to sevoflurane hypnotic effect expressed in the C-50 [steady-state C-ET eliciting half of the maximum response (E-max)] was 2.1 (68) \% with CST and 2.1. (16)\% with BIS (NS). The E-max with CST 45 (0) was higher than that with BIS 27 (39) (P {\textlangle} 0.05). The population prediction error was significantly better for BIS (-0.7 +/- 26.9) than for CST (-3.0 +/- 178.6) (P {\textlangle} 0.05).

CONCLUSIONS: In children, the t(1/2) k(e0) of sevoflurane and the pharmacodynamics of sevoflurane were quantified and the results were entirely dependent on the monitor used to measure its hypnotic effect. Within the anesthetic depth range studied, the rate of change of sevoflurane's effect was slower with the CST. To adequately guide sevoflurane administration with these monitors in children, these differences should be considered.},
  author       = {Fuentes, R. and Cortinez, L. and Struys, Michel and Delfino, A. and Munoz, H.},
  issn         = {0003-2999},
  journal      = {ANESTHESIA AND ANALGESIA},
  keyword      = {PHARMACODYNAMICS,PERFORMANCE,INFANTS,BIS,AGE,EEG,PROPOFOL ANESTHESIA,CONTROLLED INFUSION},
  language     = {eng},
  number       = {5},
  pages        = {1573--1578},
  publisher    = {LIPPINCOTT WILLIAMS \& WILKINS,},
  title        = {The Dynamic Relationship Between End-Tidal Sevoflurane Concentrations, Bispectral Index, and Cerebral State Index in Children},
  url          = {http://dx.doi.org/10.1213/ane.0b013e318181ef88},
  volume       = {107},
  year         = {2008},
}

Chicago
Fuentes, R., L. Cortinez, Michel Struys, A. Delfino, and H. Munoz. 2008. “The Dynamic Relationship Between End-Tidal Sevoflurane Concentrations, Bispectral Index, and Cerebral State Index in Children.” Anesthesia and Analgesia 107 (5): 1573–1578.
APA
Fuentes, R., Cortinez, L., Struys, M., Delfino, A., & Munoz, H. (2008). The Dynamic Relationship Between End-Tidal Sevoflurane Concentrations, Bispectral Index, and Cerebral State Index in Children. ANESTHESIA AND ANALGESIA, 107(5), 1573–1578.
Vancouver
1.
Fuentes R, Cortinez L, Struys M, Delfino A, Munoz H. The Dynamic Relationship Between End-Tidal Sevoflurane Concentrations, Bispectral Index, and Cerebral State Index in Children. ANESTHESIA AND ANALGESIA. 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA: LIPPINCOTT WILLIAMS & WILKINS,; 2008;107(5):1573–8.
MLA
Fuentes, R., L. Cortinez, Michel Struys, et al. “The Dynamic Relationship Between End-Tidal Sevoflurane Concentrations, Bispectral Index, and Cerebral State Index in Children.” ANESTHESIA AND ANALGESIA 107.5 (2008): 1573–1578. Print.