Electroencephalogram-based pharmacodynamic measures: a review
OBJECTIVES Sedation is a key component in the management of pediatric patients both in the pediatric emergency department (PED) and pediatric intensive care unit (PICU) for the treatment of pain and anxiety. Bispectral (BIS) index monitoring has been developed to help clinicians assess degree of hypnosis with anesthesia and may be useful in these environments. METHODS Literature searches were conducted through MEDLINE for case series/reports, retrospective studies, and randomized trials that evaluate the validity and applications of BIS monitoring in the PED and PICU. RESULTS Most of the studies are case series or retrospective studies in children. There are several prospective studies assessing validation of the monitor in children. Only a few studies have been performed that assess the influence of monitoring on outcomes in these environments. CONCLUSIONS Bispectral values correlate fairly well with commonly used clinical sedation scores, but more variability in the scores has been observed at lighter levels of sedation. More studies are needed to assess the value of titrating sedation in the PED and PICU within specific BIS parameters to reduce morbidity and costs associated with over-sedation.