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Bispectral Index versus the University of Michigan Sedation Scale in assessing sedation depth during pediatric drug-induced sleep endoscopy

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Background and purpose

Bispectral Index (BIS) and University of Michigan Sedation Scale (UMSS) were two commonly used methods of monitoring the sedation depth, but their correlation was not clear. The purpose of this study is to ascertain if BIS correlates with UMSS in determining the sedation level during pediatric drug-induced sleep endoscopy (DISE).

Methods

One-hundred children, aged 36–143 months, with ASA I~II grade, were enrolled. They were subject to general anesthesia for an elective adenotonsillectomy. Two drug regimens were used. After UMSS ≥ 3, the sites of airway obstructions were located by checking the supraglottic airway structures with a fibrous laryngoscope. UMSS scores, BIS values, electromyography (EMG), and signal quality indices (SQIs) were recorded at the pre-medication and pre-DISE baseline (T0), 5 min subsequent to medication administration but prior to DISE initiation (T1), 1 min after DISE was initiated (T2), 1 min after DISE was completed (T3), 1 min subsequent to tracheal intubation (T4), 1 min following extubation (T5), and 30 min past extubation (T6).

Results

There were strong correlations between BIS monitor readings and UMSS scores for total and two regimens. Kappa values revealed moderate agreement between BIS and UMSS for total and two regimens. The agreement rates were 67.47% for the total, 61.43% for Regimen 1, and 73.42% for Regimen 2, respectively.

Conclusion

BIS correlates with UMSS in determining the sedation level during pediatric DISE for two regimens. BIS might serve as an appropriate indicator of sedation intensity when UMSS could not be used.

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Data availability

The novel findings presented within this research are detailed within the main text, and any additional inquiries should be addressed to the corresponding authors.

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Acknowledgements

We would like to express our sincere gratitude to all those who have supported us throughout the process of this study. And we are deeply grateful to Mr. Gao Zhanghong from the School of Foreign Languages and Literature at Wuhan University, Wuhan, Hubei, China, for his invaluable guidance and expertise in writing this manuscript.

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Author notes

  1. Zheng Yongping and Xiong Bingrui share first authorship owing to their equal contribution to this work.

Authors and Affiliations

  1. Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China

    Yongping Zheng, Bingrui Xiong, Aming Sang, Xiaorong Liu & Xinyi Li

  2. Research Centre of Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China

    Xuemin Song

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  1. Yongping Zheng
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Contributions

Z. Y. P. and X. B. R. contributed to the data analysis and manuscript preparation. Z. Y. P., S. A. M., and L. X. R. were involved in data collection. Z. Y. P., L. X. Y., and S. X. M. participated in the study design, and provided critical feedback on the manuscript. And all authors gave final approval for submission.

Corresponding authors

Correspondence to Xinyi Li or Xuemin Song.

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Ethics approval

Our research was conducted in adherence to the International Conference on Harmonization Guidelines for Good Clinical Practice and the Declaration of Helsinki, leading to its subsequent approval by the Ethical Board for Clinical/Scientific Research Projects of Zhongnan Hospital of Wuhan University (Permit Number: 2021071). The patients who participated in this study all provided their written informed consent.

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The authors declare no competing interests.

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Zheng, Y., Xiong, B., Sang, A. et al. Bispectral Index versus the University of Michigan Sedation Scale in assessing sedation depth during pediatric drug-induced sleep endoscopy. Sleep Breath (2024). https://doi.org/10.1007/s11325-024-03022-3

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