Hostname: page-component-76fb5796d-x4r87 Total loading time: 0 Render date: 2024-04-26T11:55:55.209Z Has data issue: false hasContentIssue false
  • English
  • Français

The correlation between the richmond agitation–sedation scale and bispectral index during dexmedetomidine sedation

Published online by Cambridge University Press:  27 January 2006

A. Turkmen ,
A. Altan ,
N. Turgut ,
S. Vatansever  and
S. Gokkaya
A. Turkmen
Affiliation:
Okmeydani Education and Research Hospital, Department of Anaesthesiology and Reanimation, Istanbul, Turkey
A. Altan
Affiliation:
Okmeydani Education and Research Hospital, Department of Anaesthesiology and Reanimation, Istanbul, Turkey
N. Turgut
Affiliation:
Okmeydani Education and Research Hospital, Department of Anaesthesiology and Reanimation, Istanbul, Turkey
S. Vatansever
Affiliation:
Okmeydani Education and Research Hospital, Department of Anaesthesiology and Reanimation, Istanbul, Turkey
S. Gokkaya
Affiliation:
Okmeydani Education and Research Hospital, Department of Anaesthesiology and Reanimation, Istanbul, Turkey
Get access

Extract

Summary

Background and objectives: The primary objective of sedation in the critically ill patient is to achieve security and comfort. The routine use of standardized and validated sedation scales and monitors are needed. The Richmond agitation sedation scale has been used but some patients cannot be evaluated with subjective assessment tools such as the Richmond agitation sedation scale because they lack motor responsiveness due to therapeutic paralysis or because they are receiving deep sedation. We aimed to assess the correlation of bispectral index with Richmond agitation sedation scale during dexmedetomidine sedation and evaluate the use of the bispectral index in monitoring the levels of sedation in intensive care patients. Methods: This was a single centre, prospective, clinical study. Eleven mechanically-ventilated critically ill patients, aged 17–82 (50.09 ± 17.76; mean ± SD) yr, 3 males and 8 females, APACHE II score 12.63 ± 3.90, SOFA score 3.27 ± 1.73 were enrolled in the study. Patients received a dexmedetomidine infusion of 1 μg kg−1 over 10 min followed by a maintenance infusion of 0.5 μg kg−1 h−1 for 8 h. Sedation was assessed using the Richmond agitation sedation scale and bispectral index monitoring. Heart rate, blood pressure, respiratory rate and SPO2 were monitored. Wilcoxon signed rank sum test and Spearman's rank correlation analysis were used for statistical analysis. Results: The variation of Richmond agitation sedation scale score was between 0.9 and −1.7 bispectral index varied from 65 to 75. Significant correlations between Richmond agitation sedation scale and bispectral index values were found in this study. (r = 0.900; P = 0.0001) Conclusions: Richmond agitation sedation scale levels significantly correlated with bispectral index values during dexmedetomidine sedation in critically ill patients requiring mechanical ventilation in the intensive care unit.

Keywords

CRITICAL CARE, sedation, sedation scoringDEXMEDETOMIDINEELECTROENCEPHALOGRAPHY, bispectral indexMONITORING, PHYSIOLOGICCONSCIOUS SEDATION
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 4 , April 2006 , pp. 300 - 304
Copyright
© 2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Singh H. Bispectral index (BIS) monitoring during propofol-induced sedation and anaesthesia. Eur J Anaesthesiol 1999; 16: 31–36.Google Scholar
Rubenstein JS. Bispectral index as a guide for titration of propofol during procedural sedation among children. Pediatrics 2005; 115: 1666–1674.Google Scholar
Fraser GL, Riker RR. Bispectral index monitoring in the intensive care unit provides more signal than noise. Pharmacotherapy 2005; 25: 19–27.Google Scholar
Sessler CN, Gosnell MS, Grap MJ et al. The Richmond agitation–sedation scale validity and reliability in adult intensive care unit patients. Am J Resp Crit Care Med 2002; 166: 1338–1344.Google Scholar
Venn RM, Grounds RM. Comparison between dexmedetomidine and propofol for sedation in the intensive care unit. Br J Anaesth 2001; 87: 684–690.Google Scholar
Coursin DB, Maccioli GA. Dexmedetomidine. Curr Opin Crit Care 2001; 7: 221–226.Google Scholar
Koroglu A, Demirbilek S, Teksan H, Sagir O, But AK, Ersoy MO. Sedative, haemodynamic and respiratory effects of dexmedetomidine in children undergoing magnetic resonance imaging examination: preliminary results. Br J Anaesth 2005; 94: 821–824.Google Scholar
De Wit M, Epstein SK. Administration of sedatives and level sedation: comparative evaluation via the sedation–agitation scale and the bispectral index. Am J Crit Care 2003; 12: 343–348.Google Scholar
Kollef MH, Levy NT, Ahrens TS, Schaiff R, Prentice D, Sherman G. The use of continuous IV sedation is associated with prolongation of mechanical ventilation. Chest 1998; 114: 541–548.Google Scholar
De Jonghe B, Cook D, Appere-De-Vecchi C, Guyatt G, Meade M, Outin H. Using and understanding sedation scoring systems: a systematic review. Intens Care Med 2000; 26: 275–285.Google Scholar
Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone–alphadolone. BMJ 1974; 2: 656–659.Google Scholar
Riker RR, Picard JT, Franser GL. Prospective evaluation of the sedation–agitation scale for adult critically ill patients. Crit Care Med 1999; 27: 1325–1329.Google Scholar
Devlin JW, Boleski G, Mlynarek M et al. Motor activity assessment scale: a valid and reliable sedation scale for use with mechanically ventilated patients in an adult surgical intensive care unit. Crit Care Med 1999; 27: 1271–1275.Google Scholar
Triltsch AE, Nestmann G, Orawa H et al. Bispectral index versus COMFORT score to determine the level of sedation in paediatric intensive care unit patients: a prospective study. Crit Care 2005; 9: 9–17.Google Scholar
Glass PS, Bloom M, Kearse L, Rosow C, Sebal P, Manberg P. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology 1997; 86: 836–847.Google Scholar
Liu J, Singh H, White PF. Electroencephalogram bispectral analysis predicts the depth of midazolam-induced sedation. Anesthesiology 1996; 84: 64–69.Google Scholar
Doi M, Gajraj RJ, Mantzaridis H, Kenny GNC. Relationship between calculated blood concentrations of propofol and electrophysiological variables during emergence from anaesthesia: comparison of bispectral index, spectral edge frequency, median frequency and auditory evoked potentials. Br J Anaesth 1997; 78: 180–184.Google Scholar
De Deyne C, Struys M, Decruyenaere J, Creupelandt J, Hoste E, Colardyn F. Use of continuous bispectral EEG monitoring to assess depth of sedation in ICU patients. Intens Care Med 1998; 24: 1294–1298.Google Scholar
Triltsch AE, Welte M, von Homeyer P et al. Bispectral index-guided sedation with dexmedetomidine in intensive care: a prospective, randomized, double blind, placebo-controlled phase II study. Crit Care Med 2002; 30: 1007–1014.Google Scholar
McDermott NB, VanSickle T, Motas D, Friesen RH. Validation of bispectral index monitor during conscious sedation and deep sedation in children. Anesth Analg 2003; 97: 39–43.Google Scholar
Deogaonkar A, Gupta R, DeGeorgia M et al. Bispectral Index monitoring correlates with sedation scales in brain-injured patients. Crit Care Med 2004; 32: 2403–2406.Google Scholar
Simmons LE, Riker RR, Prato BS, Fraser GL. Assessing sedation during intensive care unit mechanical ventilation with the bispectral index and sedation–agitation scale. Crit Care Med 1999; 27: 1499–1504.Google Scholar
Berkenbosch JW, Fichter CR, Tobias JD. The correlation of the bispectral index monitor with clinical sedation scores during mechanical ventilation in the pediatric intensive care unit. Anesth Analg 2002; 94: 506–511.Google Scholar
Ely EW, Gautam S, May L et al. A comparison of different sedation scales in the ICU and Validation of the Richmond agitation sedation scale (RASS). Am J Respir Crit Care Med 2001; 163: A954.Google Scholar
Ely EW, Truman B, Nielsen-Bohlman L et al. Validating the bispectral EEG for ventilated ICU patients. Am J Respir Crit Care Med 2001; 163: A899.Google Scholar
Mondello E, Siliotti R, Noto G et al. Bispectral index in ICU: correlation with Ramsay Score on assessment of sedation level. J Clin Monitor Comput 2002; 17: 271–277.Google Scholar