PDF herunterladen
CC BY-NC-ND 4.0 · Eur J Dent 2007; 01(04): 240-245
DOI: 10.1055/s-0039-1698346
Original Article
Dental Investigation Society

Nitrous Oxide Sedation and Bispectral Index

Berrin IŞIK
a   Anesthesiology and Reanimation Specialist, Gazi University, Faculty of Dentistry, Department Oral and Maxillofacial Surgery, Ankara, TURKEY
,
Tamer TÜZÜNER
b   Research Assistant, Gazi University, Faculty of Dentistry,Department of Pediatric Dentistry, Ankara, TURKEY
,
Melih TEZKİRECİOĞLU
c   Gazi University, Faculty of Dentistry, Department of Pediatric Dentistry, Ankara, TURKEY
,
Nurhan ÖZTAŞ
c   Gazi University, Faculty of Dentistry, Department of Pediatric Dentistry, Ankara, TURKEY
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
27. September 2019 (online)

Auch verfügbar auf
  als PDF herunterladen Lizenzen und Reprints

ABSTRACT

Objectives: To determine whether bispectral analysis (BIS) changes during nitrous oxide (N2O) sedation in anxious children undergoing extraction of primary teeth.

Methods: In this prospective study 45, ASA physical status I children, aged between 7 to 12 years and scheduled for primary teeth extraction under N2O/O2 sedation are included. At baseline (T0) and during the sedation procedure (T1-6); BIS levels, Ramsay Sedation Scores (RSS), oxygen saturation (Sp02), and heart rate (HR) were recorded at one-minute intervals. Forty percent N2O in O2 was given by a nasal hood, and N2O concentration was enhanced to 60% in a two-minute period. Paired measurements of BIS levels with Observer’s Assessment of Alertness and Sedation (OAA/S) scores were obtained during sedation procedure

Results: Since 5 patients refused application of the nasal hood, a total 40 of the original 45 subjects completed the study. Mean age and weight of the children were 9.5 ± 1.4 years and 23.7 ± 9.7 kg, respectively. Nitrous oxide inhalation produced no changes in BIS levels despite a sedation level in OAA/S scores were observed at 40-60% N2O concentrations

Conclusions:BIS values do not change during N2O/O2 sedation and the BIS monitor is not appropriate to evaluate the depth of sedation provided by N2O/O2 during primary teeth extraction in children. (Eur J Dent 2007;1:240-245)

Key words

Nitrous oxide sedation - Bispectral index - Anxiety - Ramsay sedation scale
 

  • References

  • 1 www.aapd.org/media/Policies_Guidelines/G_Nitrous.pdf 0
  • 2 Foley J. A prospective study of the use of nitrous oxide inhalation sedation for dental treatment in anxious children. Eur J Paediatr Dent 2005; 6: 121-128
    PubMedSuche in Google Scholar
  • 3 Foley J. Efficacy of nitrous oxide inhalation sedation and first permanent molar tooth extractions. SAAD Dig 2007; 23: 3-9
    PubMedSuche in Google Scholar
  • 4 Motas DL, McDermott NB, VanSickle T, Friesen RH. Depth of consciousness and deep sedation attained in children as administered by non-anaesthesiologists in a children’s hospital. Pediatr Anaesth 2004; 14: 256-260
    CrossrefPubMedSuche in Google Scholar
  • 5 Cravero JP, Blike GT. Review of pediatric sedation. Eur J Oral Sci 2004; 99: 1355-1364.
    Suche in Google Scholar
  • 6 Bruhn J, Myles P, Sneyd R, Struys M. Depth of anaesthesia monitoring: what’s available, what’s validated and what’s next?. Br J Anaesth 2006; 97: 85-94
    CrossrefPubMedSuche in Google Scholar
  • 7 Malviya S, Voepel-Lewis T, Tait AR. A comparison of observational and objective measures to differentiate depth of sedation in children from birth to 18 years of age. Anesth Analg 2006; 102: 389-394
    CrossrefPubMedSuche in Google Scholar
  • 8 Chernik DA, Gillings D, Laine H. et al Validity and reliability of the observer’s assessment of alertness/sedation scale: study with intravenous midazolam. J Clin Psychopharmacol 1994; 10: 244-251
    Suche in Google Scholar
  • 9 Sadhasivam S, Ganesh A, Robison A, Kaye R, Watcha MF. Validation of the bispectral index monitor for measuring the depth of sedation in children. Anesth Analg 2006; 102: 383-388
    CrossrefPubMedSuche in Google Scholar
  • 10 Park KS, Hur EJ, Han KW, Kil HY, Han TH. Bispectral index does not correlate with observer assessment of alertness and sedation scores during 0.5 % bupivacaine epidural anesthesia with nitrous oxide sedation. Anesth Analg 2006; 103: 385-389
    CrossrefPubMedSuche in Google Scholar
  • 11 Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. BMJ 1974; 2: 656-659
    CrossrefPubMedSuche in Google Scholar
  • 12 McDermott NB, VanSickle TE, Motas D, Friesen RH. Validation of the bispectral index monitor during conscious and deep sedation in children. Anesth Analg 2003; 97: 39-43
    PubMedSuche in Google Scholar
  • 13 Davidson A. Monitoring the anaesthetic depth in children: an update. Paediatr Anaesth 2007; 20: 236-243
    Suche in Google Scholar
  • 14 Murat I, Constant I. Bispectral index in pediatrics: fashion or a new tool. Pediatr Anesth 2005; 15: 177-180
    CrossrefPubMedSuche in Google Scholar
  • 15 Rampil IJ, Kim JS, Lenhardt R, Negishi C, Sessler DI. Bispectral EEG index during nitrous oxide administration. Anesthesiology 1998; 89: 671-677
    CrossrefPubMedSuche in Google Scholar
  • 16 Sandler NA, Sparks BS. The use of bispectral analysis in patients undergoing intravenous sedation for third molar extractions. J Oral Maxillofac Surg 2000; 58: 364-368
    CrossrefPubMedSuche in Google Scholar
  • 17 Rodriguez RA, Hall LE, Duggan SA, Splinter WM. The bispectral index does not correlate with clinical signs of inhalational anesthesia during sevoflurane induction and arousal in children. Can J Anaesth 2004; 51: 472-480.
    CrossrefPubMedSuche in Google Scholar
  • 18 Detsch O, Kochs E, Hapfelmeier G, Werner C. Increasing isoflurane concentration may cause paradoxical increases in the EEG bispectral index in surgical patients. Br J Anaesth 2002; 84: 33-37
    Suche in Google Scholar
  • 19 Constant I, Leport YM, Richard PM, Moutard ML, Murat I. Agitation and changes of bispectral index and electroencephalographic-derived variables during sevoflurane induction in children: clonidine premedication reduces agitation compared with midazolam. Br J Anaesth 2004; 92: 504-511
    CrossrefPubMedSuche in Google Scholar
  • 20 Leduc ML, Atherley R, Jinks SL, Antognini JF. Nitrous oxide depresses electroencephalographic responses to repetitive noxious stimulation in the rat. Br J Anaesth 2006; 96: 216-221
    CrossrefPubMedSuche in Google Scholar
  • 21 Hall DL, Weaver JM, Ganzberg S, Rashid R, Wilson S. Bispectral EEG index monitoring of high-dose nitrous oxide and low-dose sevoflurane sedation. Anesth Prog 2002; 49: 56-62
    PubMedSuche in Google Scholar
  • 22 Puri GD. Paradoxical changes in bispectral index during nitrous oxide administration. Br J Anaesth 2001; 86: 141-142
    CrossrefPubMedSuche in Google Scholar
  • 23 Frankl L, Hellman I. Symposium on child analysis. The Ego’s participation in the therapeutic alliance. Int J Psychoanal 1962; 43: 333-337
    PubMedSuche in Google Scholar
  • 24 Veerkamp JSJ, Gruythuysen RJM, van Amerongen WE. Dental treatment of fearful children using nitrous oxide. Part 3: anxiety during sequential visits. J Dent Child 1993; 60: 175-181
    Suche in Google Scholar
  • 25 Nathan JE, Venham LL, West MS, Werboff J. The effects of nitrous oxide on anxious young pediatric patients across sequential visits: a double-blind study. ASDC J Dent Child 1988; 55: 220-230
    PubMedSuche in Google Scholar
  • 26 Wallenborn J, Kluba K, Olthoff D. Comparative evaluation of Bispectral Index and Narcotrend Index in children below 5 years of age. Paediatr Anaesth 2007; 17: 140-147
    CrossrefPubMedSuche in Google Scholar
  • 27 Religa JC, Wilson S, Ganzberg SI, Casamassimo PS. Association between bispectral analysis and level of conscious sedation of pediatric dental patients. Pediatr Dent 2002; 24: 221-226
    PubMedSuche in Google Scholar
  • 28 Ramesh VJ, Umamaheswara Rao GS. Does nitrous oxide affect bispectral index in patients under isoflurane anesthesia?. J Neurosurg Anesthesiol 2006; 18: 267-268
    PubMedSuche in Google Scholar
  • 29 Barr G, Jakobsson JG, Owall AG, Anderson RE. Nitrous oxide does not alter bispectral index: study with nitrous oxide as sole agent and as an adjunct to i.v. anaesthesia. Br J Anaesth 1999; 82: 827-830
    CrossrefPubMedSuche in Google Scholar
  • 30 Anderson RE, Barr G, Jakobsson JG. Cerebral state index during anaesthetic induction: a comparative study with propofol or nitrous oxide. Acta Anaesthesiol Scand 2005; 49: 750-753
    Suche in Google Scholar
  • 31 Morse Z, Kaizu M, Sano K, Kanri T. BIS monitoring during midazolam and midazolam-ketamine conscious intravenous sedation for oral surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94: 420-424
    CrossrefPubMedSuche in Google Scholar