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MINERVA ANESTESIOLOGICA

Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2018 Jan 16

DOI: 10.23736/S0375-9393.18.12147-X

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Association between Bispectral Index System (BISTM) and airway obstruction, an observational prospective cohort analysis during third molar extractions

A. Sassan SABOURI 1 , Alireza JAFARI 2, Paul CREIGHTON 3, Adam SHEPHERD 4, Timothy J. VOTTA 5, Hao DENG 6, Christopher HEARD 1, 3, 5

1 Department of Anesthesia, University at Buffalo, Buffalo, NY, USA; 2 Shahid Beheshti University of Medical Sciences, Department of Anesthesiology, Critical Care and Pain Medicine, Tehran, Iran; 3 Department of Pediatric and Community Dentistry, University at Buffalo, Buffalo, NY USA; 4 Pediatric Dentistry, University at Buffalo, Buffalo, NY, USA; 5 Women and Children’s Hospital at Buffalo, Buffalo, NY USA 6; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA


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BACKGROUND: Sedation regimes during oral procedures frequently associated with airway obstruction. The aim of this study was to define the association of bispectral index (BIS) to the depth of sedation and airway obstruction events.
METHODS: 47 patients between 1421 years old who were candidates for 3rd molar teeth extraction were enrolled in this study. Patients received a total of 4mg midazolam, 100 microgram fentanyl followed by titrated incremental propofol in 10mg. The Richmond Agitation Sedation Score (RASS) was used to assess the depth of sedation. Each patient was attached to BIS monitor, while clinicians were not involved in the data collection process. Apnea, airway obstruction, O2 saturation, timing and interventions for controlling the situation were recorded. All data was synchronized with BIS data monitoring.
RESULTS: 97.5% of cases were ASA 1 and 2, with average age of 17.3 years (±1.4) and a median BMI of 26.1. By using linear regression, for every unit decrease of median RASS (less than zero), there was 1.78 decrease in mean BIS score (P=0.045, 95%CI (0.083.47) The mean BIS index (over 1 minute) with airway obstruction was 64 (±10.2), which was significantly lower than the BIS during nonairway obstruction (77 ±11.6), (P<0.001). By using logistic regression analysis, for every on unit increase in BIS index, there is 24% decrease in odds in having airway obstruction (P=0.0009, 95% CI 0.65=8.94).
CONCLUSIONS: This study demonstrates that the BIS could potentially be a valid continuous monitoring method to avoid airway obstruction during sedation for patients undergoing dental surgery.


KEY WORDS: Deep sedation - Airway obstrucion - Ambulatory monitoring - Oral surgery - Ambulatory care

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Publication History

Article first published online: January 16, 2018
Manuscript accepted: January 10, 2018
Manuscript revised: December 14, 2017
Manuscript received: April 19, 2017

Per citare questo articolo

Sabouri AS, Jafari A, Creighton P, Shepherd A, Votta TJ, Deng H. Association between Bispectral Index System (BISTM) and airway obstruction, an observational prospective cohort analysis during third molar extractions. Minerva Anestesiol 2018 Jan 16. DOI: 10.23736/S0375-9393.18.12147-X

Corresponding author e-mail

asabouri@mgh.harvard.edu