The peculiarities of the BIS monitoring application for anesthesia care in orthopedic-traumatology surgery on the lower extremities in children

Abstract

Objectives. To determine the effectiveness of using the BIS indicator index as a component of monitoring in orthopedic-traumatology surgery on the lower extremities in children using various methods of anesthesia. Material and methods. The present study included 40 children aged from 7 to 17 years who underwent planned orthopedic-traumatology surgical interventions on the lower extremities. The patients were randomized into two groups: in the first group (n=17) children were administered multicomponent balanced general anesthesia; the second group (n=23) included children who were administered combined anesthesia (multicomponent general anesthesia with conduction blockade of sciatic and femoral nerves). Bispectral index indications at four stages of perioperative period, the necessity for narcotic analgesics and inhalation anesthetic as well as time period from the end of the surgery to extubation and full awakening of the child were analyzed in both groups. Results. As a result of the study it was found that BIS index values were significantly higher in children of the second group at the fourth (the start of the surgery), the fifth (traumatic stage of the surgery) and the sixth (the end of the surgery) stages of the perioperative period. Statistically significant differences in the need of sevoflurane and narcotic analgesics were also obtained. The amount of fentanyl in patients of the first group was 4.1 [3.3; 5.0] mkg/kg, that is 8.2 times more than in patients of the second group 0.5 [0.4; 0.53] mkg/kg (p<0.0001).The time period from the end of the surgical intervention to extubation in the first group made up 8 [6; 10] minutes that is 2 times longer than in patients of the second group – 4 [3; 5] minutes (p<0.0001).The time to fully wake up was also significantly longer in patients of the first group – 12 [10; 17] minutes compared to the second group – 8.5 [7; 10] minutes, respectively (p=<0.001). Conclusions. The use of electroencephalographic monitoring based on BIS index determination in orthopedic-traumatology surgery on the lower extremities in children showed high clinical efficacy and made it possible to exclude cases of intraoperative awakening.

Keywords

• pediatric orthopedics
• bis monitoring
• combined anesthesia
• surgical interventions on the lower extremities
• general anesthesia
• electroencephalographic monitoring