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J Korean Soc Emerg Med > Volume 18(5); 2007 > Article
Journal of The Korean Society of Emergency Medicine 2007;18(5): 399-405.
A Study of the Usefulness of the Bispectral Index Monitor During Pediatric Procedural Sedation by Rectal Thiopental Administration in the Emergency Department
Jung Keun Kwak, Gyu Chong Cho, Ji Young Ryu, Ji Young Ryu
Department of Emergency Medicine, Hallym University, School of Medicine, Seoul, Korea. emdrcho@empal.com
Recently, the bispectral index monitor has been promoted as an objective measure of sedation depth during pediatric procedural sedation in the emergency department (ED). However, rectal administration of thiopental sodium for pediatric procedural sedation has not been validated.
Patients aged one to seven years and undergoing primary closure procedures for simple facial and hand laceration in the ED were enrolled. Procedural sedation was performed by rectal administration of thiopental sodium. The bispectral index score and the Ramsay Sedation Scale were recorded every 10 minutes during sedation. The investigator and treating physician were blinded to bispectral index scores, which were later correlated with the Ramsay Sedation Scales values. Receiver operator characteristic (ROC) curves were conducted to determine the ability of the bispectral index score to discriminate various thresholds of sedation depth.
One hundred thirty paired measurements were obtained from 12 patients. The Spearman's correlation coefficient for paired measurements, was -0.906 (95% confidence interval: [-9.8] ~ [-8.1], p<0.001). ROC curve analysis demonstrated a high discriminatory power for bi-spectral index scores in predicting the level of sedation, with areas under the curve at least 0.95 for all Ramsay Sedation Scale thresholds.
Bispectral index monitoring can serve as a useful, objective measure of sedation depth in pediatric procedural sedation with rectal administration of thiopental sodium in the ED.
Key words: Rectal Administration, Thiopental, Bispectral index score
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