IngentaConnect A comparison of bispectral index with Ramsay sedation score in pa...

Abstract:

Assessment of the depth of sedation in ICU patients is important if the deleterious consequences of over- or under-sedation are to be avoided. The Ramsay sedation score (RSS) whilst being easy to use, is very subjective in nature and neuromuscular paralysis makes interpretation difficult. Measurement of sedation utilizing the bispectral index (BIS), a novel and easily interpretatable, processed EEG, overcomes these problems, and its use has been explored in the ICU setting.¹ BIS has previously been shown to correlate with the modified RSS.² Dexmedetomidine, a highly selective alpha 2 agonist, is being investigated for sedation in the ICU, and we have studied its effects on BIS and correlated this with the RSS in the ICU.

Following approval of the LREC, six medical patients (mean APACHE II score 23, range 20–26) requiring ventilation in the ICU, received a dexmedetomidine infusion (0.2–2.5 mcg kg^–1 h^–1) for up to 24 h and depth of sedation was assessed using RSS. BIS was continuously monitored on Aspect A-2000 with the sensor placed in a fronto-temporal montage. Hourly RSS were recorded and corresponding BIS measurements averaged over 1 min. ANOVA with Newman-Keuls post test analysis for repeated observations and linear regression analysis were used for statistical comparison. P<0.05 was considered statistically significant.

BIS can be usefully used to monitor the depth of sedation with dexmedetomidine in the ICU (Table 26), as has been shown previously with other agents.² BIS can be classified into a low, middle and high range corresponding to RSS of 1&2, 3&4, 5&6, when dexmedetomidine is used as the sole sedation agent in critically ill patients.

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A comparison of bispectral index with Ramsay sedation score in patients sedated with dexmedetomidine in the ICU