Simultaneous comparison of depth of sedation performance between SedLine and BIS during general anesthesia using custom passive interface hardware: study protocol for a prospective, non-blinded, non-randomized trial
Abstract Background Intraoperative brain function monitoring with processed electroencephalogram (EEG) indices, such as the bispectral index (BIS) and patient state index (PSI), may improve characterization of the depth of sedation or anesthesia when compared to conventional physiologic monitors, su...
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| Format: | Article |
| Language: | English |
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BMC
2021-04-01
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| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12871-021-01326-5 |
| _version_ | 1818329484877627392 |
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| author | James Harvey Jones Vinay Ravikumar Nittur Neal Fleming Richard L. Applegate |
| author_facet | James Harvey Jones Vinay Ravikumar Nittur Neal Fleming Richard L. Applegate |
| author_sort | James Harvey Jones |
| collection | DOAJ |
| description | Abstract Background Intraoperative brain function monitoring with processed electroencephalogram (EEG) indices, such as the bispectral index (BIS) and patient state index (PSI), may improve characterization of the depth of sedation or anesthesia when compared to conventional physiologic monitors, such as heart rate and blood pressure. However, the clinical assessment of anesthetic depth may not always agree with available processed EEG indices. To concurrently compare the performance of BIS and SedLine monitors, we present a data collection system using shared individual generic sensors connected to a custom-built passive interface box. Methods This prospective, non-blinded, non-randomized study will enroll 100 adult American Society of Anesthesiologists (ASA) class I-III patients presenting for elective procedures requiring general anesthesia. BIS and SedLine electrodes will be placed preoperatively according to manufacturer recommendations and their respective indices tracked throughout anesthesia induction, maintenance and emergence. The concordance between processed EEG indices and clinical assessments of anesthesia depth will be analyzed with chi-square and kappa statistic. Discussion Prior studies comparing brain function monitoring devices have applied both sensors on the forehead of study subjects simultaneously. With limited space and common sensor locations between devices, it is not possible to place both commercial sensor arrays according to the manufacturer’s recommendations, thus compromising the validity of these comparisons. This trial utilizes a custom interface allowing signals from sensors to be shared between BIS and SedLine monitors to provide an accurate comparison. Our results will also characterize the degree of agreement between processed EEG indices and clinical assessments of anesthetic depth as determined by the anesthesiologists’ interpretations of acute changes in blood pressure and heart rate as well as the administration, or change to the continuous delivery, of medications at these timepoints. Patient factors (such as burst suppression state or low power EEG conditions from aging brain), surgical conditions (such as use of electrocautery), artifacts (such as electromyography), and anesthesia medications and doses (such as end-tidal concentration of volatile anesthetic or hypnotic infusion dose) that lead to lack of agreement will be explored as well. Trial registration Clinical Trials ( ClinicalTrials.gov ), NCT03865316 . Registered on 4 February 2019 – retrospectively registered. Sponsor: Masimo Corporation. |
| first_indexed | 2024-12-13T12:48:48Z |
| format | Article |
| id | doaj.art-5ce37cbb09c54bef890d3cc0f6fcf700 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-12-13T12:48:48Z |
| publishDate | 2021-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-5ce37cbb09c54bef890d3cc0f6fcf7002022-12-21T23:45:25ZengBMCBMC Anesthesiology1471-22532021-04-012111910.1186/s12871-021-01326-5Simultaneous comparison of depth of sedation performance between SedLine and BIS during general anesthesia using custom passive interface hardware: study protocol for a prospective, non-blinded, non-randomized trialJames Harvey Jones0Vinay Ravikumar Nittur1Neal Fleming2Richard L. Applegate3Department of Anesthesiology and Pain Medicine, University of California Davis Medical CenterDepartment of Anesthesiology and Pain Medicine, University of California Davis Medical CenterDepartment of Anesthesiology and Pain Medicine, University of California Davis Medical CenterDepartment of Anesthesiology and Pain Medicine, University of California Davis Medical CenterAbstract Background Intraoperative brain function monitoring with processed electroencephalogram (EEG) indices, such as the bispectral index (BIS) and patient state index (PSI), may improve characterization of the depth of sedation or anesthesia when compared to conventional physiologic monitors, such as heart rate and blood pressure. However, the clinical assessment of anesthetic depth may not always agree with available processed EEG indices. To concurrently compare the performance of BIS and SedLine monitors, we present a data collection system using shared individual generic sensors connected to a custom-built passive interface box. Methods This prospective, non-blinded, non-randomized study will enroll 100 adult American Society of Anesthesiologists (ASA) class I-III patients presenting for elective procedures requiring general anesthesia. BIS and SedLine electrodes will be placed preoperatively according to manufacturer recommendations and their respective indices tracked throughout anesthesia induction, maintenance and emergence. The concordance between processed EEG indices and clinical assessments of anesthesia depth will be analyzed with chi-square and kappa statistic. Discussion Prior studies comparing brain function monitoring devices have applied both sensors on the forehead of study subjects simultaneously. With limited space and common sensor locations between devices, it is not possible to place both commercial sensor arrays according to the manufacturer’s recommendations, thus compromising the validity of these comparisons. This trial utilizes a custom interface allowing signals from sensors to be shared between BIS and SedLine monitors to provide an accurate comparison. Our results will also characterize the degree of agreement between processed EEG indices and clinical assessments of anesthetic depth as determined by the anesthesiologists’ interpretations of acute changes in blood pressure and heart rate as well as the administration, or change to the continuous delivery, of medications at these timepoints. Patient factors (such as burst suppression state or low power EEG conditions from aging brain), surgical conditions (such as use of electrocautery), artifacts (such as electromyography), and anesthesia medications and doses (such as end-tidal concentration of volatile anesthetic or hypnotic infusion dose) that lead to lack of agreement will be explored as well. Trial registration Clinical Trials ( ClinicalTrials.gov ), NCT03865316 . Registered on 4 February 2019 – retrospectively registered. Sponsor: Masimo Corporation.https://doi.org/10.1186/s12871-021-01326-5Bispectral index (BIS)Patient state index (PSI)SedLineProcessed electroencephalogram (EEG)Depth of anesthesiaDepth of sedation |
| spellingShingle | James Harvey Jones Vinay Ravikumar Nittur Neal Fleming Richard L. Applegate Simultaneous comparison of depth of sedation performance between SedLine and BIS during general anesthesia using custom passive interface hardware: study protocol for a prospective, non-blinded, non-randomized trial BMC Anesthesiology Bispectral index (BIS) Patient state index (PSI) SedLine Processed electroencephalogram (EEG) Depth of anesthesia Depth of sedation |
| title | Simultaneous comparison of depth of sedation performance between SedLine and BIS during general anesthesia using custom passive interface hardware: study protocol for a prospective, non-blinded, non-randomized trial |
| title_full | Simultaneous comparison of depth of sedation performance between SedLine and BIS during general anesthesia using custom passive interface hardware: study protocol for a prospective, non-blinded, non-randomized trial |
| title_fullStr | Simultaneous comparison of depth of sedation performance between SedLine and BIS during general anesthesia using custom passive interface hardware: study protocol for a prospective, non-blinded, non-randomized trial |
| title_full_unstemmed | Simultaneous comparison of depth of sedation performance between SedLine and BIS during general anesthesia using custom passive interface hardware: study protocol for a prospective, non-blinded, non-randomized trial |
| title_short | Simultaneous comparison of depth of sedation performance between SedLine and BIS during general anesthesia using custom passive interface hardware: study protocol for a prospective, non-blinded, non-randomized trial |
| title_sort | simultaneous comparison of depth of sedation performance between sedline and bis during general anesthesia using custom passive interface hardware study protocol for a prospective non blinded non randomized trial |
| topic | Bispectral index (BIS) Patient state index (PSI) SedLine Processed electroencephalogram (EEG) Depth of anesthesia Depth of sedation |
| url | https://doi.org/10.1186/s12871-021-01326-5 |
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