Anesthesia depth monitoring in children

Nadzor nad dubinom anestezije nužan je kako bi se izbjegle sve posljedice neadekvatne dubine anestezije. Iako nema zamjene za iskusnog anesteziologa koji izravno prati bolesnikove vitalne funkcije tijekom kirurškog zahvata, monitoriranje vrijednosti bispektralnog indeksa omogućava procjenu dubine anestezije i time smanjuje incidenciju budnosti, olakšava doziranje lijekova te ubrzava vrijeme opravka uključujući i vrijeme ekstubacije. Cilj ovoga rada bio je usporediti vrijeme ekstubacije u bolesnika u kojih je dubina anestezije nadzirana pomoću bispektralnog indeksa (BIS) i bolesnika u kojih je dubina anestezije praćena pomoću kliničkih znakova i vitalnih parametara. Istraživanje je provedeno u Zavodu za dječju anesteziologiju, reanimatologiju i intenzivnu medicinu u Klinici za dječje bolesti Zagreb, na uzorku od 20 djece, dobi od 6 do 12 godina, s postavljenom dijagnozom akutne upale crvuljka podvrgnutih zahvatu apendektomije. Za uvod u anesteziju u obje skupine korišten je propofol, fentanil i rokuronij. Održavanje anestezije postignuto je smjesom sevoflurana, kisika i dušičnog oksidula te eventualno dodatno potrebitom primjenom fentanila i rokuronija. Vrijeme ekstubacije u skupini djece nadziranoj prema vrijednosti BIS-a iznosilo je 2,30±0,95 min, dok je u skupini djece nadziranoj pomoću kliničkih i vitalnih parametara bilo 6,30±2,41 min. Vrijednost t-testa ( t=4,891; df=11,732) i testa statističke značajnosti (p=0,00034) pokazale su da je razlika između grupa statistički značajna, na razini p<0,01.Monitoring the depth of anaesthesia is necessary in order to avoid possible consequences of inadequate depth of anaesthesia. Although there is no substitution for an experienced anaesthesiologist who directly monitors patient`s vital functions during surgical procedure, monitoring the value of bispectral index allows evaluation of the depth of anaesthesia, decreases the incidence of awareness, facilitates the dosage of medications and accelerates recovery time including extubation time. The main goal of this thesis was to compare the extubation time in patients whose depth of anaesthesia was monitored by bispectral index (BIS) and patients whose depth of anaesthesia was monitored by clinical signs and vital parameters. The research was conducted at the Department of Pediatric Anesthesiology, Reanimation and Intensive Medicine at the Children's Hospital Zagreb. It was conducted on the sample of 20 children, ages 6 to 12, diagnosed with acute appendicitis and undergone appendectomy. Propofol, fentanyl and rocuronium were used for induction of anaesthesia in both groups. Maintenance of anaesthesia was achieved with a mixture of sevoflurane, oxygen and nitrogen oxide, as well as with the additional application of fentanyl and rocuronium if necessary. The extubation time in a group of children monitored by BIS value was 2,30±0,95 min while in a group of children monitored by clinical and vital paremeters extubation time was 6,30±2,41 min. The values of t-test ( t=4,891; df=11,732) and probability test (p=0,00034) have shown that the difference between groups is statistically significant, with p