Bispectral Index Monitoring During the Administration of Neuromuscular Blocking Agents in the Pediatric Intensive Care Unit Patient

Bispectral index (BIS) values were prospectively recorded in pediatric intensive care unit patients receiving continuous infusion of a neuromuscular blocking agent. Sedation was provided by a continuous infusion of midazolam or propofol. The BIS number was recorded by a bedside computer every 10 seconds but was concealed from health care workers. BIS values were recorded for 476 hours (161 893 BIS values) in 12 patients. The BIS number was 50 to 70, 57% of the time; ≤49, 35% of the time; and ≥71, 8% of the time. When supplemental doses of sedatives were administered, the BIS number was >70, 64% of the time; 50 to 70, 31% of the time; and ≤49, 5% of the time. Oversedation was more likely with propofol than midazolam. During the use of neuromuscular blocking agents, oversedation is a common occurrence. Physiologic parameters are not an accurate means of assessing the depth of sedation.