BIS-monitored Sedation With Midazolam In Children Undergoing ASD Or VSD Neoplasty Operation And Cardiopulmonary Bypass(CPB)

Objective The purpose of this study was to assess the different dose midazolam (0.1mg/kg or 0.2mg/kg) were given in children undergoing ASD or VSD neoplasty and cardiopulmonary bypass(CPB) at 10 min before CPB.There were monitored SP, DP, MAP,HR and BIS before CPB, BIS, AQ and PP were monitored during CPB. To evaluate the effect of different dose midazolam through the change of bispectral index(BIS) during cardiopulmonary bypass(CPB), which is to establish a safe and effective dosage of the midazolam for sedation of children during CPB.To investigate the feasibility of BIS response to the depth of anesthesic sedation in children undergoing ASD or VSD neoplasty operation and CPB.Methods Forty-five ASAⅡorⅢpatients of both sexes (23 male, 22 female) aged 6 months to 3 years scheduled for elective ASD or VSD neoplasty and CPB. 45 patients were involved and divided into three groups randomly: group A(blank), 15 patients; group B(0.1mg/kg midazolam injected i. V.over 20 seconds),15 patients; group C(0.2 mg/kg midazolam injected i.v.over 20 seconds), 15 patients. The patients were premedicated intramuscular ketamine 6 mg/kg. Anesthesia was induced with midazolam 0.2mg/kg, fentanyl 10ug/kg, vecuronium 0.1mg/kg and maintained with 1%～1.5% isoflurane. At 15 min before CPB, isoflurane inhalation were stopped. At 10 min before CPB, group B were given 0.1mg/kg midazolam, group C were given 0.2mg/kg midazolam, group A were given normal saline 2 mL. BIS, SP, DP, MAP and HR were recorded at 10 min before CPB (T0, baseline), 7 min before CPB, 5 min before CPB (T1,T2 ), immediately CPB to end(T12). BIS, PP and AQ were recorded at immediately started CPB (T3), cooling to 36℃, 34℃, 32℃, 30℃(T4-T7). Immediately rewarming (T8), rewarming to 32℃,34℃,36℃(T9-T11), The temperature was nasal temperature.Results 1 At T2(5 min before CPB) in group C Bispectral index (BIS) was significantly decreased than group B( P<0.05), at T2(5 min before CPB) in group B BIS was significantly decreased than group A( P < 0.05); at T3 (immediately started CPB) in group C BIS was significantly decreased than group A, group B( P<0.05); at T9 ( rewarming to 32℃) in group A BIS was significantly high than group C( P<0.05); at T10 ( rewarming to 34℃) in group A BIS as significantly high than group B,group C( P<0.05); at T11 (rewarming to 36℃) in group A BIS was significantly high than B group( P<0.05), in group B BIS was significantly high than group C( P < 0.05).BIS in group A at T3-10 was significantly decreased than at T2, T3,4 compared to T7 was significantly high( P < 0.05). T9-11compared to T7 was significantly high( P<0.05). In group B BIS was significantly degraded at T2 than T0, at T4-11 was significantly decreased than at T2, at T3,4 was significantly high than at T7( P<0.05).In group C BIS was significantly degraded at T1,2 than T0, at T7-9 was significantly decreased than at T3. ( P<0.05).2. At T0-2 , there were no significant difference of SP, DP, MAP and HR among three groups(P>0.05).3. At T3-11 , there were no significant difference of PP and AQ among three groups(P>0.05) .conclusions 1 Minitoring BIS was available to detect the depth sedation of midazolam,immediately to response the depth anesthesia, to guide anesthetists about drug administration, to prevent lighter anesthesia in children undergoing ASD or VSD neoplasty and cardiopulmonary bypass . 2 0.2mg/kg midazolam was applied, which can maintain depth of sedation steady and do not effect of cardiovascular system during CPB in children undergoing ASD or VSD neoplasty and cardiopulmonary bypass (CPB). 3 BIS was influented obviously by CPB and temperature change, especially during cooling in children undergoing ASD or VSD neoplasty and cardiopulmonary bypass(CPB).