Electroencephalographic Narcotrend Index monitoring during procedural sedation and analgesia in children

Background: The electroencephalographic Narcotrend Index (NI) may potentially help to titrate sedative medication during diagnostic and therapeutic procedures in children.

Methods: With local ethics committee approval and informed parental consent, 31 patients, aged 8.9 ± 4.3 years, scheduled for elective upper gastrointestinal endoscopy were enrolled in this prospective, double-blinded observational study. Initially, patients received a single dose of intravenous piritramide 0.1 mg·kg⁻¹, followed by propofol 2 mg·kg⁻¹ and, if necessary, additional propofol doses (0.5 mg·kg⁻¹) to achieve and maintain a level of deep sedation throughout the procedure. Sedation was assessed by the University of Michigan Sedation Scale (UMSS). We investigated the relationship between depth of sedation, and the NI, and the classical EEG parameters (cEEG), total EEG power (Power), spectral edge (SEF) and median frequency, and relative power in the beta, alpha, theta and delta bands. The performance of the NI and cEEG parameters was evaluated by prediction probability (P_K), receiver operating characteristic (ROC) and Spearman rank order correlation analysis.

Results: Mean P_K values for NI (0.88) vs UMSS were higher than for the other cEEG parameters, except for Power (0.82) and SEF(0.81). Spearman correlation analysis revealed superiority of the NI over all cEEG parameters. The area under the curve for the NI was 0.93, which was superior to all other EEG parameters beside Power (0.86) and relative power in alpha (0.82).

Conclusions: The results of this study suggest that the NI may be an objective nondisruptive tool for assessment of hypnotic depth in children under propofol-induced procedural sedation.