Anesthesiologists used less sevoflurane to maintain adequate anesthesia in children monitored with Masimo SedLine
Masimo announced the results of a randomized controlled study published in the Journal of Clinical Anesthesia . In this study, Drs. Melody HY Long and colleagues from Singapore’s KK Women’s and Children’s Hospital demonstrated the ability of electroencephalogram-guided (EEG) anesthesia using Masimo SedLine ® brain function monitoring to reduce the amount of the drug sevoflurane needed to maintain anesthesia in pediatric patients undergoing surgery undergo a minor operation is necessary. 1They concluded that the use of SedLine to manage anesthesia reduced the need for sevoflurane and resulted in a reduced incidence of burst suppression, previously reported to be associated with postoperative delirium.
“We believe that the significant reduction in burst suppression observed in the EEG group – less than a third of the amount in the control group – is an important finding. This could show deeper utility for the results in future studies with larger samples.”
Because the infant brain is still developing, current anesthetic practice aims to minimize the dosage of drugs needed to maintain anesthesia, and the use of new technologies such as real-time EEG spectrogram monitoring in children has not yet been adequately explored the researchers conducted a study to examine what impact such a technology could have. They studied 195 children aged 1 to 6 years who were scheduled for minor surgery in which general anesthesia with sevoflurane was initiated and maintained. The children were randomly assigned to either a Masimo SedLine EEG group (n=100) or a standard of care group (n=95). In the SedLine EEG group, the anesthesiologists used SedLine to guide the administration of sevoflurane with the aim of maintaining continuous slow/delta oscillations in the raw EEG and spectrogram, avoiding burst suppression and achieving a Patient State Index (PSi) – one of Masimo developed EEG parameter – to keep between 25 and 50. In the standard of care group, physicians were blinded to the EEG data.
Investigators assessed the mean end-tidal concentration of sevoflurane used during induction and maintenance of anesthesia as a primary outcome. They found that in the EEG group, concentration increased both during induction (4.80% vs. 5.67% in the control group, p=0.003) and during maintenance of anesthesia (2.23% vs. 2nd .38%, p=0.005) was lower. As one of the secondary findings, the researchers compared the frequency and duration of intraoperative burst suppression and found that the EEG group had a lower incidence of burst suppression (3.1% vs. 10.9% in the control group, p=0 .0440).
The authors concluded: “This is one of the first randomized controlled trials in the pediatric population to show that EEG-guided anesthesia delivery using the spectrogram is feasible and results in modest reductions in intraoperative doses of sevoflurane for induction and maintenance in young children.” at the age of 1 to 6 years. EEG guidance makes it possible to visualize the changes in the brain caused by anesthesia in real time, identifying which individuals need more (or less) anesthetic to maintain unconsciousness and adjusting the dose accordingly. This could be particularly important for children aged 1 to 2 years, who appear to require higher concentrations of sevoflurane during surgery and in patients at risk of neurological damage. Our results highlight the importance of EEG monitoring as an adjunct to current standard ASA monitors to ensure personalized anesthesia care.”
William C. Wilson, MD, MA, CMO and SVP of Clinical Research and Medical Affairs at Masimo, noted, “We believe that the significant reduction in burst suppression observed in the EEG group — less than a third of the amount in the control group – is an important finding. This could show deeper utility for the results in future studies with larger samples.”
SedLine is currently indicated in the US for pediatric use without the PSi parameter.
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About Masimo
Masimo (Nasdaq: MASI) is a global medical technology company that designs and manufactures a wide range of industry-leading monitoring technologies, including innovative measurements, sensors, patient monitoring devices, and automation and connectivity solutions. Our mission is to improve patient outcomes and reduce the cost of care. Masimo SET ® Measure-through Motion and Low Perfusion™ pulse oximetry was first introduced in 1995 and has been shown in over 100 independent, objective studies to outperform other pulse oximetry technologies. 8 Masimo SET ® has also been proven to help clinicians reduce severe retinopathy of prematurity in newborns,9 Improving neonatal CCHD screening 10 and when used for continuous monitoring with Masimo Patient SafetyNet™ in postoperative wards, reducing emergency team activations, ICU transfers and lowering costs. 11-14 Masimo SET ® is estimated to serve more than 200 million patients in leading hospitals and other care settings worldwide 15 and is the primary pulse oximetry in nine of the top ten hospitals included in the US News and World Report are listed. 16 Masimo refines SET ®continues and announced in 2018 that the SpO 2 accuracy of RD-SET ® sensors during motion had improved significantly. Clinicians can be even more confident that the SpO 2 values they rely on accurately reflect a patient’s physiological status. In 2005, Masimo introduced rainbow ® pulse CO-oximetry technology . This enabled non-invasive, continuous monitoring of the blood components, which previously required invasive interventions: hemoglobin content (SpHb ® ), oxygen content (SpOC™), carboxyhemoglobin (SpCO ® ), methemoglobin (SpMet ®), Pleth Variability Index (PVi ® ), RPVi™ (rainbow ® PVi) and Oxygen Reserve Index (ORi™). In 2013, Masimo introduced the Root ® platform for patient monitoring and connectivity. It was designed from the start to be as flexible and extensible as possible to add other monitoring technologies from Masimo and other vendors. Key additions from Masimo include Next Generation SedLine ® brain function monitoring , O3 ® regional oximetry and ISA™ capnography with NomoLine ® sampling lines. Join the Masimo family of Pulse CO-Oximeters ®for continuous or random monitoring include devices designed for use in a variety of clinical and non-clinical scenarios, such as: Examples include wireless, handheld technologies like the Radius-7 ® and Radius PPG™, handheld devices like the Rad-67 ® , fingertip pulse oximeters like the MightySat ® Rx, and devices like the Rad-97 ® that are designed for hospital or home use are available at home. Masimo’s hospital automation and connectivity solutions are centered on Masimo’s Hospital Automation™ platform and include Iris ® Gateway, iSirona™, Patient SafetyNet, Replica ® , Halo ION™, UniView ®, UniView :60™ and Masimo SafetyNet ® . In 2022, Masimo acquired Sound United, a leading developer of premium consumer sound and home integration technologies, to its brands Bowers & Wilkins ® , Denon ® , Polk Audio ® , Marantz ® , Definitive Technology ® , Classé ® and Boston Acoustics ® belong. For more information about Masimo and the company’s products, visit www.masimo.com . For published clinical studies on Masimo products, visit www.masimo.com/evidence/featured-studies/feature/ .
