Monitoring the Level of Anesthesia and Sedation in Children — An Overview

Abstract

Anesthesia is a balance between the amount of anesthetic drugs administered and the state of arousal of the patient. A large number of variables can interfere with the conduction of anesthesia, such as age, concomitant disease or therapies, physiological parameters and human variability. Moreover, clinical signs, such as blood pressure and heart rate, are routinely used by anesthesiologists to monitor anesthetic depth, but such methods are unreliable. Furthermore, patient movement in response to noxious stimulation remains an important sign of inadequate anesthetic dosage, but is unreliable and is suppressed by paralysis. As a consequence, an imbalance between anesthetic requirement and anesthetic drug administration is not uncommon. Under-dosing of anesthetic drugs may be caused by equipment failure or error. Conversely, over-dosing of the hypnotic components, leading to an excessive depth of anesthesia, might compromise patient outcome. How can the “depth of anesthesia” be measured and monitored? Several devices tested in adults with promising results have been recently introduced in clinical practice. Much more difficult is monitoring in the pediatric age group and the interpretation of data derived from such monitoring.