Monitoring brain activity using Pediatric Sedation State Scale, Patient State Index and Near-Infrared Spectroscopy during procedural sedoanalgesia in pediatric patients

Pediatric patients frequently require painful and invasive procedures as part of their diagnostic and therapeutic treatment. The aim of our study was to evaluate different scales to monitor cerebral activity, namely Pediatric Sedation State Scale (PSSS), Patient State Index (PSI) and Near-Infrared Spectroscopy (NIRS) to identify their usefulness and reliability during sedoanalgesia in pediatric patients. Thirty-five patients were included in our study and underwent 77 sedo-analgesia sessions. Overall, 90 painful or invasive procedures were performed. Subgroups treated with the combination of ketamine and propofol (KET+PPF) and Fentanyl and Propofol (FNT+PPF) were compared. Administration of a single bolus of PPF significantly reduced PSI >5% in 66.7% of cases. Instead, KET and FNT did not influence PSI. Interestingly, a PSI < 70 correlated with reduced perception of the painful stimulus. The combination of FNT+PPF was more frequently associated to PSI values between 30 and 70, as well as to lower PSI values (<70) compared to KET+PPF (p=<0.001, p=<0.001). We did not observe significant variations in NIRS values during the procedure. In our study, we observed that all the scales may give specific information from different points of view. PSSS is a behavioral scale which gave information about safety and adequacy of sedation. PSI was altered by the administration of drugs and the application of noxious stimuli, reflecting patient’s state of consciousness. NIRS technology reflects brain oxygenation, and in our study testified that no dangerous cerebral desaturation happened.