Processed <scp>EEG</scp> Monitoring During Pediatric Procedural Sedation: Correlation Between the Narcotrend Index and the Pediatric Sedation State Scale

BACKGROUND: Objective assessment of sedation depth in children undergoing procedural sedation while maintaining spontaneous breathing and protective reflexes can be challenging. Processed electroencephalogram (pEEG) monitoring systems such as the Narcotrend monitor may provide continuous information regarding the depth of sedation. The aim of this study was to investigate the correlation between the Narcotrend Index (NI) and the Pediatric Sedation State Scale (PSSS) during procedural sedation with propofol and fentanyl in children. METHODS: Children and adolescents aged 6 months to 17 years undergoing procedural sedation with propofol and fentanyl in the procedure room of a pediatric intensive care unit were included. Sedation depth was assessed using the Narcotrend monitor and the Pediatric Sedation State Scale. Spearman's rank correlation coefficient was calculated to evaluate the relationship between the NI and PSSS. RESULTS: A total of 311 paired measurements (NI and PSSS) from 29 patients were analyzed. Spearman's rank correlation analysis demonstrated a moderate to good correlation between the NI and PSSS (r = 0.61; 95% CI 0.54-0.68; p < 0.0001). The median NI corresponding to the desired deep sedation level (PSSS 2) was 39 (IQR 30-50), with a 95% confidence interval for the median of 36-42. CONCLUSION: The Narcotrend Index demonstrated an acceptable correlation with the Pediatric Sedation State Scale. Processed EEG monitoring using the Narcotrend Index may therefore represent a useful adjunct to clinical monitoring for avoiding both over-sedation and inadequate sedation in children, particularly for less experienced sedation providers. TRIAL REGISTRATION: German Clinical Trials Register: DRKS00033129.