Correlation of Comfort Score and Narcotrend Index during Procedural Sedation with Midazolam and Propofol in Children

Nora Bruns; Carolina A Joist; Constantin M Joist; Anna Daniels; Ursula Felderhoff-Müser; Christian Dohna-Schwake; Eva Tschiedel

doi:10.3390/jcm13051483

Correlation of Comfort Score and Narcotrend Index during Procedural Sedation with Midazolam and Propofol in Children

J Clin Med. 2024 Mar 4;13(5):1483. doi: 10.3390/jcm13051483.

Authors

Nora Bruns^{1

2}, Carolina A Joist^{1

2}, Constantin M Joist^{1

2}, Anna Daniels^{1

2}, Ursula Felderhoff-Müser^{1

2}, Christian Dohna-Schwake^{1

2}, Eva Tschiedel^{1

2}

Affiliations

¹ Department of Pediatrics I, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany.
² Center for Translational Neuro- and Behavioural Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany.

Abstract

Background/Objectives: Precise assessment of hypnotic depth in children during procedural sedation with preserved spontaneous breathing is challenging. The Narcotrendindex (NI) offers uninterrupted information by continuous electrocortical monitoring without the need to apply a stimulus with the risk of assessment-induced arousal. This study aimed to explore the correlation between NI and the Comfort Scale (CS) during procedural sedation with midazolam and propofol and to identify an NI target range for deep sedation. Methods: A prospective observational study was conducted on 176 children (6 months to 17.9 years) undergoing procedural sedation with midazolam premedication and continuous propofol infusion. Statistical analyses included Pearson correlation of NI and CS values, logistic regression, and receiver operating curves. Results: Median NI values varied with CS and age. The correlation coefficient between CS and NI was 0.50 and slightly higher in procedure-specific subgroup analyses. The optimal NI cut-off for deep sedation was between 50 and 60 depending on the analyzed subgroup and displayed high positive predictive values for sufficient sedation throughout. Conclusion: Our study found a moderate correlation between NI and CS, demonstrating reliable identification of adequately sedated patients.

Keywords: Comfort scale; Narcotrend index; children; depth of sedation; midazolam; procedural sedation; propofol; sedation monitoring.

Grants and funding

The study received funding from the Stiftung Universitätsmedizin Essen and the Medical Faculty of the University of Duisburg-Essen (Josepha and Charlotte von Siebold program). NB received funding from the Medical Faculty of the University of Duisburg-Essen (IFORES, grant number D/107-41020). The manufacturer of the Narcotrend monitor (MT Monitortechnik, Bad Bramsted, Germany) provided two BrainTrend devices with appropriate software to conduct Narcotrend monitoring for the duration of the study. The devices were later purchased for continued clinical use by the Department of Pediatrics I at the University Hospital Essen. None of the funders was involved in the study design, analyses, interpretation or drafting of the manuscript. The content of this manuscript has not been subject to any kind of influence by the manufacturer of the Narcotrend monitor.