The evaluation of propofol dosage for anesthesia induction in children with cerebral palsy with bispectral index (BIS) monitoring

Background: We designed a randomized prospective study to investigate whether developmentally delayed children with cerebral palsy (CP) need a lower dosage of propofol for induction than normal children using bispectral index (BIS) monitoring criteria. Methods: After approval by the University Ethical Committee and written informed consent obtained from parents, 20 children with noncommunicative/nonverbal CP and 20 normal children requiring general anesthesia for elective orthopedic surgery were enrolled in the study. The patients were not premedicated. BIS leads were placed before the induction of anesthesia. Propofol was administered at a rate of 20 mg center dot 30 s(-1) (i.e. 40 mg center dot min(-1)).When BIS value had reached a steady number of 35-45, infusion was stopped. Results: There was no significant difference between Group N and Group CP in age and sex distribution (P > 0.05), however children in Group CP weighed less than Group N (P = 0.05). The propofol dosage for induction was significantly lower in Group CP than Group N (P = 0.03). There were no differences in propofol doses administered to children using anticonvulsants and those not on anticonvulsants in Group CP. BIS values were comparable between the two groups (i.e. Group N and Group CP) at baseline and after propofol administration. Conclusions: Our data suggest that noncommunicative/nonverbal children with CP require less propofol to obtain the same BIS values (i.e. 35-45) than do otherwise healthy children.