{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T06:12:40Z","timestamp":1788502360974,"version":"build-2803163510"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Background<\/jats:title>\n Both the Bispectral Index (BIS) and the Modified Observer\u2019s Assessment of Alertness\/Sedation (MOAA\/S) scale are commonly used to evaluate the depth of anesthesia in studies investigating the effective dosing of remimazolam. However, their correlation remains unclear. This prospective observational study aimed to characterize the correlation between BIS values and MOAA\/S scores during induction of anesthesia with remimazolam\u2013sufentanil in elderly and non-elderly patients.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Sixty patients were enrolled and stratified into elderly and non-elderly cohorts (\n n<\/jats:italic>\n = 30 each). All participants received intravenous sufentanil (0.1 \u03bcg\/kg), followed by remimazolam infusion (0.16 mg\/kg in elderly patients; 0.22 mg\/kg in non-elderly patients). BIS values and corresponding MOAA\/S scores were recorded at 1-min intervals for 5 min after induction. The minimum BIS value and its corresponding MOAA\/S score were also captured. Spearman\u2019s rank correlation and Cohen\u2019s kappa coefficient were used to assess the relationship and agreement between BIS &lt; 60 and MOAA\/S = 0. A generalized linear mixed model (GLMM) was applied to evaluate the association between BIS and the probability of deep sedation (MOAA\/S = 0).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The correlation between BIS and MOAA\/S showed a dynamic pattern, demonstrating a moderate association at the initiation of induction (T1;\n r<\/jats:italic>\n = 0.681,\n p<\/jats:italic>\n &lt; 0.001) that progressively weakened over time. The area under the receiver operating characteristic curve (AUC) of BIS for predicting deep sedation (MOAA\/S = 0) was 0.635 in elderly patients and 0.780 in non-elderly patients. The GLMM identified a significant non-linear association between BIS and the probability of deep sedation (\u03c7\n 2<\/jats:sup>\n (1) = 6.62,\n p<\/jats:italic>\n = 0.010). Overall agreement between BIS and MOAA\/S was slight (\u03baappa = 0.175).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Bispectral Index and MOAA\/S exhibit a complex non-linear relationship and slight concordance during induction with remimazolam\u2013sufentanil.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2026.1877209","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:29:43Z","timestamp":1788499783000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["An evaluation of the relationship between BIS and MOAA\/S during remimazolam-sufentanil induction: a prospective observational study"],"prefix":"10.3389","volume":"13","author":[{"given":"Jun-li","family":"Zheng","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, The First People\u2019s Hospital of Lin-ping District","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Cai","sequence":"additional","affiliation":[{"name":"The Fourth Clinical Medical College, Zhejiang Chinese Medicine University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun-xia","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The First People\u2019s Hospital of Lin-ping District","place":["Hangzhou, China"]},{"name":"The Fourth Clinical Medical College, Zhejiang Chinese Medicine University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The First People\u2019s Hospital of Lin-ping District","place":["Hangzhou, China"]},{"name":"The Fourth Clinical Medical College, Zhejiang Chinese Medicine University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao-dong","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Hangzhou Women\u2019s Hospital (Hangzhou Maternity and Child Health Care Hospital)","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-long","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Hangzhou Women\u2019s Hospital (Hangzhou Maternity and Child Health Care Hospital)","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen-feng","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Affiliated Hangzhou First People\u2019s Hospital, School of Medicine, Westlake University (The Forth Clinical Medical College, Zhejiang Chinese Medicine University)","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1221","DOI":"10.2147\/DDDT.S453440","article-title":"Clinical application and research progress of remimazolam for pediatric patients.","volume":"18","author":"Bai","year":"2024","journal-title":"Drug Des Devel Ther"},{"key":"B2","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1186\/s12871-023-02095-z","article-title":"Effect of remimazolam versus propofol for the induction of general anesthesia on cerebral blood flow and oxygen saturation in elderly patients undergoing carotid endarterectomy.","volume":"23","author":"Gao","year":"2023","journal-title":"BMC Anesthesiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s44254-025-00160-z","article-title":"Efficacy of remimazolam versus midazolam for outpatient dental sedation: a multicenter, randomized, controlled, non-inferiority trial.","volume":"4","author":"Liu","year":"2026","journal-title":"Anesthesiol Perioperat Sci"},{"key":"B4","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1213\/ANE.0b013e31823f0c28","article-title":"A placebo- and midazolam-controlled phase I single ascending-dose study evaluating the safety, pharmacokinetics, and pharmacodynamics of remimazolam (CNS 7056): part I. 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