Bispectral Index Monitoring for Nurse-Administered Propofol Sedation During Upper Endoscopic Ultrasound: A Prospective, Randomized Controlled Trial

Abstract

Bispectral index monitoring (BIS) is a quantitative assessment of brain cortical activity. The aim of this study was to determine if BIS-guided nurse-administered propofol sedation would decrease by > or = 20% both recovery time and propofol dose compared to standard propofol sedation for endoscopic ultrasound (EUS). Prospectively, eligible outpatients were randomized to BIS-guided or standard propofol sedation during EUS. Propofol was given by nurses in intermittent boluses with sedation targeted at a BIS score of < 65-75. For the control group, the nurse was blinded to BIS scores and sedation was titrated to a modified observer's assessment of alertness/sedation scale (MOAA/S) score < or = 3. Of 50 patients enrolled, data for 44 randomized to BIS-guidance (n = 24) and the control group (n = 20) were evaluated. Between the BIS-guided and control group there was no difference between the mean procedure duration, total propofol dose, recovery time, mean intraoperative MOAA/S, and mean BIS score. Compared to standard propofol sedation for EUS, BIS-guided propofol sedation offers no significant decrease in postprocedure recovery times or propofol doses.

Titrated Sedation with Propofol for Medical Thoracoscopy: A Feasibility and Safety Study

“…Since that time, propofol has emerged as a drug of choice for managing sedation, given its excellent safety profile and ease of titration to the desired level of sedation even by nonanesthesiologists [12,13]. In contrast to gastroenterologists or cardiologists, chest physicians are well qualified to control ventilation and manage the upper airways in case of sudden respiratory depression.…”

“…In contrast, MT is routinely performed by chest physicians under light sedation (or so-called ‘conscious sedation’) in spontaneously breathing patients in facilities outside the costly environment of operating rooms [5,6,7,8]. Among nonanesthesiologists, midazolam remains the preferred sedative drug, although gastrointestinal endoscopists have gained much experience with the administration of propofol [9,10,11,12,13]. In patients undergoing flexible bronchoscopy, preliminary results also support the feasibility, safety and potential advantages of propofol sedation compared with midazolam [14,15,16,17].…”

Bispectral Index Monitoring Reduces the Dosage of Propofol and Adverse Events in Sedation for Endobronchial Ultrasound

“…Monitoring of the depth of anesthesia using the bispectral index (BIS) [29,30] allows us to objectively evaluate the level of sedation achieved and prevent the adverse events of overdose [31,32]. The BIS monitor has been found to be useful for dosing drugs and reducing recovery time in patients under sedation in diagnostic and therapeutic procedures [33,34,35]. In fiberoptic bronchoscopy, it has been estimated that BIS levels for appropriate sedation are between 65 and 85 [36,37,38,39], and its ability to reduce the dose of sedatives has not been demonstrated [39].…”

Extended Monitoring of the Sedated Patient: Bispectral Index, Narcotrend® and Automated Responsiveness Monitor

“…There was a substantial time lag between the decrease of the BIS level below 70 and the respective clinical findings, indicative of a deeper sedation state. These observations were confirmed when using BIS monitoring during nurse-administered propofol sedation for endoscopic ultrasound examinations [7]. An insufficient sensitivity of the BIS to predict the clinically determined patient’s consciousness was also observed in another study using sedation with midazolam and meperidine for colonoscopy [8].…”