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

Abstract

Background: Current guidelines recommend monitoring the anesthetic depth of sedation during respiratory endoscopy by using clinical scales despite their subjective nature and the potential change in the level of sedation caused by frequent stimulation. Monitoring by means of the bispectral index (BIS) has shown its utility in reducing the use of drugs and their adverse events in general anesthesia, but evidence in prolonged sedation is insufficient. Objective: Our objective was to evaluate BIS in patients undergoing endobronchial ultrasound (EBUS). Methods: A randomized cohort study of 90 patients with mediastinal lymph node involvement and/or lung or mediastinal lesions for whom EBUS was indicated, comparing the modified observer's assessment of alertness/sedation scale clinical evaluation (n = 45) versus the BIS evaluation (n = 45) of sedation with propofol-remifentanil, was conducted in order to evaluate the clinical parameters, doses used, adverse events, and tolerance of the procedure. Results: We found a shorter waking time and a significantly lower dose of total propofol in the BIS group. Significantly fewer overall adverse events were recorded in the BIS group and included desaturation, hypotension, and bradypnea. Tolerance was better in the BIS group. No significant differences were found in terms of cough, memory of the procedure, or the level of difficulty of EBUS on the part of the pulmonologists. Conclusions: BIS monitoring of sedation in EBUS makes it possible to reduce the dosage of propofol, thereby shortening the waking time and reducing adverse events. This form of monitoring should be taken into consideration in the future for systematic use in prolonged sedation, as in the case of EBUS.

High-Flow Nasal Cannula and Mandibular Advancement Bite Block Decrease Hypoxic Events during Sedative Esophagogastroduodenoscopy: A Randomized Clinical Trial

“…The MA group demonstrated significantly less AUC Desat , while decreasing airway obstruction and hypoxic events. The percentage of patients using the standard bite block with airway obstruction and hypoxic events was compatible with previous studies of 60~95% and 47~80%, respectively [8, 9, 30].…”

“…Sedation using common medications such as midazolam, opioids, and propofol causes respiratory depression, hypoventilation, and subsequent hypoxemia [7]. Airway management is crucial during deep sedation, since desaturation is noted in up to 60% of patients [8] and as high as 95% of patients have different degrees of airway obstruction [9]. During deep sedation, the laryngeal muscle loses tone, causing partial or complete upper airway obstruction [10].…”

Effects of electroencephalography and regional cerebral oxygen saturation monitoring on perioperative neurocognitive disorders: a systematic review and meta-analysis

“…Furthermore, higher incidence or longer duration of burst suppression are significantly associated with the incidence of POD [ 55 , 56 ]. On the other hand, the use of EEG monitoring also reduced the dosage of general anesthetics, such as volatile agents and propofol [ 57 , 58 ]. Previous studies have reported that excessively exposure to potent volatile agents might increase the incidence of POD [ 59 ].…”

Effects of Electroencephalogram Guided Anesthesia on Postoperative Delirium: A Systematic Review and Meta-analysis

“…Furthermore, high incidence or longer duration of burst suppression are significantly associated with the incidence of postoperative delirium [46][47][48] . In addition, the use of EEG monitoring also reduce the dosage of general anesthetics, such as volatile agents and propofol [49,50] . Previous studies have reported that excessively exposure to potent volatile agents might increase the incidence of POD [51] .…”