Efficacy of Bispectral Monitoring as an Adjunct to Nurse-Administered Propofol Sedation for Colonoscopy: A Randomized Controlled Trial

Drake, Luke M; Chen, Shawn C.; Rex, Douglas K.

doi:10.1111/j.1572-0241.2006.00806.x

Cited by 89 publications

(55 citation statements)

References 17 publications

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“…Bispectral (BIS) monitoring is now available for the assessment of the depth of sedation, and some studies on its use during endoscopic procedures for the purpose of reducing the dose of propofol have been reported (17)(18)(19). Unfortunately, no study could succeed in reduction of the dose of propofol, although satisfaction of anesthesiologists and patients was improved.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Propofol Sedation for Endoscopic Submucosal Dissection (ESD): Assessment with Prospective Data Collection

et al. 2011

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Objective The indications for endoscopic treatment in early stage cancer of the digestive tract are expanding with the emergence and technical development of endoscopic submucosal dissection (ESD). ESD requires longer term stable sedation than conventional endoscopic procedures due to the necessity of meticulous control of the devices during the procedure. Propofol has a very short half-life and can be administered continuously, which is advantageous for long-term sedation. Propofol, thus, is likely to be useful for sedation during ESD. Methods Fifty consecutive patients who underwent ESD for early gastric cancer with propofol sedation (Group P) and those with midazolam sedation (Group M) were included in this study. Cardiorespiratory suppression rate and the condition of arousal were compared between the groups. A questionnaire survey on the satisfaction of endoscopists, anesthesiologists, endoscopy nurses, and ward nurses with the use of propofol was also carried out. Results Respiratory suppression was observed in 50% in Group M and in 20% in Group P (p<0.05). Hypotension was seen in 14% and 36% in Groups M and P, respectively (p<0.05). No sedation-related complications were encountered in either of the groups. Arousal rates 1 hour and 3 hours after the procedure were 23% and 60% in group M and 86% and 100% in Group P (p<0.05). As for the questionnaire survey, most respondents, in particular the ward nurses, supported the use of propofol. Conclusion Our data suggest that propofol is safe and useful during ESD as compared with midazolam.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Propofol Sedation for Endoscopic Submucosal Dissection (ESD): Assessment with Prospective Data Collection

et al. 2011

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“…Initial studies of BIS or alternative EEG-based monitoring of sedation during endoscopy reported that these tools correlated well with the level of patient consciousness [32], and permitted more effective titration of propofol and faster recovery from sedation during endoscopy [33]. However, subsequent studies at our institution have questioned the utility of BIS monitoring during nurse-administered propofol sedation (NAPS) for outpatient colonoscopy [34,35]. The use of BIS monitoring for advanced endoscopic procedures such as EUS has not been studied to date.…”

Section: Introductionmentioning

confidence: 96%

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

DeWitt

2008

Dig Dis Sci

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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.

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“…Another pilot study described bispectral monitoring as part of a closed monitoring cycle for the continuous infusion of propofol in 16 patients sedated for colonoscopy [4]. However, in more recent studies, BIS monitoring was not found useful to titrate propofol sedation for colonoscopy [5,6]. In both trials, neither propofol dose reduction nor corresponding shorter recovery times were attained by using BIS monitoring.…”

Section: Eeg Monitoring With Bispectral Index Monitoringmentioning

confidence: 99%

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

Wehrmann

2010

Digestion

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It has been demonstrated that a processed EEG derivative may reflect the patient’s level of consciousness during endoscopic sedation. However, to date a clinical benefit of EEG monitoring with respect to relevant safety parameters in routine gastrointestinal endoscopy has not been demonstrated. During long-lasting procedures (e.g. ERCP, ESD) a propofol-sparing effect has been shown, but a benefit regarding patient safety could not be documented. The use of an automated responsiveness monitor may help to achieve and to maintain the level of conscious sedation with propofol, but its precise role in endoscopic sedation is undefined.

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Efficacy of Bispectral Monitoring as an Adjunct to Nurse-Administered Propofol Sedation for Colonoscopy: A Randomized Controlled Trial

Abstract: BIS did not lead to reductions in mean propofol dose or recovery time when used as an adjunct to NAPS for colonoscopy, or when used as the primary target for sedation. No clinically important role for BIS monitoring as an adjunct to NAPS has yet been established.

Cited by 89 publications

References 17 publications

Efficacy of Propofol Sedation for Endoscopic Submucosal Dissection (ESD): Assessment with Prospective Data Collection

Efficacy of Propofol Sedation for Endoscopic Submucosal Dissection (ESD): Assessment with Prospective Data Collection

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

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

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