The utility of bispectral index monitoring in flexible bronchoscopy: A single‐center, retrospective observational study

Abstract

Background: The desired depth of sedation during flexible bronchoscopy is one in which verbal contact is possible whenever necessary. Although it is common that the depth of sedation is assessed by validated instruments such as the modified observer's assessment of alertness and sedation (MOAA/S) score, the repeated stimulation associated with the assessment can affect the sedation. The bispectral index (BIS) has been widely used for general anesthesia due to its objective and noninvasive nature. However, the utility of BIS monitoring and a target BIS value for use during bronchoscopy have not been fully elucidated. Methods: We performed a retrospective observational study to assess the utility of the BIS value for monitoring conscious sedation during bronchoscopy at Kobe University Hospital from August 2020 to April 2021. Results: Eighteen patients underwent bronchoscopy with BIS monitoring. The BIS value significantly correlated with the MOAA/S score (r = 0.2, p < 0.01), and the correlation was stronger in sufficiently sedated patients (r = 0.486, p < 0.01). The lowest MOAA/S score during the procedure was highly correlated with the BIS value (r = 0.625, p < 0.01). The BIS monitoring seemed to be more sensitive to changes in the sedation level than the MOAA/S score, heart rate and mean arterial pressure. The median BIS value at an MOAA/S score of 3-4, the desired depth of sedation, was 82.0. Conclusions: BIS value is useful for monitoring sedation during bronchoscopy. This study suggests that a BIS value of 82 reflects an adequate level of sedation.

Intravenous Ganaxolone: Pharmacokinetics, Pharmacodynamics, Safety, and Tolerability in Healthy Adults

“…qEEG and BIS are important PD variables for capturing the timing and severity of EEG slowing in relation to the doses administered. The MOAA/S scale is a validated 6‐point scale used for assessing the subject's level of sedation and ranges from 0 to 5, with a score of 0 indicating lack of response to painful trapezius squeeze and presence of deep sedation and a score of 5 indicating the subject is readily responsive to their name spoken in a normal tone and no sedation present 22‐24 …”

Effect of esketamine on the EC50 of remifentanil for blunting cardiovascular responses to endotracheal intubation in female patients under general anesthesia: a sequential allocation dose-finding study

“…Lethargic response to demand in normal tone is 4. Responds readily to demand in normal tone is 5) of 0 [ 19 , 20 ]. Rocuronium 0.6 mg/kg was administered after stabilizing the drug concentration.…”

Pharmacokinetics, pharmacodynamics, and safety of ciprofol emulsion in Chinese subjects with normal or impaired renal function

“…The BIS values decreased rapidly following the start of the infusion and reached their lowest levels (ranging from 41.13 to 47.63) at median times of 4.00, 3.48, and 3.00 min post-infusion for the normal function, mild renal impairment, and moderate renal impairment groups, respectively. The mean BIS corresponding to a 3-4 MOAA/S score, the desired sedation depth (Yamada et al, 2022), was 69. BIS peak and BIS AUC 0-t were similar across the three groups.…”

“…These observations continued until the participants were fully awakened and achieved an MOAA/S score of 5 for three consecutive assessments. MOAA/S scores (Yamada et al, 2022) (Supplementary Table S1) were evaluated at various time points, including 5 min before drug administration, 1 min after the start of the loading dose, every 5 min during the continuous maintenance infusion, and every 2 min until the end of the infusion. BIS values were recorded 5 min before and 60 min after drug administration.…”