Verification of the performance of the Bispectral Index as a hypnotic depth indicator during dexmedetomidine sedation

Ki, Seunghee; Lee, Dongeon; Lee, Won Jin; Cho, Kwangrae; Han, Yongjae; Lee, Jeonghan

doi:10.17085/apm.21065

Cited by 9 publications

(4 citation statements)

References 27 publications

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“…We demonstrated the utility of BIS monitoring for assessing the level of sedation in patients undergoing FB. In accordance with previous reports, 4 , 10 , 14 the BIS value correlated with the clinically observed sedation scales. In this study, the correlation was stronger in patients under sufficient sedation (MOAA/S ≤ 4) than in all patients.…”

Section: Discussionsupporting

confidence: 92%

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

et al. 2022

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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.

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Section: Discussionsupporting

confidence: 92%

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

et al. 2022

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“…The BIS value has been validated during sedation with dexmedetomidine. 57 The SPI value has been widely used for several years and has been reported to be more valid than other nociceptive monitors, such as the pupillary pain index and nociception level (NoL). 58 , 59 As expected, the BIS and SPI values of patients receiving OFA were within acceptable ranges.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Opioid-Free Anesthesia on the Quality of Recovery After Gynecological Laparoscopy: A Prospective Randomized Controlled Trial

Choi¹,

Song²,

Oh³

et al. 2022

JPR

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Purpose Opioid-free anesthesia (OFA) is an emerging technique that eliminates intraoperative use of opioids and is associated with lower postoperative opioid consumption and reduced adverse postoperative events. The present study investigated the effect of OFA on the quality of recovery in patients undergoing gynecological laparoscopy. Patients and Methods Seventy-five adult patients undergoing elective gynecological laparoscopy were randomly assigned to the OFA group with dexmedetomidine and lidocaine or the remifentanil-based anesthesia (RA) group with remifentanil. Patients, surgeons, and medical staff members providing postoperative care and assessing outcomes were blinded to group allocation. The anesthesiologist performing general anesthesia could not be blinded due to the different drug administration protocols by groups. The primary outcome was the quality of recovery measured using the Quality of Recovery-40 (QoR-40) questionnaire. Secondary outcomes were postoperative pain score, intraoperative and postoperative adverse events, and stress hormones levels. Results The patients in both groups had comparable baseline characteristics. The QoR-40 score on postoperative day 1 was significantly higher in the OFA group than in the RA group (155.9 ± 21.2 in the RA group vs 166.9 ± 17.8 in the OFA group; mean difference: −11.0, 95% confidence interval: −20.0, −2.0; p = 0.018). The visual analog scale score at 30 min after surgery was significantly lower in the OFA group than in the RA group (6.3 ± 2.3 in the RA group vs 4.1 ± 2.1 in the OFA group; p < 0.001). The incidences of nausea and shivering in the post-anesthetic care unit were also significantly lower in the OFA group ( p = 0.014 and 0.025; respectively). Epinephrine levels were significantly lower in the OFA group ( p = 0.002). Conclusion OFA significantly improved the quality of recovery in patients undergoing gynecological laparoscopy.

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“…A receiver operating characteristic (ROC) curve analysis was performed to estimate the performance of EEG parameters at specific sedation levels, referring to previous studies. 18,19 A state in which the MOAA/S score is greater than or equal to a specific score is defined as an event of "MOAA/S ≥ n," where n = 1, 2, 3, 4, and 5. The ROC curves for "MOAA/S ≥ n" were plotted for each EEG parameter, and the area under the ROC curves (AUROC) was estimated.…”

Section: Discussionmentioning

confidence: 99%

Comparative Analysis of the Performance of Electroencephalogram Parameters for Monitoring the Depth of Sedation During Remimazolam Target-Controlled Infusion

Bae,

Song

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: The changes in hypnotic indicators in remimazolam sedation remain unclear. We investigated the correlation of the electroencephalogram (EEG) parameters with the effect-site remimazolam concentration and the depth of sedation in patients receiving a target-controlled infusion of remimazolam. METHODS: This prospective observational study enrolled 35 patients (32 analyzed) who underwent lower extremity varicose vein surgery or lower extremity orthopedic surgery under spinal anesthesia. We administered remimazolam by target-controlled infusion using the pharmacokinetic model introduced by Schüttler et al. The EEG data were continuously recorded, including the bispectral index (BIS), patient state index (PSI), spectral edge frequency (SEF), and raw EEG signals. The relative beta ratio (RBR), defined as log (spectral power [30–47 Hz]/spectral power [11–20 Hz]), was obtained by analyzing raw EEG. The level of sedation corresponding to each effect-site remimazolam concentration was assessed using the Modified Observer’s Assessment of Alertness/Sedation (MOAA/S). The prediction probability (Pk) and Spearman’s correlation coefficients (R) were calculated between effect-site remimazolam concentration, MOAA/S, and EEG parameters. RESULTS: BIS and PSI showed significantly higher Pk for effect-site remimazolam concentration (Pk = 0.76 [0.72–0.79], P < .001 for BIS; Pk = 0.76 [0.73–0.79], P < .001 for PSI) compared to RBR (Pk = 0.71 [0.68–0.74], P < .001) and SEF (Pk = 0.58 [0.53–0.63], P = .002). BIS, PSI, and RBR showed significantly higher correlation coefficients for effect-site remimazolam concentration (R = −0.70 [−0.78 to −0.63], P < .001 for BIS; R = −0.72 [−0.79 to −0.66], P < .001 for PSI; R = −0.61 [−0.69 to −0.54], P < .001 for RBR) compared to SEF (R = −0.22 [−0.36 to −0.08], P = .002). BIS and PSI also had significantly higher Pk and correlation coefficients for MOAA/S (Pk = 0.81 [0.79–0.83], P < .001; R = 0.84 [0.81–0.88], P < .001 for BIS) (Pk = 0.80 [0.78–0.83], P < .001; R = 0.82 [0.78–0.87], P < .001 for PSI) compared to RBR (Pk = 0.74 [0.72–0.77], P < .001; R = 0.72 [0.65–0.78], P < .001) and SEF (Pk = 0.55 [0.50–0.59], P = .041; R = 0.13 [−0.01 to 0.27], P = .067). CONCLUSIONS: BIS, PSI, and RBR showed an acceptable correlation with the effect-site remimazolam concentration and depth of sedation in this study, suggesting that these EEG-derived parameters are potentially reliable hypnotic indicators during remimazolam sedation. BIS and PSI showed superior performance as hypnotic indicators to RBR and SEF in patients receiving target-controlled infusion of remimazolam.

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Verification of the performance of the Bispectral Index as a hypnotic depth indicator during dexmedetomidine sedation

Cited by 9 publications

References 27 publications

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

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

The Effect of Opioid-Free Anesthesia on the Quality of Recovery After Gynecological Laparoscopy: A Prospective Randomized Controlled Trial

Comparative Analysis of the Performance of Electroencephalogram Parameters for Monitoring the Depth of Sedation During Remimazolam Target-Controlled Infusion

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