Bispectral Index Monitoring during Anesthesiologist-Directed Propofol and Remifentanil Sedation for Endoscopic Submucosal Dissection: A Prospective Randomized Controlled Trial.
10.3349/ymj.2014.55.5.1421
- Author:
Woo Young PARK
1
;
Yang Sik SHIN
;
Sang Kil LEE
;
So Yeon KIM
;
Tai Kyung LEE
;
Yong Seon CHOI
Author Information
1. Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
- Publication Type:Original Article ; Randomized Controlled Trial
- Keywords:
Bispectral index;
endoscopic submucosal dissection;
propofol;
remifentanil
- MeSH:
Aged;
Anesthetics, Intravenous/*administration & dosage/therapeutic use;
*Consciousness Monitors;
Endoscopy/methods;
Female;
Humans;
Intraoperative Complications/*prevention & control;
Male;
Middle Aged;
Monitoring, Physiologic/methods;
Piperidines/*administration & dosage/adverse effects/therapeutic use;
Propofol/*administration & dosage/adverse effects/therapeutic use
- From:Yonsei Medical Journal
2014;55(5):1421-1429
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Endoscopic submucosal dissection (ESD) is a technically difficult and lengthy procedure requiring optimal depth of sedation. The bispectral index (BIS) monitor is a non-invasive tool that objectively evaluates the depth of sedation. The purpose of this prospective randomized controlled trial was to evaluate whether BIS guided sedation with propofol and remifentanil could reduce the number of patients requiring rescue propofol, and thus reduce the incidence of sedation- and/or procedure-related complications. MATERIALS AND METHODS: A total of 180 patients who underwent the ESD procedure for gastric adenoma or early gastric cancer were randomized to two groups. The control group (n=90) was monitored by the Modified Observer's Assessment of Alertness and Sedation scale and the BIS group (n=90) was monitored using BIS. The total doses of propofol and remifentanil, the need for rescue propofol, and the rates of complications were recorded. RESULTS: The number of patients who needed rescue propofol during the procedure was significantly higher in the control group than the BIS group (47.8% vs. 30.0%, p=0.014). There were no significant differences in the incidence of sedation- and/or procedure-related complications. CONCLUSION: BIS-guided propofol infusion combined with remifentanil reduced the number of patients requiring rescue propofol in ESD procedures. However, this finding did not lead to clinical benefits and thus BIS monitoring is of limited use during anesthesiologist-directed sedation.
