Bispectral index monitoring during anesthesiologist-directed propofol and remifentanil sedation for endoscopic submucosal dissection: a prospective randomized controlled trial

Woo Young Park, Yang-Sik Shin, Sang Kil Lee, So Yeon Kim, Tai Kyung Lee, Yong Seon Choi, Woo Young Park, Yang-Sik Shin, Sang Kil Lee, So Yeon Kim, Tai Kyung Lee, Yong Seon Choi

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.

Keywords: Bispectral index; endoscopic submucosal dissection; propofol; remifentanil.

Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1
Visual analog scale ranged from 0 mm (no pain) to 100 mm (worst pain imaginable).
Fig. 2
Fig. 2
Hemodynamic data including heart rate (A) and mean blood pressure (B) during the procedures. Data are expressed as mean±SD. No differences between the groups. BIS, bispectral index.

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Source: PubMed

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