Yonsei Med J.  2014 Sep;55(5):1421-1429. 10.3349/ymj.2014.55.5.1421.

Bispectral Index Monitoring during Anesthesiologist-Directed Propofol and Remifentanil Sedation for Endoscopic Submucosal Dissection: A Prospective Randomized Controlled Trial

• Park WY
• Shin YS
• Lee SK
• Kim SY
• Lee TK
• Choi YS

• KMID: 1799512
• DOI: http://doi.org/10.3349/ymj.2014.55.5.1421

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.

Keyword

Bispectral index; endoscopic submucosal dissection; propofol; remifentanil

MeSH Terms

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
Anesthetics, Intravenous
Piperidines
Propofol

Figure

• 

  Fig. 1 Visual analog scale ranged from 0 mm (no pain) to 100 mm (worst pain imaginable).

• 

  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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