A target-controlled infusion system with bispectral index monitoring of propofol sedation during endoscopic submucosal dissection

Abstract

Background and study aims: Propofol administration via a target-controlled infusion system with bispectral index monitoring (BIS/TCI system) is expected to prevent complications from sedation during complex and long endoscopic procedures. We evaluated the feasibility of setting the BIS/TCI system for non-anesthesiologist administration of propofol (NAAP) during endoscopic submucosal dissection (ESD). Patients and methods: From May 2009 to February 2013, 250 patients with esophagogastric neoplasms were treated with ESD using the BIS/TCI system with NAAP. In the TCI system, the initial target blood concentration of propofol was set at 1.2 μg/mL. The titration speed of propofol was adjusted according to the BIS score and the movement of the patient. The BIS target level ranged from moderate to deep sedation, at which a stable BIS score between 60 and 80 was obtained. Results: In 80.4 % of patients, it was possible to maintain stable sedation with a blood concentration of propofol of less than 1.6 µg/mL using TCI throughout the ESD procedure. The default setting for ideal blood concentration of propofol was 1.2 μg/mL, because the medians of the lower and upper bounds of blood concentration were 1.2 μg/mL (range 0.6 – 1.8 μg/mL) and 1.4 μg/mL (range 1.0 – 3.8 μg/mL), respectively. Although hypotension occurred in 27 patients (10.8 %), oxygen desaturation occurred in only nine patients (3.6 %), and severe desaturation in only two patients (0.8 %). Conclusions: Using our settings, it is possible for a non-anesthesiologist to maintain stable sedation during a lengthy endoscopic procedure through propofol sedation with a BIS/TCI system.

Dexmedetomidine provides less body motion and respiratory depression during sedation in double-balloon enteroscopy than midazolam

“…Although both RSS levels 3-5 (used in the MDZ group) and BIS 60-80 are equivalent to moderate or deep sedation, there are no reports that they are equal. 11,25 BIS monitoring leads to higher patient and endoscopist satisfaction scores; thus, less adverse events in the DEX group might have been affected by BIS monitoring. 26 Finally, the criterion additional sedatives and analgesic differs between the MDZ and the DEX groups.…”

Computer-Assisted Target Control Infusion System for Elderly Patients during Endoscopic Retrograde Cholangiopancreateography

“…Although deep sedation in general endoscopic treatment has been reported, data are limited on the monitoring of propofol infusion in older patients [8,9]. This report evaluated the efficacy of the TCI system for propofol sedation during ERCP in different age period elder patients.…”

“…Propofol was administered intravenously by using the Diprifusor system which is a TCI system using the pharmacokinetic kinetic parameter set according to the Marsh model. The initial setting of the target blood concentration of propofol (1% Diprivan Injection-kit; AstraZeneca) was set at 2.0μg/mL for the nonelderly patients <70 years old) [7].The initial setting for the elderly patients (>70 years old) was 1.0μg/mL, which was chosen for moderate sedation based on a previous study [8] .The blood concentration of propofol at each time point was calculated automatically and shown on the monitor of the TCI pump. For the objective measurement of the level of consciousness in sedated patients, the A2000 BIS monitor (Aspect Medical Systems, Newton, Mass) was used.…”

Target Control Infusion (TCI) Computer-Assisted Pump and Bispectral Index (BIS ) Monitoring Sedation System in Elderly Patients during Endoscopic Retrograde Cholangiopancreateography (ERCP)

“…Propofol was administered intravenously by using the Diprifusor system which is a TCI system using the pharmacokinetic kinetic parameter set according to the Marsh model. The initial setting of the target blood concentration of propofol (1% Diprivan Injection-kit; AstraZeneca) was set at 2.0μg/mL for the nonelderly patients<70 years old).The initial setting for the elderly patients (>70 years old) was 1.0μg/mL, which was chosen for moderate sedation [7]. The blood concentration of propofol at each time point was calculated automatically and shown on the monitor of the TCI pump.…”

“…Bispectral index (BIS) monitoring is an electroencephalography based method that quantifies the depth of anesthesia by analyzing the electroencephalogram and uses a complex algorithm to generate an index score, providing an objective measurement of the level of consciousness in sedated patients [6]. Recently, the utility of the combination of a TCI pump and BIS monitoring system (TCI/BIS system) for endoscopic treatment was reported [7].…”