Bispectral Index Monitoring and Observer Rating Scale Correlate with Dreaming during Propofol Anesthesia for Gastrointestinal Endoscopies

Abstract

Background and objectives: Dreaming is a commonly reported side effect of propofol anesthesia. Materials and Methods: We investigated the inci-dence and character of dreams in patients undergoing intravenous propofol anesthesia and cor-related it with an observer rating scale of facial expression on the seven-point scale from pain to smile. A total of 124 patients undergoing gastrointestinal endoscopy were recruited in the pro-spective observational study. Bispectral index (BIS), blood pressure (BP), and pulse were moni-tored. Upon emergence from anesthesia, the patient’s facial expression was rated numerically. Thereafter, patients were asked whether they had dreams and to rate their dreams as pleasant or unpleasant. The mean age of participants was 53; body mass index, 26.17; duration of procedure, 20 min; and average propofol dose, 265 mg. Results: Dreaming was reported by 43% of patients. Dreams were pleasant in all but one patient. There was a significant correlation of the observer’s rating of facial expression with dreaming (r = 0.260; p = 0.004). Dreamers had higher scores of observer rating of facial expression (1 (0–2) vs. 0.5 (0–1), p = 0.006). Conclusions: BIS values were lower in the dreamers vs. non-dreamers 2 min after the endoscopy started (48 (43–62) vs. 59 (45–71), p = 0.038). Both BIS and observer ratings correlate with dreaming in patients undergoing gastrointestinal endos-copy. Trial registration number: NCT04235894.

Influences of Propofol, Ciprofol and Remimazolam on Dreaming During Anesthesia for Gastrointestinal Endoscopy: A Randomized Double-Blind Parallel-Design Trial

“…14,16 Propofol induced dreaming was reported to be related to anesthetics, depth of anesthesia, age, gender, preoperative psychological state and other factors. [6][7][8][9][10] However, the baseline information of our study was comparable among the groups. Matus et al 8 found that the Bispectral Index value of dreamers at 2 min after endoscopy initiation was lower than that of non-dreamers.…”

Dreaming during gastrointestinal endoscopy under propofol, ciprofol, or remimazolam anesthesia: study protocol for a parallel-design double-blind, single-center trial

“…Xu et al [20] observed that among the dreamers, approximately one-third reported pleasant dreams. Studies have demonstrated that the main factors influencing dreams during anesthesia include the kind and dosage of anesthetics, depth of anesthesia, sex, and preoperative psychological pretreatment [4,5,[20][21][22][23]. Furthermore, Yoshida et al [24] found that a less than 11 depression score of the HADS was highly correlated with positive dreams.…”

Advances in Analgosedation and Periprocedural Care for Gastrointestinal Endoscopy

“…This includes monitoring the level of consciousness, an adequate visual examination of the patient, and monitoring the patient’s breathing and circulation [ 64 ]. One of the methods, which has often been used to assess the depth of sedation, especially when using propofol during endoscopies, is monitoring the bispectral index (BIS) [ 65 ].…”

“…BIS monitoring is a non-invasive method that processes EEG information, thus enabling measurement of the patient’s level of consciousness and depth of sedation. By using BIS monitoring, it is possible to reduce the applied dose of the drug, and the risk of too deep sedation, especially in elderly patients [ 65 , 66 , 67 , 68 ]. Considering the great heterogeneity of the conducted studies related to the use of BIS monitoring, other studies did not establish a specific clinical benefit that would include more adequate and improved oxygenation of patients, and a reduction in the risk of respiratory and circulatory complications [ 69 , 70 , 71 ].…”