Efficacy of bispectral index monitoring as an adjunct to propofol deep sedation for ERCP: a randomized controlled trial

Abstract

Our data suggest that BIS monitoring led to a reduction in the mean propofol dose when the BIS value was used as the primary target for sedation in ERCP procedures.

Deep sedation for endoscopic retrograde cholangiopacreatography

“…A combination of propofol and midazolam significantly reduces the total propofol amount required and consequently reduces the risk of apnea but prolongs recovery time in association to propofol alone. In another study by Paspatis et al [18] , BIS monitoring also reduced the total propofol dose required. Deep sedation holds some advantages over general anes thesia as far as required time and cost are concerned and is a good alternative to general anesthesia for ERCP.…”

“…For obtaining a deep sedation level, BIS 5060 is required. Paspatis et al [18] demonstrated a signi ficant reduction in the used total propofol dose and a cor respondingly shorter recovery time when using BIS mo nitoring in ERCP instead of conventional sedation. In a study where AlSammak et al [43] used midazolam and me peridine for ERCP, BIS reduced the total sedative dose.…”

“…The major risks in deep sedation constitute unintended general anesthesia and apnea. Studies about ERCP performed under deep sedation [15,18] target the re duction of the minimum effective dose for deep sedation and improvement of sedation and ventilation monitoring using devices such as Bispectral index (BIS) and cap nography respectively. The sedative agent used in deep sedation is propofol, either alone [18] or in combination with midazolam [15] and remifentanil [19] .…”

“…Studies about ERCP performed under deep sedation [15,18] target the re duction of the minimum effective dose for deep sedation and improvement of sedation and ventilation monitoring using devices such as Bispectral index (BIS) and cap nography respectively. The sedative agent used in deep sedation is propofol, either alone [18] or in combination with midazolam [15] and remifentanil [19] . A combination of propofol and midazolam significantly reduces the total propofol amount required and consequently reduces the risk of apnea but prolongs recovery time in association to propofol alone.…”

Extended Monitoring of the Sedated Patient: Bispectral Index, Narcotrend® and Automated Responsiveness Monitor

“…An insufficient sensitivity of the BIS to predict the clinically determined patient’s consciousness was also observed in another study using sedation with midazolam and meperidine for colonoscopy [8]. However, during longer-lasting interventional endoscopic procedures, like endoscopic submucosal dissection (ESD) of early gastric cancers [9], or interventional ERCP [10], two recent randomized controlled studies (conventional sedation with propofol vs. BIS-guided sedation with propofol) demonstrated a significant reduction of the used total propofol dose and a corresponding shorter recovery time when using BIS monitoring. These results were also confirmed by a former and smaller trial on 40 patients using sedation with midazolam and meperidine for ERCP [11].…”