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

Abstract

It has been demonstrated that a processed EEG derivative may reflect the patient’s level of consciousness during endoscopic sedation. However, to date a clinical benefit of EEG monitoring with respect to relevant safety parameters in routine gastrointestinal endoscopy has not been demonstrated. During long-lasting procedures (e.g. ERCP, ESD) a propofol-sparing effect has been shown, but a benefit regarding patient safety could not be documented. The use of an automated responsiveness monitor may help to achieve and to maintain the level of conscious sedation with propofol, but its precise role in endoscopic sedation is undefined.

Sedation in gastrointestinal endoscopy: a prospective study comparing nonanesthesiologist-administered propofol and monitored anesthesia care

“…Sedation and analgesia represent a continuum ranging from minimal (anxiolysis) or moderate to deep sedation and general anesthesia 16 17 24 25 29 . Moderate sedation is recommended as it provides adequate anxiolysis, pain control, and amnesia, being safer than deep sedation 25 30 .…”

Propofol sedation with bispectral index monitoring is useful for endoscopic submucosal dissection: a randomized prospective phase II clinical trial

“…Capnometry has also been reported to be useful for preventing oversedation during ESD [23]. The concurrent use of BIS index assessment and capnometry might allow close monitoring of patients [24]. The types and dosages of concurrently used analgesics remain largely uninvestigated.…”

Updated S3 Guideline “Sedation for Gastrointestinal Endoscopy” of the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) – June 2023 – AWMF-Register-No. 021/014

“…Most of the many other studies [432][433][434][435][436][437][438][439][440][441], however, showed no significant reduction in the required propofol dose in mostly interventional endoscopies. The use of BIS monitoring also did not lead to a reduction in surrogate patient safety parameters (hypoxemia and RR drop) [436].…”