Feasibility of Bispectral Index-Guided Propofol Infusion for Flexible Bronchoscopy Sedation: A Randomized Controlled Trial

Lo, Yu Lun; Lin, Ting; Fang, Yueh‐Fu; Wang, Tsai Yu; Chen, Hao Cheng; Chou, Chun Liang; Chung, Fu‐Tsai; Kuo, Chih Hsi; Feng, Po Hao; Liu, Chien Ying; Kuo, Han Pin

doi:10.1371/journal.pone.0027769

Cited by 63 publications

(93 citation statements)

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“…9 It has been widely applied during general anesthesia and procedures requiring consciousness sedation to avoid oversedation, reduce adverse effects, and prevent awareness during anesthesia. 10,11 Loss of consciousness has been reported to occur at BIS values between 60 and 80. 12,13 Lately, several DISE studies have also investigated BIS during propofol sedation to evaluate sedation levels.…”

Section: Bispectral Index In Evaluating Effects Of Sedation Depth On mentioning

confidence: 99%

Bispectral Index in Evaluating Effects of Sedation Depth on Drug-Induced Sleep Endoscopy

Wang

et al. 2015

Journal of Clinical Sleep Medicine

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achieve a target effect site (brain) concentration of propofol. However, patients may lose consciousness at variable effect site concentrations (Ce), with a higher Ce being associated with higher upper airway critical closing pressure.6,7 Most DISE procedures are started shortly after the patients lose consciousness. Objective:To evaluate the effect of sedation depth on druginduced sleep endoscopy (DISE). Methods: Ninety patients with obstructive sleep apnea (OSA) and 18 snorers underwent polysomnography and DISE under bispectral index (BIS)-guided propofol infusion at two different sedation levels: BIS 65-75 (light sedation) and 50-60 (deep sedation). Results: For the patients with OSA, the percentages of velopharynx, oropharynx, hypopharynx, and larynx obstructions under light sedation were 77.8%, 63.3%, 30%, and 33.3%, respectively. Sedation depth was associated with the severity of velopharynx and oropharynx obstruction, oropharynx obstruction pattern, tongue base obstruction, epiglottis anteroposterior prolapse and folding, and arytenoid prolapse. In comparison, OSA severity was associated with the severity of velopharynx obstruction, severity of oropharynx obstruction, and arytenoid prolapse (odds ratio (95% confi dence interval); 14.3 (4.7-43.4), 11.7 (4.2-32.9), and 13.2 (2.8-62.3), respectively). A good agreement was noted between similar DISE fi ndings at different times and different observers (kappa value 0.6 to 1, respectively 1 Drug-induced sleep endoscopy (DISE) has been used for decades to directly examine the upper airways in sedative-induced sleep and improve treatment outcomes by acting as an adjuvant tool to assess surgical or nonsurgical treatment options. 2-4Various sedation methods have been used to allow for the performance of DISE. Roblin introduced target-controlled infusion (TCI) of propofol to DISE to allow for better control of the sedation level.5 TCI of propofol uses computer-based pharmacokinetic and pharmacodynamic models to predict and Bispectral Index in Evaluating Effects of Sedation Depth on Drug-Induced Sleep EndoscopyYu-Lun Lo, MD BRIEF SUMMARYCurrent Knowledge/Study Rationale: Drug-induced sleep endoscopy (DISE) were performed under different sedative conditions and might affect upper airway obstructions. We aimed to evaluate the affects of sedation depth and obstructive sleep apnea severity on different upper airway obstruction patterns. Study Impact: Under DISE, sedation depth affected velopharynx and oropharynx obstruction severity, oropharynx obstruction pattern, tongue base obstruction, epiglottis anteroposterior prolapse and folding, and arytenoid prolapse; however, OSA severity was associated with velopharynx and oropharynx obstruction severity as well as arytenoid prolapse. Bispectral index guided DISE offers an objective and reproducible method to evaluate upper airway collapsibility.

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Section: Bispectral Index In Evaluating Effects Of Sedation Depth On mentioning

confidence: 99%

Bispectral Index in Evaluating Effects of Sedation Depth on Drug-Induced Sleep Endoscopy

Wang

et al. 2015

Journal of Clinical Sleep Medicine

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“…For moderate sedation a depth of sedation should not be greater than that of level 3. Bispectral (BIS) index monitoring is an electroencephalographic-based method of assessing a patient's level of consciousness and has been used in two trials of moderate sedation for bronchoscopy [20,21]. Both studies concluded that BIS can be used safely by the nonanaesthetist to titrate sedation with propofol.…”

Section: Safe Delivery Of Moderate Sedationmentioning

confidence: 99%

“…These studies have demonstrated that sedation with propofol compared to no sedation leads to less cough, pain, sensation of asphyxiation, total amnesia and improved tolerance of the procedure with no differences in oxygen saturations between the groups [5]. Compared to sedation with midazolam, propofol has similar efficacy and safety [21] but faster onset of action and a more rapid patient recovery for propofol leading to early discharge [20,21,[54][55][56] and improved patient tolerance [20,21,[54][55][56]. Propofol can be administered with other pharmacological agents including opiates.…”

Section: Propofolmentioning

confidence: 99%

Sedation for flexible bronchoscopy: current and emerging evidence

José¹,

Shaefi²,

Navani³

2013

European Respiratory Review

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Flexible bronchoscopy is commonly performed by respiratory physicians and is the gold standard for directly visualising the airways, allowing for numerous diagnostic and therapeutic interventions. With the widespread use of flexible bronchoscopy and the evolution of interventional bronchoscopy with more complex and longer procedures, physicians are placing increasing importance on the use of sedation as a necessary adjunct to topical anaesthesia. There is no standardised practice for the use of sedation in bronchoscopy with a good deal of variation among physicians regarding the use of pre-procedure medication and pharmacological sedatives. In addition, there is ongoing debate and controversy about proceduralist-administered versus anaesthetist-administered sedation whilst at the same time there is a growing body of evidence that nonanaesthetist administered sedation is safe and cost-effective. In this review we summarise the evidence for the use of sedation as an adjunct to topical anaesthesia in bronchoscopy and provide the clinician with up-todate concise guidance for the use of pharmacological sedatives in bronchoscopy and future directions for sedation in the bronchoscopy suite.

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“…Bu konuda yapılan çalışmalarda propofol uygulamasının amnezi yaparak, öksürük ve boğulma hissini azaltarak işlem toleransını artırdığı gösterilmiştir (2). Midazolamla karşılaştırıldığında, propofol benzer etkinlik ve güvenirliliğe sahiptir ancak etkisinin hızlı başlaması ve anesteziden hızlı çıkış hem de hasta toleransının daha iyi olması nedeniyle giderek daha fazla önerilmeye başlanmıştır (14,19). Propofol, analjezi sağlamak, öksürüğü azaltmak, gerekli propofol dozunu azaltmak ve anestezi ve sedasyonu artırmak için opiyat ve sedatiflerle kombinasyon tedavisinde de kullanılabilir (20,21).…”

Section: Propofolunclassified