Satisfaction with bispectral index monitoring of propofol-mediated sedation during endoscopic submucosal dissection: a prospective, randomized study

Imagawa, Atsushi; Fujiki, Shigeatu; Kawahara, Yoshiro; Matsushita, Haruo; Ota, S.; Tomoda, Takeshi; Morito, Yuki; Sakakihara, Ichiro; Fujimoto, Takehide; Taira, Akihiro; Tsugeno, Hirofumi; Kawano, Seiji; Yagi, Shunjiro; Takenaka, Ryuta

doi:10.1055/s-2008-1077641

Cited by 68 publications

(63 citation statements)

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“…There were also significant differences between the light and deep sedation groups in median [IQR] PACU discharge times (18 [15][16][17][18][19][20][21][22] min vs 20 [17][18][19][20][21][22][23][24][25] min, respectively; P = 0.013) and median [IQR] hospital discharge times (65 [57-80] min vs 74 [63-86] min, respectively; P = 0.001) favouring the light sedation group, although the magnitudes of the respective differences (i.e., 2 min and 9 min) were small ( Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…[18][19][20] Therefore, no recall in 95% of patients undergoing deep propofol-based sedation was used as the baseline for sample size calculation. An equivalence margin of 10% in the incidence of recall between the light and deep sedation groups was selected by investigator consensus, given the lack of literature to inform this decision.…”

Section: Discussionmentioning

confidence: 99%

“…Given our limited sample size, the conclusions relating to complications for endoscopy sedation are guarded, but our findings are consistent with other studies. 15,19,[25][26][27][28] Cogstate tasks reported as mean (standard error at median age). The model includes pre-procedure cognitive testing performance, American Society of Anesthesiologists' physical status, and sex.…”

Section: Discussionmentioning

confidence: 99%

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A randomized controlled trial of light versus deep propofol sedation for elective outpatient colonoscopy: recall, procedural conditions, and recovery

Allen

Leslie

Hebbard

et al. 2015

Can J Anesth/J Can Anesth

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A randomized controlled trial of light versus deep propofol sedation for elective outpatient colonoscopy: recall, procedural conditions, and recovery Une étude randomisée contrôlée sur la sédation légère vs profonde au propofol pour la colonoscopie non urgente en ambulatoire: le souvenir, les conditions entourant l'intervention et la récupération sedation; P \ 0.0001). The incidence of recall was 12% in the light sedation group and 1% in the deep sedation group. The risk difference for recall was 0.11 (90% confidence interval, 0.05 to 0.17) in the intention-to-treat analysis, thus refuting equivalence in recall between light and deep sedation (0.05 significance level; 10% equivalence margin). Overall sedation-related complications were more frequent with deep sedation than with light sedation (66% vs 47%, respectively; P = 0.008). Recovery was more rapid with light sedation than with deep sedation as determined by the mean (SD) time to reach a score of 5 on the Modified Observer's Assessment of Alertness/Sedation Scale [3 (4) min vs 7 (4) min, respectively; P \ 0.001] and by the median [IQR] time to min, respectivement; P = 0.001). L'incidence des troubles cognitifs post-procéduraux était semblable chez les personnes randomisées à recevoir une sédation légère (19 %) ou profonde (16 %) (P = 0,554). Conclusion La sédation légère n'était pas équivalente à la sédation profonde en matière de souvenir de l'intervention, du spectre de complications ou des temps de récupération. Cette étude procure des données probantes nécessaires pour informer les patients concernant la sédation pour la colonoscopie. Cette étude a été enregistrée au Registre australien et néozélandais des études cliniques, no. 12611000320954.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A randomized controlled trial of light versus deep propofol sedation for elective outpatient colonoscopy: recall, procedural conditions, and recovery

Allen

Leslie

Hebbard

et al. 2015

Can J Anesth/J Can Anesth

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“…Bispectral (BIS) monitoring is now available for the assessment of the depth of sedation, and some studies on its use during endoscopic procedures for the purpose of reducing the dose of propofol have been reported (17)(18)(19). Unfortunately, no study could succeed in reduction of the dose of propofol, although satisfaction of anesthesiologists and patients was improved.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Propofol Sedation for Endoscopic Submucosal Dissection (ESD): Assessment with Prospective Data Collection

et al. 2011

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Objective The indications for endoscopic treatment in early stage cancer of the digestive tract are expanding with the emergence and technical development of endoscopic submucosal dissection (ESD). ESD requires longer term stable sedation than conventional endoscopic procedures due to the necessity of meticulous control of the devices during the procedure. Propofol has a very short half-life and can be administered continuously, which is advantageous for long-term sedation. Propofol, thus, is likely to be useful for sedation during ESD. Methods Fifty consecutive patients who underwent ESD for early gastric cancer with propofol sedation (Group P) and those with midazolam sedation (Group M) were included in this study. Cardiorespiratory suppression rate and the condition of arousal were compared between the groups. A questionnaire survey on the satisfaction of endoscopists, anesthesiologists, endoscopy nurses, and ward nurses with the use of propofol was also carried out. Results Respiratory suppression was observed in 50% in Group M and in 20% in Group P (p<0.05). Hypotension was seen in 14% and 36% in Groups M and P, respectively (p<0.05). No sedation-related complications were encountered in either of the groups. Arousal rates 1 hour and 3 hours after the procedure were 23% and 60% in group M and 86% and 100% in Group P (p<0.05). As for the questionnaire survey, most respondents, in particular the ward nurses, supported the use of propofol. Conclusion Our data suggest that propofol is safe and useful during ESD as compared with midazolam.

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“…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].…”

Section: Eeg Monitoring With Bispectral Index Monitoringmentioning

confidence: 99%

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

Wehrmann

2010

Digestion

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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.

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Satisfaction with bispectral index monitoring of propofol-mediated sedation during endoscopic submucosal dissection: a prospective, randomized study

Cited by 68 publications

References 15 publications

A randomized controlled trial of light versus deep propofol sedation for elective outpatient colonoscopy: recall, procedural conditions, and recovery

A randomized controlled trial of light versus deep propofol sedation for elective outpatient colonoscopy: recall, procedural conditions, and recovery

Efficacy of Propofol Sedation for Endoscopic Submucosal Dissection (ESD): Assessment with Prospective Data Collection

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

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