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

 

 Buy Article Permissions and Reprints

Background and study aims: Endoscopic submucosal dissection (ESD) is one of the most complex and lengthy endoscopic procedures, so deep sedation during ESD is indispensable. Our study aims were to determine whether bispectral index (BIS) monitoring is useful in titrating and reducing the dose of the sedative propofol during ESD, and to measure the satisfaction of patients and endoscopists involved in this complex and lengthy endoscopic therapy.

Patients and methods: We performed a prospective, randomized clinical trial from July 2006 to February 2008. A total of 156 patients, with gastric neoplasm to be treated using ESD, were randomized to two groups. The BIS group (n = 78) was monitored for propofol sedation using BIS, and the no-BIS group (n = 78) was monitored by standard methods only. The two groups were compared by evaluating the doses of propofol administered to patients and the satisfaction scores (scale of 0 – 10) of patients and endoscopists.

Results: Although there were no significant differences between the two groups in the mean dose of propofol used (BIS group vs. no-BIS group, 5.32 mg/kg/hour vs. 4.85 mg/kg/hour; P = 0.10), the satisfaction scores of the patients (9.15 vs. 7.94; P < 0.01) and endoscopists (8.53 vs. 6.42; P < 0.001) were significantly higher with BIS monitoring.

Conclusions: Monitoring with BIS during the ESD procedure did not lead to a reduction in the dose of propofol required, but did lead to higher satisfaction scores from the patients and endoscopists. A complicated and prolonged endoscopic treatment such as ESD can be carried out with optimal safety, control, and comfort by using BIS to monitor propofol sedation.

References

• 1 Imagawa A, Okada H, Kawahara Y. et al . Endoscopic submucosal dissection for early gastric cancer: results and degrees of technical difficulty as well as success.  Endoscopy. 2006;  38 987-990
  Article in Thieme ConnectPubMedGoogle Scholar
• 2 Ono H, Kondo H, Gotoda T. et al . Endoscopic mucosal resection for treatment of early gastric cancer.  Gut. 2001;  48 225-229
  CrossrefPubMedGoogle Scholar
• 3 Ohkuwa M, Hosokawa K, Boku N. et al . New endoscopic treatment for intramucosal gastric tumors using an insulated-tip diathermic knife.  Endoscopy. 2001;  33 221-226
  Article in Thieme ConnectPubMedGoogle Scholar
• 4 Neuhaus H, Costamagna G, Devière J. et al . Endoscopic submucosal dissection (ESD) of early neoplastic gastric lesions using a new double-channel endoscope (the ”R-scope”).  Endoscopy. 2006;  38 1016-1023
  Article in Thieme ConnectPubMedGoogle Scholar
• 5 Yahagi N, Fujishiro M, Kakushima K. et al . Endoscopic submucosal dissection for early gastric cancer using the tip of an electrosurgical snare (thin type).  Dig Endosc. 2004;  16 34-38
  CrossrefPubMedGoogle Scholar
• 6 Oda I, Gotoda T, Hamanaka H. et al . Endoscopic submucosal dissection for early gastric cancer: technical feasibility, operation time and complications from a large consecutive series.  Dig Endosc. 2005;  17 54-58
  CrossrefPubMedGoogle Scholar
• 7 American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologist . Practice guidelines for sedation and analgesia by non-anesthesiologists.  Anesthesiology. 2002;  96 1004-1017
  CrossrefPubMedGoogle Scholar
• 8 Faigel D O, Baron T H, Goldstein J L. et al . Practice Committe, American Society for Gastrointestinal Endoscopy. Guidelines for the use of deep sedation and anesthesia for GI endoscopy.  Gastrointest Endosc. 2002;  56 613-617
  CrossrefPubMedGoogle Scholar
• 9 Cohen L, Wecsler J, Gaetano J. et al . Endoscopic sedation in the United States: results from a nationwide survey.  Am J Gastroenterol. 2006;  101 967-974
  CrossrefPubMedGoogle Scholar
• 10 Carlsson U, Grattidge P. Sedation for upper gastrointestinal endoscopy: a comparative study of propofol and midazolam.  Endoscopy. 1995;  27 240-243
  PubMedGoogle Scholar
• 11 Wehrmann T, Kokabpick S, Lembcke B. et al . Efficacy and safety of intravenous propofol sedation during routine ERCP: a prospective, controlled study.  Gastrointest Endosc. 1999;  49 677-683
  PubMedGoogle Scholar
• 12 Jung M, Hofmann C, Kiesslich R. et al . Improved sedation in diagnostic and therapeutic ERCP: propofol is an alternative to midazolam.  Endoscopy. 2000;  32 233-238
  Article in Thieme ConnectPubMedGoogle Scholar
• 13 Koshy G, Nair S, Norkus E. et al . Propofol versus midazolam and meperidine for conscious sedation in GI endoscopy.  Am J Gastroenterol. 2000;  95 1476-1479
  CrossrefPubMedGoogle Scholar
• 14 Külling D, Fantin A, Biro P. et al . Safer colonoscopy with patient-controlled analgesia and sedation with propofol and alfentanil.  Gastrointest Endosc. 2001;  54 1-7
  CrossrefPubMedGoogle Scholar
• 15 Vargo J J, Zuccaro G, Dumot J A. et al . Gastroenterologist-administered propofol versus meperidine and midazolam for advanced upper endoscopy: a prospective, randomized trial.  Gastroenterology. 2002;  123 8-16
  CrossrefPubMedGoogle Scholar
• 16 Qureshi W A, Zuckerman M J, Adler D G. et al . Standards of Practice Committee. ASGE guideline: modifications in endoscopic practice for the elderly.  Gastrointest Endosc. 2006;  63 566-569
  CrossrefPubMedGoogle Scholar
• 17 Heuss L T, Schnieper P, Drewe J. et al . Conscious sedation with propofol in elderly patients: a prospective evaluation.  Aliment Pharmacol Ther. 2003;  17 1493-1501
  CrossrefPubMedGoogle Scholar
• 18 Riphaus A, Stergiou N, Wehrmann T. Sedation with propofol for routine ERCP in high-risk octogenarians: a randomized, controlled study.  Am J Gastroenterol. 2005;  100 1957-1963
  CrossrefPubMedGoogle Scholar
• 19 Chen S C, Rex D K. An initial investigation of bispectral monitoring as an adjunct to nurse-administered propofol sedation for colonoscopy.  Am J Gastroenterol. 2004;  99 1081-1086
  CrossrefPubMedGoogle Scholar
• 20 Drake L M, Chen S C, Rex D K. Efficacy of bispectral monitoring as an adjunct to nurse-administered propofol sedation for colonoscopy: a randomized controlled trial.  Am J Gastroenterol. 2006;  101 2003-2007
  CrossrefPubMedGoogle Scholar
• 21 Dewitt J, Mcgreevy K, Manzi D. et al . Utility of bispectral index monitoring during nurse-administered propofol sedation for outpatient upper endoscopic ultrasound: a prospective, randomized, single-blinded comparative study [abstract].  Gastrointest Endosc. 2006;  63 AB193
  PubMedGoogle Scholar
• 22 Bower A L, Ripepi A, Dilger J. et al . Bispectral index monitoring of sedation during endoscopy.  Gastrointest Endosc. 2000;  52 192-196
  CrossrefPubMedGoogle Scholar
• 23 Johansen J W. Update on bispectral index monitoring.  Best Pract Res Clin Anaesthesiol. 2006;  20 81-99
  CrossrefPubMedGoogle Scholar
• 24 Külling D, Orlandi M, Inauen W. Propofol sedation during endoscopic procedures: how much staff and monitoring are necessary?.  Gastrointest Endosc. 2007;  66 443-449
  CrossrefPubMedGoogle Scholar
• 25 Tohda G, Higashi S, Wakahara S. et al . Propofol sedation during endoscopic procedures: safe and effective administration by registered nurses supervised by endoscopists.  Endoscopy. 2006;  38 360-367
  Article in Thieme ConnectPubMedGoogle Scholar
• 26 Rampil I J. A primer for EEG signal processing in anesthesia.  Anesthesiology. 1998;  89 980-1002
  CrossrefPubMedGoogle Scholar
• 27 Gan T J, Glass P S, Windsor A. et al . Bispectral index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anesthesia. BIS Utility Study Group.  Anesthesiology. 1997;  87 808-815
  CrossrefPubMedGoogle Scholar
• 28 Qadeer M A, Vargo J J, Patel S. et al . Bispectral index monitoring of conscious sedation with the combination of meperidine and midazolam during endoscopy.  Clin Gastroenterol Hepatol. 2008;  6 102-108
  CrossrefPubMedGoogle Scholar
• 29 Avidan M S, Zhang L, Burnside B A. et al . Anesthesia awareness and the bispectral index.  N Engl J Med. 2008;  358 1097-1108
  CrossrefPubMedGoogle Scholar
• 30 Sipe B, Rex D, Latinovich D. et al . Propofol versus midazolam/meperidine for outpatient colonoscopy: administration by nurses supervised by endoscopists.  Gastrointest Endosc. 2002;  55 815-825
  CrossrefPubMedGoogle Scholar
• 31 Sipe B W, Scheidler M, Baluyut A. et al . A prospective safety study of a low-dose propofol sedation protocol for colonoscopy.  Clin Gastroenterol Hepatol. 2007;  5 563-566
  CrossrefPubMedGoogle Scholar
• 32 Flaishon R, Windsor A, Sigl J. et al . Recovery of consciousness after Thiopental or Propofol: bispectral index and the isolated forearm technique.  Anesthesiology. 1997;  86 613-619
  PubMedGoogle Scholar

Atsushi ImagawaMD 

Tsuyama Central Hospital
Department of Gastroenterology

1756 Kawasaki Tsuyama-city
Okayama
Japan, 708-0841

Fax: +81-868-218200

Email: imagawa-gi@umin.ac.jp