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Bispectral index monitoring during anesthesiologist-directed propofol and remifentanil sedation for endoscopic submucosal dissection: A prospective randomized controlled trial

 Woo Young Park  ;  Yang-Sik Shin  ;  Sang Kil Lee  ;  So Yeon Kim  ;  Tai Kyung Lee  ;  Yong Seon Choi 
 YONSEI MEDICAL JOURNAL, Vol.55(5) : 1421-1429, 2014 
Journal Title
Issue Date
Aged ; Anesthetics, Intravenous/administration & dosage* ; Anesthetics, Intravenous/therapeutic use ; Consciousness Monitors* ; Endoscopy/methods ; Female ; Humans ; Intraoperative Complications/prevention & control* ; Male ; Middle Aged ; Monitoring, Physiologic/methods ; Piperidines/administration & dosage* ; Piperidines/adverse effects ; Piperidines/therapeutic use ; Propofol/administration & dosage* ; Propofol/adverse effects ; Propofol/therapeutic use
Bispectral index ; endoscopic submucosal dissection ; propofol ; remifentanil
PURPOSE: Endoscopic submucosal dissection (ESD) is a technically difficult and lengthy procedure requiring optimal depth of sedation. The bispectral index (BIS) monitor is a non-invasive tool that objectively evaluates the depth of sedation. The purpose of this prospective randomized controlled trial was to evaluate whether BIS guided sedation with propofol and remifentanil could reduce the number of patients requiring rescue propofol, and thus reduce the incidence of sedation- and/or procedure-related complications. MATERIALS AND METHODS: A total of 180 patients who underwent the ESD procedure for gastric adenoma or early gastric cancer were randomized to two groups. The control group (n=90) was monitored by the Modified Observer's Assessment of Alertness and Sedation scale and the BIS group (n=90) was monitored using BIS. The total doses of propofol and remifentanil, the need for rescue propofol, and the rates of complications were recorded. RESULTS: The number of patients who needed rescue propofol during the procedure was significantly higher in the control group than the BIS group (47.8% vs. 30.0%, p=0.014). There were no significant differences in the incidence of sedation- and/or procedure-related complications. CONCLUSION: BIS-guided propofol infusion combined with remifentanil reduced the number of patients requiring rescue propofol in ESD procedures. However, this finding did not lead to clinical benefits and thus BIS monitoring is of limited use during anesthesiologist-directed sedation.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, So Yeon(김소연) ORCID logo https://orcid.org/0000-0001-5352-157X
Park, Woo Young(박우영)
Shin, Yang Sik(신양식)
Lee, Sang Kil(이상길) ORCID logo https://orcid.org/0000-0002-0721-0364
Choi, Yong Seon(최용선) ORCID logo https://orcid.org/0000-0002-5348-864X
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