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
imagawa-gi@umin.ac.jp
