title: Electroencephalogram monitoring facilitates sedation with propofol for routine ERCP: a randomized, controlled trial.
abstract: BACKGROUND
  Endoscopy with the patient under sedation with propofol requires careful monitoring of patient consciousness and vital signs to achieve the desired hypnotic effect without overdosage. Because level of consciousness is difficult to judge by clinical observation alone, electroencephalogram monitoring has been used to guide general anesthesia.
  
  
  METHODS
  Eighty consecutive patients (mean [SD] age 62 [14] years) undergoing ERCP for various indications were randomly allocated to 2 groups. In group A (n = 40), propofol sedation was guided by conventional monitoring (heart rate, blood pressure, oxygen saturation, electrocardiogram), whereas electroencephalogram monitoring was performed but not displayed to the physician who administered the drug. In group B (n = 40), electroencephalogram monitoring was displayed online and used to guide propofol administration to maintain a preselected sedation level. Procedure-related parameters, recovery time, and quality (postanesthesia recovery score), as well as patient cooperation and tolerance for the procedure (visual analog scale) were prospectively assessed.
  
  
  RESULTS
  The groups were comparable with regard to demographic, clinical, and procedure-related parameters. Mean propofol dose was significantly lower in group B than in group A (respectively, 290 [158] mg vs. 374 [166] mg; p = 0.02). The mean decrease in arterial blood pressure was significantly lower in group B than in group A (respectively, 11 [6] mm Hg vs. 14 [7] mm Hg; p < 0.05). Clinically relevant changes in vital signs to below critical values were observed in both groups, albeit infrequently. Efficacy of sedation was also rated similar in both groups, whereas mean recovery time was significantly faster in group B than in group A (respectively, 16 [7] minutes vs. 20 [8] minutes; p = 0.02). Accordingly, the recovery score tended to be better in group B compared with group A (respectively, 8.4 [1.0] points vs. 8.0 [0.9] points; p = 0.06). The predefined target level of sedation was maintained during 75% of the procedure time in group B but in only 58% of the time in group A (p < 0.05), and deeper sedation levels were achieved significantly more often in group B patients compared with group A patients (p < 0.05).
  
  
  CONCLUSIONS
  Electroencephalogram monitoring enables more effective titration of propofol dosage for sedation during endoscopy and is, therefore, associated with faster patient recovery.
authors.affiliation: Department of Internal Medicine I, Academic Hospital Hanover-Siloah, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Wehrmann
authors.forename: Jörg
authors.initials: J
authors.lastname: Grotkamp
authors.forename: Nikos
authors.initials: N
authors.lastname: Stergiou
authors.forename: Andrea
authors.initials: A
authors.lastname: Riphaus
authors.forename: Annegret
authors.initials: A
authors.lastname: Kluge
authors.forename: Bernhard
authors.initials: B
authors.lastname: Lembcke
authors.forename: Arthur
authors.initials: A
authors.lastname: Schultz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004569:Electroencephalography; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol