title: Bispectral index monitoring for conscious sedation in intervention: better, safer, faster.
abstract: OBJECTIVE
  The aim of this study was to compare subjective (Ramsay sedation score, RSS) with objective electroencephalogram-based bispectral index (BIS) assessment, and to validate the appropriate BIS range for measurement of conscious sedation in interventional procedures.
  
  
  METHODS
  One hundred patients undergoing sedo-analgesia (midazolam and fentanyl) for interventional gastrointestinal procedures were divided into two groups. In group A (n=30) sedation was guided by the RSS with the operator blinded to the BIS recording. In group B (n=70) the operator titrated intravenous sedation to maintain an optimal BIS, predetermined from the results in group A. Recovery time, procedure duration, physiological parameters and unplanned events were recorded in both groups.
  
  
  RESULTS
  There was a significant correlation between the BIS and RSS (p<0.001). BIS values of 87.2 and 80.9 corresponded to an RSS of 3 and 4, respectively. The optimal BIS level was defined as 80-85. Fifty-seven point five percent of readings were within this range in group B compared with 26.5% in group A (p<0.001). Sedation approaching general anaesthesia (BIS<60) occurred in 5.5% of patients in group A but not in group B. Mean recovery time, duration of procedure, midazolam and fentanyl doses were significantly reduced in group B. Unplanned events were reduced from 27 to 17%, but this was not statistically significant (p=0.29).
  
  
  CONCLUSIONS
  BIS monitoring enables more effective titration of sedatives to maintain a suitable level of consciousness, whilst reducing procedure time. The BIS offers an objective, safe and reliable measure of sedation, without disturbing either patient or operator. BIS monitoring raises the standard of patient care, and in our view, should be used to augment standard assessment.
authors.affiliation: Academic Department of GI-Radiology, South Manchester University Hospitals Trust, Manchester, UK.
authors.forename: J K
authors.initials: JK
authors.lastname: Bell
authors.forename: H-U
authors.initials: HU
authors.lastname: Laasch
authors.forename: L
authors.initials: L
authors.lastname: Wilbraham
authors.forename: R E
authors.initials: RE
authors.lastname: England
authors.forename: J A
authors.initials: JA
authors.lastname: Morris
authors.forename: D F
authors.initials: DF
authors.lastname: Martin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D004334:Drug Administration Schedule; D004569:Electroencephalography / Q000379:methods; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D041981:Gastrointestinal Tract / Q000601:surgery; D006801:Humans; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D017060:Patient Satisfaction; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D018686:Anesthetics, Intravenous; D008874:Midazolam; D005283:Fentanyl