title: Bispectral-index-guided versus clinically guided remifentanil/propofol analgesia/sedation for interventional radiological procedures: an observer-blinded randomized study.
abstract: Patients undergoing potentially painful interventional radiological procedures generally require a combination of analgesia and sedation. This sedation/analgesia should allow the patient to communicate while also remaining calm. Bispectral index (BIS) monitoring could be useful in achieving this. The primary end-point of our study was to compare the percentage time with optimal sedation, defined as Sedation Agitation Scale (SAS) grade 4, between a BIS-guided remifentanil/propofol regimen and a clinically guided regimen in 54 randomly allocated patients. The mean +/- sd percentage time with optimal sedation was significantly longer (P = 0.004) in the BIS group (76.6% +/- 14.7%) than in the SAS group (63.8% +/- 16.4%). There was a significant difference in the weighted mean infusion rates of remifentanil (P = 0.0067) and propofol (P = 0.0075) in the BIS group (0.066 +/- 0.027 microg.kg(-1) . min(-1) 1.59 +/- 0.44 mg.kg(-1) . h(-1)) compared with the SAS group (0.091 +/- 0.036 microg.kg(-1).min(-1) 1.92 +/- 0.43 mg.kg(-1).h(-1)), respectively. BIS values exhibited a temporal correlation to SAS scores (r2 = 0.72). In conclusion, a BIS-guided regimen was more effective than a SAS-guided regimen. The use of BIS resulted in fewer remifentanil and propofol doses. The targeted BIS range of 80-85 provided a sufficient functional level of sedation.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Graz Medical University, Graz, Austria. Auenbruggerplatz 29, A-8036, Graz, Austria. ashraf.dahaba@meduni-graz.at
authors.forename: Ashraf A
authors.initials: AA
authors.lastname: Dahaba
authors.forename: Ulrike
authors.initials: U
authors.lastname: Lischnig
authors.forename: Robert
authors.initials: R
authors.lastname: Kronthaler
authors.forename: Helmar
authors.initials: H
authors.lastname: Bornemann
authors.forename: Vassil
authors.initials: V
authors.lastname: Georgiev
authors.forename: Peter H
authors.initials: PH
authors.lastname: Rehak
authors.forename: Helfried
authors.initials: H
authors.lastname: Metzler
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D004569:Electroencephalography / Q000187:drug effects*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000494:pharmacology*; D015742:Propofol / Q000494:pharmacology*; D015642:Radiology, Interventional; D000077208:Remifentanil
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol