title: Usefulness of bispectral monitoring of conscious sedation during endoscopic mucosal dissection.
abstract: OBJECTIVE
  To assess the usefulness of bispectral index (BIS) monitoring in order to carry out endoscopic submucosal dissection (ESD) safely and with patients' satisfaction.
  
  
  METHODS
  Three hundred sixty-six patients with an early-stage neoplasm of the digestive tract were enrolled. The BIS monitor (A-1050: Aspect medical systems/NIHON KOHDEN, Tokyo, Japan) was used. The appropriate sedative condition was set at 55 to 75 BIS levels (BIS value) during the endoscopic procedures.
  
  
  RESULTS
  Among 366 cases, 13 were accompanied by adverse events during and/or after ESD. All episodes occurred in cases with BIS value between 56 and 65. Hypotension was observed in four cases, and bradycardia in six. Respiratory distress was observed in two cases with chronic pulmonary obstructive disease. All patients with adverse events were able to leave the hospital without extension of the hospitalization.
  
  
  CONCLUSIONS
  BIS monitoring is useful to safely perform ESD. A BIS value of 70 to 75 is suitable for ESD.
authors.affiliation: Department of Medicine, Shiga University of Medical Science, Seta-Tukinowa, Otsu 520-2192, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Hata
authors.forename: Akira
authors.initials: A
authors.lastname: Andoh
authors.forename: Kiyoyuki
authors.initials: K
authors.lastname: Hayafuji
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Ogawa
authors.forename: Tamio
authors.initials: T
authors.lastname: Nakahara
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Tsujikawa
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Fujiyama
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Saito
mesh_terms: D001919:Bradycardia / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000601:surgery*; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D004210:Dissection; D004724:Endoscopy; D004938:Esophageal Neoplasms / Q000601:surgery*; D005753:Gastric Mucosa / Q000601:surgery*; D006801:Humans; D007022:Hypotension / Q000453:epidemiology; D007413:Intestinal Mucosa / Q000601:surgery*; D016343:Monitoring, Intraoperative; D008991:Monitoring, Physiologic; D009092:Mucous Membrane / Q000601:surgery; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology; D012120:Respiration Disorders / Q000453:epidemiology; D013274:Stomach Neoplasms / Q000601:surgery*