title: A target-controlled infusion system with bispectral index monitoring of propofol sedation during endoscopic submucosal dissection.
abstract: OBJECTIVE
  Propofol administration via a target-controlled infusion system with bispectral index monitoring (BIS/TCI system) is expected to prevent complications from sedation during complex and long endoscopic procedures. We evaluated the feasibility of setting the BIS/TCI system for non-anesthesiologist administration of propofol (NAAP) during endoscopic submucosal dissection (ESD).
  
  
  METHODS
  From May 2009 to February 2013, 250 patients with esophagogastric neoplasms were treated with ESD using the BIS/TCI system with NAAP. In the TCI system, the initial target blood concentration of propofol was set at 1.2 μg/mL. The titration speed of propofol was adjusted according to the BIS score and the movement of the patient. The BIS target level ranged from moderate to deep sedation, at which a stable BIS score between 60 and 80 was obtained.
  
  
  RESULTS
  In 80.4 % of patients, it was possible to maintain stable sedation with a blood concentration of propofol of less than 1.6 µg/mL using TCI throughout the ESD procedure. The default setting for ideal blood concentration of propofol was 1.2 μg/mL, because the medians of the lower and upper bounds of blood concentration were 1.2 μg/mL (range 0.6 - 1.8 μg/mL) and 1.4 μg/mL (range 1.0 - 3.8 μg/mL), respectively. Although hypotension occurred in 27 patients (10.8 %), oxygen desaturation occurred in only nine patients (3.6 %), and severe desaturation in only two patients (0.8 %).
  
  
  CONCLUSIONS
  Using our settings, it is possible for a non-anesthesiologist to maintain stable sedation during a lengthy endoscopic procedure through propofol sedation with a BIS/TCI system.
authors.affiliation: Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Imagawa
authors.affiliation: Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Hata
authors.affiliation: Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan.
authors.forename: Morihito
authors.initials: M
authors.lastname: Nakatsu
authors.affiliation: Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Matsumi
authors.affiliation: Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan.
authors.forename: Eijiro
authors.initials: E
authors.lastname: Ueta
authors.affiliation: Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan.
authors.forename: Kozue
authors.initials: K
authors.lastname: Suto
authors.affiliation: Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Terasawa
authors.affiliation: Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sakae
authors.affiliation: Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Takeuchi
authors.affiliation: Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Fujihara
authors.affiliation: Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan.
authors.forename: Hitomi
authors.initials: H
authors.lastname: Endo
authors.affiliation: Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan.
authors.forename: Hisae
authors.initials: H
authors.lastname: Yasuhara
authors.affiliation: Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ishihara
authors.affiliation: Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Kanzaki
authors.affiliation: Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Jinno
authors.affiliation: Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Kamada
authors.affiliation: Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan.
authors.forename: Eisuke
authors.initials: E
authors.lastname: Kaji
authors.affiliation: Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Moriya
authors.affiliation: Department of Gastroenterology, Mitoyo General Hospital, Kagawa, Japan.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Ando