During endoscopy, patients under sedation with propofol require careful monitoring to achieve the desired hypnotic effect without overdose.
As level of consciousness is difficult to judge by clinical observation, electroencephalogram monitoring has been used to guide general anesthesia.
In this study, published in the latest issue of Gastrointestinal Endoscopy, 80 consecutive patients (mean age 62 years) underwent ERCP for various indications.
|Mean propofol dose was significantly lower in group B than in group A.|
The research team randomly allocated patients to 2 groups. The groups were comparable with regard to demographic, clinical, and procedure-related parameters.
In group A, propofol sedation was guided by conventional monitoring (heart rate, blood pressure, oxygen saturation, electrocardiogram). Electroencephalogram monitoring was also performed, but this was not displayed to the physician who administered the drug.
However in group B, electroencephalogram monitoring was displayed online and used to guide propofol administration.
The team assessed procedure-related parameters, recovery time, and quality (post-anesthesia recovery score).
They also measured patient cooperation and tolerance for the procedure.
The researchers found that the mean propofol dose was significantly lower in group B than in group A (290 mg versus 374 mg).
In addition, the mean decrease in arterial blood pressure was significantly lower in group B than in group A (11 mm Hg versus 14 mm Hg).
However, clinically relevant changes in vital signs to below critical values were infrequently observed in both groups.
The team rated the efficacy of sedation as similar in both groups.
However, mean recovery time was significantly faster in group B than in group A (16 minutes versus 20 minutes). Accordingly, the recovery score tended to be better in group B compared with group A (8.4 points versus 8.0 points).
Furthermore, a predefined target level of sedation was maintained 75% of the time for group B, but in only 58% of the time in group A. Deeper sedation levels were achieved significantly more often in group B patients compared with group A patients.
Dr Till Wehrmann's team concludes, "Electroencephalogram monitoring enables more effective titration of propofol dosage for sedation during endoscopy and is, therefore, associated with faster patient recovery".