Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Kronthaler, R.
Bispectral-guided versus SAS-guided analgo-sedation in interventional radiology
[ Dissertation ] Graz Medical University; 2004. pp.45.
- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Metzler Helfried
- Altmetrics:
- Abstract:
- BACKGROUND BIS monitoring of the depth of sedation makes is potentially beneficial for sedation an analgesia in patients undergoing painful interventional radiological procedures. We compared the efficacy and safety of BIS-guided regimen to a standard clinical SAS-guided regimen for the provision of optimal analgesia-sedation. We also assessed the feasibility of using Bispectral index-XP (BISxp) monitoring in quantifying the level of sedation. We hypothesized that the efficacy of a BIS-guided regimen was more than that of a standard clinical SAS-guided analgesia and sedation regimen. METHODS Forty patients were randomly allocated to either the BIS-guided regimen of the SAS-guided group. In the intent-to-treat patients remifentanil (0.05 g kg-1min-1) infusion was titrated, in the first intent, to achieve optimal sedation defined as Sedation Agitation scale of 4. Propofol 1.5 mg kg-1h-1 infusion was started if additional sedation was required. Sedation Agitation scale of 4 achieved by the titration of remifentanil in the first intent followed by propofol infusion, to maintain patients at optimal sedation defined as SAS 4 (patient calm and cooperative and easily arousable). RESULTS The mean percentage hours of optimal sedation was significantly longer in the BIS-group (78.5 plus/minus 24.5) than in the SAS-group (66.5 plus/minus 8.5) (P value 0.0428). This was chieved with less frequent infusion rate adjustments in the BIS-group (2.33 changes/h remifentanil and 2.64 changes/h propofol) than in the SAS-group (3.46 changes/h remifentanil and 2.89 changes/h propofol). The mean total time of sedation and analgesia was not significantly different between the BIS-guided and SAS-guided group (59.0 plus/minus 18.61 and 60.5 plus/minus 23.50 min respectively). Remifentanil mean infusion rate was 0.0661 plus/minus 0.0264 g/kg/min in the BIS-group and 0.0713 plus/minus 0.0356 g/kg/min in the SAS-group, whereas propofol mean infusion rate was 1.55 plus/minus 0.44 mg/kg/h in the BIS-group and 1.82 plus/minus 0.44 mg/kg/h in the SAS-group. More subjects in the SAS-group (17/20) required propofol than in the BIS-group (11/20). The incidence of reported hypotension and apnea adverse events was low and comparable across the two treatment groups. BISxp correlated to SAS score (r2=0.6242) of our study patients, although there was wide variability for any given level of SAS score.