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Safety of EEG BIS-guided nurse-administered procedural sedation during gastro-intestinal intervention

Authors :
Alexander Oh
Sviatlana Vasileuskaya
Nabil Kibriya
Paula Puro
Damian Mullan
Hans-Ulrich Laasch
Source :
International Journal of Gastrointestinal Intervention, Vol 13, Iss 1, Pp 8-10 (2024)
Publication Year :
2024
Publisher :
Society of Gastrointestinal Intervention, 2024.

Abstract

Background: Sedation remains a subject of contention and anxiety for many interventional teams. We reviewed our outcomes of electroencephalographic (EEG) bi-spectral index sensor (BIS) guidance, which allowed us to transfer the role of the sedation practitioner to the interventional radiology nurses. Methods: In total, 150 consecutive cancer-related interventional procedures were collected prospectively at a tertiary center. All patients were given 4 L oxygen via a nasal cannula and had conscious sedation administered by two trained interventional nurses. In addition to standard monitoring, frontal lobe EEG BIS monitoring was used. The initial amount of midazolam or fentanyl administered were dependant on the patient’s age and American Society of Anesthesiologists classification score. Thereafter, conscious sedation was maintained by titrating small incremental doses to maintain BIS between 80 and 85. The patients’ vitals were monitored at 5-minute intervals and recorded along with the Ramsay sedation scale and tolerance score. Results: The three most common procedures were: radiologically inserted gastrostomy (48%), percutaneous transhepatic cholangiography (35%), and esophageal stenting (11%). All procedures were completed without disruption or unexpected patient movements. No reversal agents or airway management were required and no incidences of hypoxia occurred. Conclusion: BIS monitoring is an invaluable tool that has successfully allowed the role of the sedation practitioner to be transferred to the interventional nurses. It allows sedation to be personalized to each patient and their individual susceptibility to combination sedation and represents a vast improvement over interval clinical assessment of patients’ responsiveness to stimuli.

Details

Language :
English
ISSN :
26360004
Volume :
13
Issue :
1
Database :
Directory of Open Access Journals
Journal :
International Journal of Gastrointestinal Intervention
Publication Type :
Academic Journal
Accession number :
edsdoj.04bfa410e247adadd858f93ea29d84
Document Type :
article
Full Text :
https://doi.org/10.18528/ijgii240001