High Incidence of Burst Suppression during Propofol Sedation for Outpatient Colonoscopy: Lessons Learned from Neuromonitoring
Background. Although anesthesia providers may plan for moderate sedation, the depth of sedation is rarely quantified. Using processed electroencephalography (EEG) to assess the depth of sedation, this study investigates the incidence of general anesthesia with variable burst suppression in patients...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2020-01-01
|
| Series: | Anesthesiology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2020/7246570 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850174782533795840 |
|---|---|
| author | Jamie Bloom David Wyler Marc C. Torjman Tuan Trinh Lucy Li Amy Mehta Evan Fitchett David Kastenberg Michael Mahla Victor Romo |
| author_facet | Jamie Bloom David Wyler Marc C. Torjman Tuan Trinh Lucy Li Amy Mehta Evan Fitchett David Kastenberg Michael Mahla Victor Romo |
| author_sort | Jamie Bloom |
| collection | DOAJ |
| description | Background. Although anesthesia providers may plan for moderate sedation, the depth of sedation is rarely quantified. Using processed electroencephalography (EEG) to assess the depth of sedation, this study investigates the incidence of general anesthesia with variable burst suppression in patients receiving propofol for outpatient colonoscopy. The lessons learned from neuromonitoring can then be used to guide institutional best sedation practice. Methods. This was a prospective observational study of 119 outpatients undergoing colonoscopy at Thomas Jefferson University Hospital (TJUH). Propofol was administered by CRNAs under anesthesiologists’ supervision. The Patient State Index (PSi™) generated by the Masimo SedLine® Brain Root Function monitor (Masimo Corp., Irvine, CA) was used to assess the depth of sedation. PSi data correlating to general anesthesia with variable burst suppression were confirmed by neuroelectrophysiologists’ interpretation of unprocessed EEG. Results. PSi values of <50 consistent with general anesthesia were attained in 118/119 (99.1%) patients. Of these patients, 33 (27.7%) attained PSi values <25 consistent with variable burst suppression. The 118 patients that reached PSi <50 spent a significantly greater percentage (53.1% vs. 42%) of their case at PSi levels <50 compared to PSi levels >50 (p=0.001). Mean total propofol dose was significantly correlated to patient PSi during periods of PSi <25 (R=0.406, p=0.021). Conclusion. Although providers planned for moderate to deep sedation, processed EEG showed patients were under general anesthesia, often with burst suppression. Anesthesiologists and endoscopists may utilize processed EEG to recognize their institutional practice patterns of procedural sedation with propofol and improve upon it. |
| format | Article |
| id | doaj-art-d7664a79f9474ca7b38749d34e01d5eb |
| institution | OA Journals |
| issn | 1687-6962 1687-6970 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Anesthesiology Research and Practice |
| spelling | doaj-art-d7664a79f9474ca7b38749d34e01d5eb2025-08-20T02:19:34ZengWileyAnesthesiology Research and Practice1687-69621687-69702020-01-01202010.1155/2020/72465707246570High Incidence of Burst Suppression during Propofol Sedation for Outpatient Colonoscopy: Lessons Learned from NeuromonitoringJamie Bloom0David Wyler1Marc C. Torjman2Tuan Trinh3Lucy Li4Amy Mehta5Evan Fitchett6David Kastenberg7Michael Mahla8Victor Romo9Department of Anesthesiology, Division of Neurological Anesthesia, Thomas Jefferson University, 111 S. 11th Street, Philadelphia, PA 19107, USADepartment of Anesthesiology, Division of Neurological Anesthesia, Thomas Jefferson University, 111 S. 11th Street, Philadelphia, PA 19107, USADepartment of Anesthesiology, Division of Neurological Anesthesia, Thomas Jefferson University, 111 S. 11th Street, Philadelphia, PA 19107, USADepartment of Anesthesiology, Division of Neurological Anesthesia, Thomas Jefferson University, 111 S. 11th Street, Philadelphia, PA 19107, USASidney Kimmel Medical College, 1025 Walnut Street, Philadelphia, PA 19107, USADepartment of Anesthesiology, Division of Neurological Anesthesia, Thomas Jefferson University, 111 S. 11th Street, Philadelphia, PA 19107, USASidney Kimmel Medical College, 1025 Walnut Street, Philadelphia, PA 19107, USADepartment of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University, 132 S. 10th Street, Philadelphia, PA 19107, USADepartment of Anesthesiology, Division of Neurological Anesthesia, Thomas Jefferson University, 111 S. 11th Street, Philadelphia, PA 19107, USADepartment of Anesthesiology, Division of Neurological Anesthesia, Thomas Jefferson University, 111 S. 11th Street, Philadelphia, PA 19107, USABackground. Although anesthesia providers may plan for moderate sedation, the depth of sedation is rarely quantified. Using processed electroencephalography (EEG) to assess the depth of sedation, this study investigates the incidence of general anesthesia with variable burst suppression in patients receiving propofol for outpatient colonoscopy. The lessons learned from neuromonitoring can then be used to guide institutional best sedation practice. Methods. This was a prospective observational study of 119 outpatients undergoing colonoscopy at Thomas Jefferson University Hospital (TJUH). Propofol was administered by CRNAs under anesthesiologists’ supervision. The Patient State Index (PSi™) generated by the Masimo SedLine® Brain Root Function monitor (Masimo Corp., Irvine, CA) was used to assess the depth of sedation. PSi data correlating to general anesthesia with variable burst suppression were confirmed by neuroelectrophysiologists’ interpretation of unprocessed EEG. Results. PSi values of <50 consistent with general anesthesia were attained in 118/119 (99.1%) patients. Of these patients, 33 (27.7%) attained PSi values <25 consistent with variable burst suppression. The 118 patients that reached PSi <50 spent a significantly greater percentage (53.1% vs. 42%) of their case at PSi levels <50 compared to PSi levels >50 (p=0.001). Mean total propofol dose was significantly correlated to patient PSi during periods of PSi <25 (R=0.406, p=0.021). Conclusion. Although providers planned for moderate to deep sedation, processed EEG showed patients were under general anesthesia, often with burst suppression. Anesthesiologists and endoscopists may utilize processed EEG to recognize their institutional practice patterns of procedural sedation with propofol and improve upon it.http://dx.doi.org/10.1155/2020/7246570 |
| spellingShingle | Jamie Bloom David Wyler Marc C. Torjman Tuan Trinh Lucy Li Amy Mehta Evan Fitchett David Kastenberg Michael Mahla Victor Romo High Incidence of Burst Suppression during Propofol Sedation for Outpatient Colonoscopy: Lessons Learned from Neuromonitoring Anesthesiology Research and Practice |
| title | High Incidence of Burst Suppression during Propofol Sedation for Outpatient Colonoscopy: Lessons Learned from Neuromonitoring |
| title_full | High Incidence of Burst Suppression during Propofol Sedation for Outpatient Colonoscopy: Lessons Learned from Neuromonitoring |
| title_fullStr | High Incidence of Burst Suppression during Propofol Sedation for Outpatient Colonoscopy: Lessons Learned from Neuromonitoring |
| title_full_unstemmed | High Incidence of Burst Suppression during Propofol Sedation for Outpatient Colonoscopy: Lessons Learned from Neuromonitoring |
| title_short | High Incidence of Burst Suppression during Propofol Sedation for Outpatient Colonoscopy: Lessons Learned from Neuromonitoring |
| title_sort | high incidence of burst suppression during propofol sedation for outpatient colonoscopy lessons learned from neuromonitoring |
| url | http://dx.doi.org/10.1155/2020/7246570 |
| work_keys_str_mv | AT jamiebloom highincidenceofburstsuppressionduringpropofolsedationforoutpatientcolonoscopylessonslearnedfromneuromonitoring AT davidwyler highincidenceofburstsuppressionduringpropofolsedationforoutpatientcolonoscopylessonslearnedfromneuromonitoring AT marcctorjman highincidenceofburstsuppressionduringpropofolsedationforoutpatientcolonoscopylessonslearnedfromneuromonitoring AT tuantrinh highincidenceofburstsuppressionduringpropofolsedationforoutpatientcolonoscopylessonslearnedfromneuromonitoring AT lucyli highincidenceofburstsuppressionduringpropofolsedationforoutpatientcolonoscopylessonslearnedfromneuromonitoring AT amymehta highincidenceofburstsuppressionduringpropofolsedationforoutpatientcolonoscopylessonslearnedfromneuromonitoring AT evanfitchett highincidenceofburstsuppressionduringpropofolsedationforoutpatientcolonoscopylessonslearnedfromneuromonitoring AT davidkastenberg highincidenceofburstsuppressionduringpropofolsedationforoutpatientcolonoscopylessonslearnedfromneuromonitoring AT michaelmahla highincidenceofburstsuppressionduringpropofolsedationforoutpatientcolonoscopylessonslearnedfromneuromonitoring AT victorromo highincidenceofburstsuppressionduringpropofolsedationforoutpatientcolonoscopylessonslearnedfromneuromonitoring |