Digestive Diseases and Sciences

, Volume 58, Issue 12, pp 3576–3583 | Cite as

Efficacy of Bispectral Index Monitoring During Balanced Propofol Sedation for Colonoscopy: A Prospective, Randomized Controlled Trial

  • Yeon Hwa Yu
  • Dong Soo Han
  • Hyun Soo Kim
  • Eun Kyung Kim
  • Chang Soo Eun
  • Kyo-Sang Yoo
  • Woo Jong Shin
  • Seungho Ryu
Original Article


Background and Aims

Appropriate use of propofol is necessary, and objective monitoring of sedation with propofol may be helpful. Studies on the efficacy of bispectral index (BIS) monitoring in deep sedation have been conducted, but its efficacy in colonoscopy with moderate sedation is unknown. In this study, the efficacy of BIS monitoring during colonoscopy with moderate level sedation via balanced propofol sedation was investigated.


To determine the cut-off value of BIS before the test, an optimal BIS value was determined. Patients who were scheduled to undergo outpatient colonoscopy were prospectively randomized to either a BIS or control group. Finally, a total of 115 patients were selected for this study. The satisfaction level, the complication, and the dosage of the administered propofol were compared.


The BIS values and the modified observer’s assessment of alertness/sedation scores (MOAA/S) were positively correlated (r = 0.66 and p < 0.001). The optimal cut-off value of BIS for maintaining moderate sedation was 81, and the area under the ROC curve was 0.88 (95 % CI 0.82–0.93), indicating high prediction accuracy. However, there was no difference between the BIS group and the control group in levels of satisfaction of either patients or endoscopists. In addition, there was no difference in the complication and the required dose of propofol between both groups.


BIS and clinical sedation scores, MOAA/S scores, showed a high level of correlation. However, no significant efficacy was observed in the BIS group who underwent outpatient colonoscopy.


Conscious sedation Propofol Bispectral index monitor Colonoscopy 

Supplementary material

10620_2013_2833_MOESM1_ESM.doc (36 kb)
Supplementary material 1 (DOC 35 kb)


  1. 1.
    Vargo JJ, Cohen LB, Rex DK, et al. Position statement: nonanesthesiologist administration of propofol for GI endoscopy. Gastrointest Endosc. 2009;70:1053–1059.PubMedCrossRefGoogle Scholar
  2. 2.
    Cohen LB, Hightower CD, Wood DA, et al. Moderate level sedation during endoscopy: a prospective study using low-dose propofol, meperidine/fentanyl, and midazolam. Gastrointest Endosc. 2004;59:795–803.PubMedCrossRefGoogle Scholar
  3. 3.
    Sipe BW, Scheidler M, Baluyut A, et al. A prospective safety study of a low-dose propofol sedation protocol for colonoscopy. Clin Gastroenterol Hepatol. 2007;5:563–566.PubMedCrossRefGoogle Scholar
  4. 4.
    Cohen LB, Dubovsky AN, Aisenberg J, et al. Propofol for endoscopic sedation: A protocol for safe and effective administration by the gastroenterologist. Gastrointest Endosc. 2003;58:725–732.PubMedCrossRefGoogle Scholar
  5. 5.
    VanNatta ME, Rex DK. Propofol alone titrated to deep sedation versus propofol in combination with opioids and/or benzodiazepines and titrated to moderate sedation for colonoscopy. Am J Gastroenterol. 2006;101:2209–2217.PubMedCrossRefGoogle Scholar
  6. 6.
    Wehrmann T, Riphaus A. Sedation with propofol for interventional endoscopic procedures: a risk factor analysis. Scand J Gastroenterol. 2008;43:368–374.PubMedCrossRefGoogle Scholar
  7. 7.
    Johansen JW. Update on bispectral index monitoring. Best Pract Res Clin Anaesthesiol. 2006;20:81–99.PubMedCrossRefGoogle Scholar
  8. 8.
    Paspatis GA, Chainaki I, Manolaraki MM, et al. Efficacy of bispectral index monitoring as an adjunct to propofol deep sedation for ERCP: a randomized controlled trial. Endoscopy. 2009;41:1046–1051.PubMedCrossRefGoogle Scholar
  9. 9.
    Imagawa A, Fujiki S, Kawahara Y, et al. Satisfaction with bispectral index monitoring of propofol-mediated sedation during endoscopic submucosal dissection: a prospective, randomized study. Endoscopy. 2008;40:905–909.PubMedCrossRefGoogle Scholar
  10. 10.
    Chen SC, Rex DK. An initial investigation of bispectral monitoring as an adjunct to nurse-administered propofol sedation for colonoscopy. Am J Gastroenterol. 2004;99:1081–1086.PubMedCrossRefGoogle Scholar
  11. 11.
    Drake LM, Chen SC, Rex DK. Efficacy of bispectral monitoring as an adjunct to nurse-administered propofol sedation for colonoscopy: a randomized controlled trial. Am J Gastroenterol. 2006;101:2003–2007.PubMedCrossRefGoogle Scholar
  12. 12.
    Billard V, Gambus PL, Chamoun N, et al. A comparison of spectral edge, delta power, and bispectral index as EEG measures of alfentanil, propofol, and midazolam drug effect. Clin Pharmacol Ther. 1997;61:45–58.PubMedCrossRefGoogle Scholar
  13. 13.
    Bower AL, Ripepi A, Dilger J, et al. Bispectral index monitoring of sedation during endoscopy. Gastrointest Endosc. 2000;52:192–196.PubMedCrossRefGoogle Scholar
  14. 14.
    Glass PS, Bloom M, Kearse L, et al. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology. 1997;86:836–847.PubMedCrossRefGoogle Scholar
  15. 15.
    Cohen LB, Delegge MH, Aisenberg J, et al. AGA Institute review of endoscopic sedation. Gastroenterology. 2007;133:675–701.PubMedCrossRefGoogle Scholar
  16. 16.
    American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96:1004–1017.Google Scholar
  17. 17.
    Aldrete JA. Modifications to the postanesthesia score for use in ambulatory surgery. J Perianesth Nurs. 1998;13:148–155.PubMedCrossRefGoogle Scholar
  18. 18.
    Sigl JC, Chamoun NG. An introduction to bispectral analysis for the electroencephalogram. J Clin Monit. 1994;10:392–404.PubMedCrossRefGoogle Scholar
  19. 19.
    Kearse LA Jr, Rosow C, Zaslavsky A, et al. Bispectral analysis of the electroencephalogram predicts conscious processing of information during propofol sedation and hypnosis. Anesthesiology. 1998;88:25–34.PubMedCrossRefGoogle Scholar
  20. 20.
    von Delius S, Thies P, Rieder T, et al. Auditory evoked potentials compared with bispectral index for monitoring of midazolam and propofol sedation during colonoscopy. Am J Gastroenterol. 2009;104:318–325.CrossRefGoogle Scholar
  21. 21.
    Cohen LB, Wecsler JS, Gaetano JN, et al. Endoscopic sedation in the United States: results from a nationwide survey. Am J Gastroenterol. 2006;101:967–974.PubMedCrossRefGoogle Scholar
  22. 22.
    Benson AA, Cohen LB, Waye JD, et al. Endoscopic sedation in developing and developed countries. Gut Liver. 2008;2:105–112.PubMedCrossRefGoogle Scholar
  23. 23.
    Riphaus A, Rabofski M, Wehrmann T. Endoscopic sedation and monitoring practice in Germany: results from the first nationwide survey. Z Gastroenterol. 2010;48:392–397.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Yeon Hwa Yu
    • 1
  • Dong Soo Han
    • 2
    • 5
  • Hyun Soo Kim
    • 2
  • Eun Kyung Kim
    • 2
  • Chang Soo Eun
    • 2
  • Kyo-Sang Yoo
    • 2
  • Woo Jong Shin
    • 3
  • Seungho Ryu
    • 4
  1. 1.Department of Internal MedicineSeoul Metropolitan Dongbu HospitalSeoulKorea
  2. 2.Department of Internal MedicineHanyang University College of MedicineGuriKorea
  3. 3.Department of Anesthesia and Pain MedicineHanyang University College of MedicineGuriKorea
  4. 4.Department of Occupational Medicine, Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulKorea
  5. 5.Division of Gastroenterology, Department of Internal MedicineHanyang University Guri HospitalGuri-siKorea

Personalised recommendations