Bispectral Index Monitoring & Procedural Sedation
You are working a shift and are seeing a 30 year old male, who has sustained a posterior hip dislocation in an MVC. As he is muscular, you are expecting the reduction to be physically challenging. He will obviously need conscious sedation for the procedure. During your pre-procedure checklist, you note that he has no significant medical history, although he tells you that he remembers hearing the surgeons talking in the middle of his hernia repair 2 years ago, and felt severe pain at the operative site during the procedure. You and your patient are both very concerned about making sure he receives adequate sedation.
During your time in the CT-ICU, you heard about the JCAHO recommended use of bispectral index monitoring (BIS) during sedation and anesthesia. A quick check with the nurses reveals that our ED monitors are capable of utilizing the device. After formulating the PICO question “Do Emergency Department patients undergoing conscious sedation experience less procedural awareness with the use of bispectral index monitoring than do those utilizing standard conscious sedation”, you do a Pubmed search using the term, “Bispectral Index,” (718 references) and you combine this result with “emergency,” to get 12 selections. You then combine “bispectral index” with “awareness” and find two other articles which look promising, although they are not ED based studies.
First years: The utility of the bispectral index in procedural sedation with propofol in the emergency department. Acad EM 2005;12:190
Second years: A study of the Bispectral Index Monitor during procedural sedation and analgesia in the emergency department. Annals EM 2003;41:234
Third years: Bispectral index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anesthesia. Anesthesiology 1997;87:808
Fourth years: Bispectral Index monitoring to prevent awareness during anesthesia: the B-Aware randomized controlled trial. Lancet 2004;363:1757
First, Third Year Residents: use the Therapy Critical Review Form
Second, Fourth Year Residents: use the Meta-Analysis Critical Review Form
Article 1: Utility of BIS in Proc Sed with Propofol in the ED, Acad EM 2005. 12:3;190-196
Article 2: A Study of the Bispectral Index Monitor During Procedural Sedation and Analgesia in the Emergency Department, Annals EM 41:2;234-241
Article 3: BIS allows faster emergence AND Improved Recovery from Propofol, Alfentanil and Nitrous Oxide Anesthesia, Anesthesiology1997.87:4;808-815
Article 4: Bispectral Index monitoring to prevent awareness during anesthesia: the B-Aware randomized controlled trial, Lancet 2004; 363:1757-1763