Bispectral Index Versus Standard Monitoring in Sedation for Endoscopic Procedures: A Systematic Review and Meta-Analysis

Abstract

Bispectral index (BIS ) monitoring has been used as an objective measurement tool for sedation depth and has been proposed as a guidance to reduce the risk of intraprocedural over-sedation. However, the results of several studies evaluating the benefits of BIS monitoring for gastrointestinal endoscopy were not consistent. This meta-analysis aimed to assess the reduction in total consumption of administrated propofol and recovery time under BIS during gastrointestinal endoscopy. Electronic databases (MEDLINE, EMBASE, WEB of SCIENCE, and the Cochrane Central Register of Controlled Trials) were searched for articles published through March 2015. After screening, the reviewers extracted information on 11 randomized controlled trials. A total of 1039 patients (526 in BIS and 513 in non-BIS group) were included in this study. Meta-analyses showed that the total propofol consumption (the pooled standardized mean difference [SMD]: -0.15, 95 % confidence interval [CI]: -0.28 to -0.01) was significantly lower in the BIS group than in the non-BIS group, although mean propofol consumption was not significantly different. Recovery time (the pooled SMD: -0.04 [95 % CI -0.46 to 0.38, P = 0.85]), procedure time (the pooled SMD: 0.13 [95 % CI -0.03 to 0.29, P = 0.11]), adverse events, and satisfaction-related outcomes were not significantly superior in the BIS group when compared with the non-BIS group. This first meta-analysis showed that BIS monitoring appears to be an effective and safe method for avoiding unnecessary administration of propofol and for providing adequate sedation during endoscopic procedures.