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01-06-2021 | Endoscopy | ENT • Original Article

Depth of sedation during drug induced sedation endoscopy monitored by BiSpectral Index® and Cerebral State Index®

Authors: Michael Herzog, Mathias Rudzki, Sebastian Plößl, Stefan Plontke, Patrick Kellner

Published in: Sleep and Breathing | Issue 2/2021

Abstract

Purpose

Drug induced sedation endoscopy (DISE) is performed to investigate patterns and sites of obstruction in patients with sleep-disordered breathing (SDB). During DISE the patients are sedated to obtain a muscular relaxation of the upper airway which mimics the relaxation during natural sleep. Different sleep stages are intended to be simulated by drug induced sedation, and it is helpful to measure the depth of sedation. The BiSpectral Index® (BIS) is often used for this procedure. Besides the BIS, other means of sedation depth monitoring exist in anaesthesiology but have not yet been investigated with respect to DISE. Monitoring of the Cerebral State Index® (CSI) is one of these methods. The aim of the study was to compare the BIS and CSI for sedation depth monitoring during DISE.

Methods

Sixty patients underwent DISE monitored by the BIS and CSI in parallel. The BIS and CSI values were compared using the Bland-Altman analysis.

Results

The BIS and CSI values differed during the course of sedation during DISE by a mean of – 6.07. At light sedation (BIS 60–80), lower values by 10 scale points of CSI compared with BIS were detectable. At deeper sedation levels (BIS 40–50), the CSI turned to present equal and even higher values compared with the BIS.

Conclusion

Sedation depth measurement during DISE can be performed by the BIS or CSI, but the differences should be interpreted carefully as comparable data for sleep stages in natural sleep are available only for BIS.

Pringle MB, Croft CB (1991) A comparison of sleep nasendoscopy and the Muller manoeuvre. Clin Otolaryngol Allied Sci 16(6):559–562CrossRef

Pringle MB, Croft CB (1993) A grading system for patients with obstructive sleep apnoea--based on sleep nasendoscopy. Clin Otolaryngol Allied Sci 18(6):480–484CrossRef

de Vito A, Carrasco Llatas M, Ravesloot MJ, Kotecha B, de Vries N, Hamans E, Maurer J, Bosi M, Blumen M, Heiser C, Herzog M, Montevecchi F, Corso RM, Braghiroli A, Gobbi R, Vroegop A, Vonk PE, Hohenhorst W, Piccin O, Sorrenti G, Vanderveken OM, Vicini C (2018) European position paper on drug-induced sleep endoscopy: 2017 Update. Clin Otolaryngol 43(6):1541–1552. https://doi.org/10.1111/coa.13213CrossRefPubMed

Kellner P, Herzog B, Plossl S et al (2016) Depth-dependent changes of obstruction patterns under increasing sedation during drug-induced sedation endoscopy: results of a German monocentric clinical trial. Sleep Breath 20:1035–1043. https://doi.org/10.1007/s11325-016-1348-6CrossRefPubMed

Borek RC, Thaler ER, Kim C, Jackson N, Mandel JE, Schwab RJ (2012) Quantitative airway analysis during drug-induced sleep endoscopy for evaluation of sleep apnea. Laryngoscope 122(11):2592–2599. https://doi.org/10.1002/lary.23553CrossRefPubMed

Hong SD, Dhong H-J, Kim HY, Sohn JH, Jung YG, Chung SK, Park JY, Kim JK (2013) Change of obstruction level during drug-induced sleep endoscopy according to sedation depth in obstructive sleep apnea. Laryngoscope 123(11):2896–2899. https://doi.org/10.1002/lary.24045CrossRefPubMed

Lo Y-L, Ni Y-L, Wang T-Y, Lin TY, Li HY, White DP, Lin JR, Kuo HP (2015) Bispectral index in evaluating effects of sedation depth on drug-induced sleep endoscopy. J Clin Sleep Med 11(9):1011–1020. https://doi.org/10.5664/jcsm.5016CrossRefPubMedPubMedCentral

Abdullah VJ, Lee DLY, Ha SCN, van Hasselt CA (2013) Sleep endoscopy with midazolam: sedation level evaluation with bispectral analysis. Otolaryngol Head Neck Surg 148(2):331–337. https://doi.org/10.1177/0194599812464865CrossRefPubMed

Nieuwenhuijs D, Coleman EL, Douglas NJ et al (2002) Bispectral index values and spectral edge frequency at different stages of physiologic sleep. Anesth Analg 94(1):125–129 table of contentsPubMed

10.

Sleigh JW, Andrzejowski J, Steyn-Ross A, Steyn-Ross M (1999) The bispectral index: a measure of depth of sleep? Anesth Analg 88(3):659–661CrossRef

11.

Dahaba AA, Xue JX, Xu GX, Liu QH, Metzler H (2011) Bilateral bispectral index (BIS)-vista as a measure of physiologic sleep in sleep-deprived anesthesiologists. Minerva Anestesiol 77(4):388–393PubMed

12.

Giménez S, Romero S, Alonso JF, Mañanas MÁ, Pujol A, Baxarias P, Antonijoan RM (2017) Monitoring sleep depth: analysis of bispectral index (BIS) based on polysomnographic recordings and sleep deprivation. J Clin Monit Comput 31(1):103–110. https://doi.org/10.1007/s10877-015-9805-5CrossRefPubMed

13.

Jameson LC, Sloan TB (2006) Using EEG to monitor anesthesia drug effects during surgery. J Clin Monit Comput 20(6):445–472. https://doi.org/10.1007/s10877-006-9044-xCrossRefPubMed

14.

Rampil IJ (1998) A primer for EEG signal processing in anesthesia. Anesthesiology 89(4):980–1002. https://doi.org/10.1097/00000542-199810000-00023CrossRefPubMed

15.

Jensen EW, Litvan H, Revuelta M, Rodriguez BE, Caminal P, Martinez P, Vereecke H, Struys MMRF (2006) Cerebral state index during propofol anesthesia: a comparison with the bispectral index and the A-line ARX index. Anesthesiology 105(1):28–36. https://doi.org/10.1097/00000542-200607000-00009CrossRefPubMed

16.

Jensen EW, Lindholm P, Henneberg SW (1996) Autoregressive modeling with exogenous input of middle-latency auditory-evoked potentials to measure rapid changes in depth of anesthesia. Methods Inf Med 35(3):256–260CrossRef

17.

Nishiyama T (2009) Cerebral state index vs. bispectral index during sevoflurane-nitrous oxide anaesthesia. Eur J Anaesthesiol 26(8):638–642. https://doi.org/10.1097/EJA.0b013e328324e946CrossRefPubMed

18.

Anderson RE, Jakobsson JG (2006) Cerebral state monitor, a new small handheld EEG monitor for determining depth of anaesthesia: a clinical comparison with the bispectral index during day-surgery. Eur J Anaesthesiol 23(3):208–212. https://doi.org/10.1017/S0265021505002206CrossRefPubMed

19.

Hoymork SC, Hval K, Jensen EW, Raeder J (2007) Can the cerebral state monitor replace the bispectral index in monitoring hypnotic effect during propofol/remifentanil anaesthesia? Acta Anaesthesiol Scand 51(2):210–216. https://doi.org/10.1111/j.1399-6576.2006.01213.xCrossRefPubMed

20.

Cortínez LI, Delfino AE, Fuentes R et al (2007) Performance of the cerebral state index during increasing levels of propofol anesthesia: a comparison with the bispectral index. Anesth Analg 104(3):605–610. https://doi.org/10.1213/01.ane.0000255152.96354.17CrossRefPubMed

21.

Nishiyama T, Komatsu K (2010) Cerebral state index versus bispectral index during propofol-fentanyl-nitrous oxide anesthesia. J Anesth 24(3):380–385. https://doi.org/10.1007/s00540-010-0906-5CrossRefPubMed

22.

Pilge S, Kreuzer M, Kochs EF et al (2012) Monitors of the hypnotic component of anesthesia - correlation between bispectral index and cerebral state index. Minerva Anestesiol 78(6):636–645PubMed

23.

Zhong T, Guo QL, Pang YD, Peng LF, Li CL (2005) Comparative evaluation of the cerebral state index and the bispectral index during target-controlled infusion of propofol. Br J Anaesth 95(6):798–802. https://doi.org/10.1093/bja/aei253CrossRefPubMed

24.

Yang S-h, Zhong T, Guo Q-l et al (2006) Bispectral index, cerebral state index and the predicted effect-site concentration at different clinical end-points during target-controlled infusion of propofol. Zhong Nan Da Xue Xue Bao Yi Xue Ban 31(6):929–933PubMed

Title: Depth of sedation during drug induced sedation endoscopy monitored by BiSpectral Index® and Cerebral State Index®
Authors: Michael Herzog
Mathias Rudzki
Sebastian Plößl
Stefan Plontke
Patrick Kellner
Publication date: 01-06-2021
Publisher: Springer International Publishing
Keywords: Endoscopy
Propofol
Published in: Sleep and Breathing / Issue 2/2021
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-020-02180-4

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