Department of Internal Medicine, Chest Medical Centre, Montana, Switzerland.
Respiration. 2011;82(5):451-7. doi: 10.1159/000329438. Epub 2011 Oct 13.
Bispectral index (BIS) is a valuable tool for assessing the depth of sedation and guiding the administration of sedative drugs. We previously demonstrated the benefits of BIS-guided propofol sedation in patients undergoing flexible bronchoscopy.
To examine the feasibility and safety profile of propofol sedation in patients undergoing medical thoracoscopy (MT).
Patients undergoing MT for diagnostic evaluation or treatment of pleuropulmonary diseases were enrolled over a 2-year period. Nurses and chest physicians were trained by anesthetists to provide analgosedation, to detect and correct cardiopulmonary disturbances. The level of sedation was optimized individually by titrating the propofol infusion according to the BIS and clinical evaluation. Patients' clinical data, procedure time, medications and any adverse events were recorded.
Fifty-three patients (60% male) with a median age of 62 years (range 19-84 years) underwent MT. The operative procedure lasted a median time of 28 min (range 9-112 min). The median doses of anesthetic drugs were 145 mg of propofol (range 20-410 mg) and 84 μg of fentanyl (range 0-225 μg). Hemodynamic disturbances occurred in 39 patients (bradycardia n = 4, tachycardia n = 12, hypotension n = 34) and required drug administration in only 4 cases. Hypoxemic events (n = 4) resolved upon gentle patient stimulation (verbal command, chin lift, oral cannula). All patients could be discharged from the recovery unit within 105 min after the procedure.
BIS-guided propofol sedation is a safe method that might replace midazolam sedation in MT and can be managed by well-trained nonanesthesiologist personnel.
双频谱指数（BIS）是评估镇静深度和指导镇静药物管理的有价值工具。我们之前已经证明了 BIS 指导下丙泊酚镇静在接受软性支气管镜检查的患者中的益处。
检查丙泊酚镇静在接受内科胸腔镜检查（MT）的患者中的可行性和安全性概况。
在 2 年的时间内，招募了因诊断评估或治疗胸膜肺疾病而接受 MT 的患者。护士和胸科医生接受麻醉师的培训，以提供镇痛镇静，检测和纠正心肺障碍。通过根据 BIS 和临床评估滴定丙泊酚输注来个体化优化镇静水平。记录患者的临床数据、手术时间、药物和任何不良事件。
53 名（60%为男性）中位年龄为 62 岁（范围 19-84 岁）的患者接受了 MT。手术过程持续中位时间为 28 分钟（范围 9-112 分钟）。麻醉药物的中位剂量为 145mg 丙泊酚（范围 20-410mg）和 84μg 芬太尼（范围 0-225μg）。39 名患者（心动过缓 n=4、心动过速 n=12、低血压 n=34）出现血流动力学障碍，仅在 4 例中需要药物治疗。4 例低氧血症事件（n=4）通过轻轻刺激患者（口头命令、抬起下巴、口腔插管）得到解决。所有患者在手术后 105 分钟内均可从恢复单元出院。
BIS 指导下丙泊酚镇静是一种安全的方法，可能替代 MT 中的咪达唑仑镇静，并且可以由经过良好培训的非麻醉科人员管理。
