Is BIS the answer to grant optimal sedation during EBUS procedures?

Growing numbers of patients undergo invasive endoscopic procedures, with diverse sedation approaches among centers. The aim of this study is to assess the usefulness of the bispectral index (BIS) in guiding sedoanalgesia requirements and patient perception during endobronchial ultrasound procedures (EBUS). A 3-month prospective observational study was carried out where all patients undergoing EBUS with and without BIS monitoring and under sedation with fentanyl + midazolam were collected. Vitals were monitored every 5 minutes, as well as the level of sedation by BIS. 1 hour after EBUS, the patient was given a tolerance-oriented questionnaire. Of a total of 81 patients (54 males), 45 underwent monitoring with BIS. The mean age was higher for the BIS group, 68 vs 63 years in the control group, this difference being significant (p=0.03). No significant differences were observed in demographic variables or mean test duration for BIS (41min.) and control (37min.) groups. An increase in the mean use of midazolam (7mg BIS vs 6mg control group) and fentanyl (62.2mcg BIS vs 60.4mcg control) was demonstrated, this difference being significant in the first case (p=0.006). The patients' perception has been represented in graph 1. <fig><object-id>erj;64/suppl_68/PA762/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig> Our study shows an increase in the use of sedoanalgesia with BIS without improved patient tolerance to EBUS. Therefore, it is not possible to recommend it as an isolated method to assess sedation status in this type of procedure.