Background and Goal of Study: Moderate to deep sedation is generally used for endoscopic retrograde cholangiopancreatography (ERCP). The depth of sedation is usually judged by clinical assessment and EEG-guided monitoring. The aim of this study was to compare the clinical efficacy of clinical assessment and NarcotrendTM monitoring during sedated ERCP.
Materials and Methods: 138 patients who underwent ERCP in a single year, were randomly assigned to either group C or N. Patients in group C (90) were sedated by using MOAA/S scale. Patients in group N (48) were sedated by using the NarcotrendTM system. The MOAA/S scale 1 or 2 and the Narcotrend stage D0-E0 (index 27-36 to 57-64) were maintained during procedure. The primary outcome variable of the study was the total dose of propofol used during the procedure. The secondary outcome variables were complications during and immediately after procedure, and recovery time.
Results and Discussion: All endoscopies were completed successfully. Mean total dose of propofol in group C was significantly lower than in group N. However, the mean dose of propofol, expressed as dose/kg or dose/kg/hr in both groups, was not significantly different (p=0.400, 0.227). Recovery time, patient tolerance and satisfaction, and endoscopist satisfaction was comparable among the two groups. Sedation- related adverse events during and immediately after the procedure, such as hypotension, hypertension, tachycardia, bradycardia, transient hypoxia, or upper airway obstruction in group C (62.2%), were significantly higher than in group N (37.5%) (p=0.006).
Conclusion(s): Clinical assessment and Narcotrend-guided sedation using propofol for deep sedation demonstrated comparable propofol dose and recovery time. Both monitorings were equally safe and effective. However, the Narcotrend-guided sedation showed lower hemodynamic changes and complications as compare to the clinical assessment-guided sedation.