• Mohammed A Qadeer, John J Vargo, Sandeep Patel, John A Dumot, A Rocio Lopez, Patricia A Trolli, Darwin L Conwell, Tyler Stevens, and Gregory Zuccaro.
• Section of Therapeutic Endoscopy, Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
• Clin. Gastroenterol. Hepatol. 2008 Jan 1;6(1):102-8.

Unlabelledbackground & aims: Current practice guidelines strongly recommend differentiation of deep from moderate sedation during endoscopy. Standard methods of sedation monitoring are labor-intense. Bispectral index monitoring (BIS) is widely used during anesthesia, but its benefits during conscious sedation are controversial. Thus, we performed a prospective observational study to assess its ability for detecting deep sedation during endoscopy.MethodsPatients presenting for elective outpatient endoscopy were monitored simultaneously with the Modified Observer's Assessment of Alertness and Sedation (MOAA/S) and BIS. A combination of a narcotic and benzodiazepine was used, with the target being moderate sedation and analgesia. Deep sedation was defined by MOAA/S score of 1-2 and BIS score of ResultsA total of 775 simultaneous observations of BIS and MOAA/S scores were recorded on 76 patients. Deep sedation, defined by MOAA/S and BIS, was seen in 204 (26%) and 92 (12%) observations, respectively. BIS correlated poorly with deep sedation (rho, -0.02; 95% confidence interval [CI], -0.16-0.12). The sensitivity, specificity, and positive and negative predictive values (95% CI) for detecting deep sedation were 29.6 (23.4-36.3), 94.9 (92.8-96.6), 68.2 (57.4-77.7), and 78.6 (75.3-81.7), respectively.ConclusionsBIS has a low accuracy for detecting deep sedation as a result of a considerable overlap of scores across the sedation levels. Further refinements in BIS are needed to differentiate deep from moderate sedation for future studies on conscious sedation.

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