Assessing Sedation Depth with PSI in Elderly ERCP Patients: A Prospective Cohort Study
Lei Huang,1,2,* Lin-lin Liu,1,2,* Yong-da Lu,3,* Min-yuan Zhuang,1,2 Wei Dou,1,2 Hong Liu,4 Fu-hai Ji,1,2 Ke Peng1 1Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China; 2Institute of Anesthesiology, Soocho...
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Dove Medical Press
2025-02-01
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| author | Huang L Liu LL Lu YD Zhuang MY Dou W Liu H Ji FH Peng K |
| author_facet | Huang L Liu LL Lu YD Zhuang MY Dou W Liu H Ji FH Peng K |
| author_sort | Huang L |
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| description | Lei Huang,1,2,* Lin-lin Liu,1,2,* Yong-da Lu,3,* Min-yuan Zhuang,1,2 Wei Dou,1,2 Hong Liu,4 Fu-hai Ji,1,2 Ke Peng1 1Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China; 2Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China; 3Department of Gastroenterology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China; 4Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA*These authors contributed equally to this workCorrespondence: Ke Peng, Department of Anesthesiology, First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu, 215006, People’s Republic of China, Tel +86-512-67780056 ; +86-15962155989, Email [email protected]: Adequate sedation is important for elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Patient state index (PSI) via the SedLine® system has been utilized for real-time monitoring of anesthesia depth in surgical patients. We aimed to assess the correlation between PSI and Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) scores in elderly patients undergoing ERCP.Methods: This prospective cohort study included 57 elderly patients scheduled for ERCP procedures. Patients received target-controlled infusion of propofol, titrated to the sedation level of MOAA/S scores of 1 and 2. The MOAA/S scores and PSI values were recorded during sedation and recovery. We also documented procedure and recovery time, oversedation (PSI < 25 for at least 10 min and EEG burst suppression), adverse events, and fatigue scores (0– 10, higher scores indicating more fatigue).Results: All patients completed this study (mean age of 73 years and 63% male), with a mean procedure time of 53 min and recovery time of 37 min. Five patients (8.8%) experienced PSI < 25 for at least 10 min, and three of them (5.3%) showed EEG burst suppression. No patients developed desaturation or intra-procedural awareness. Hypotension and abdominal pain were uncommon. Nine patients (15.8%) experienced mild dizziness or nausea. The median (IQR) fatigue score was 3 (2– 4) at recovery room discharge. A significant correlation was observed between the MOAA/S scores and PSI values (Spearman correlation coefficient ρ = 0.742, P < 0.001). When patients were at the MOAA/S scores of 1 and 2, the median PSI was 50 (95% CI: 48 to 52).Conclusion: PSI provides a useful and real-time monitoring of sedation for elderly patients undergoing ERCP. Our results showed a significant correlation between the PSI values and MOAA/S scores and suggested a PSI value of 50 with a range of 48 to 52 for maintaining adequate sedation.Trial Registration: Chinese Clinical Trial Registry (ChiCTR2400079859).Keywords: endoscopic retrograde cholangiopancreatography, depth of sedation, elderly patients, Modified Observer’s Assessment of Alertness/Sedation, patient state index |
| format | Article |
| id | doaj-art-da21882d28b145b2b7d189987ac1c0f2 |
| institution | Kabale University |
| issn | 1178-1998 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Dove Medical Press |
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| series | Clinical Interventions in Aging |
| spelling | doaj-art-da21882d28b145b2b7d189987ac1c0f22025-02-11T17:30:56ZengDove Medical PressClinical Interventions in Aging1178-19982025-02-01Volume 20137145100076Assessing Sedation Depth with PSI in Elderly ERCP Patients: A Prospective Cohort StudyHuang LLiu LLLu YDZhuang MYDou WLiu HJi FHPeng KLei Huang,1,2,* Lin-lin Liu,1,2,* Yong-da Lu,3,* Min-yuan Zhuang,1,2 Wei Dou,1,2 Hong Liu,4 Fu-hai Ji,1,2 Ke Peng1 1Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China; 2Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China; 3Department of Gastroenterology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China; 4Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA*These authors contributed equally to this workCorrespondence: Ke Peng, Department of Anesthesiology, First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu, 215006, People’s Republic of China, Tel +86-512-67780056 ; +86-15962155989, Email [email protected]: Adequate sedation is important for elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Patient state index (PSI) via the SedLine® system has been utilized for real-time monitoring of anesthesia depth in surgical patients. We aimed to assess the correlation between PSI and Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) scores in elderly patients undergoing ERCP.Methods: This prospective cohort study included 57 elderly patients scheduled for ERCP procedures. Patients received target-controlled infusion of propofol, titrated to the sedation level of MOAA/S scores of 1 and 2. The MOAA/S scores and PSI values were recorded during sedation and recovery. We also documented procedure and recovery time, oversedation (PSI < 25 for at least 10 min and EEG burst suppression), adverse events, and fatigue scores (0– 10, higher scores indicating more fatigue).Results: All patients completed this study (mean age of 73 years and 63% male), with a mean procedure time of 53 min and recovery time of 37 min. Five patients (8.8%) experienced PSI < 25 for at least 10 min, and three of them (5.3%) showed EEG burst suppression. No patients developed desaturation or intra-procedural awareness. Hypotension and abdominal pain were uncommon. Nine patients (15.8%) experienced mild dizziness or nausea. The median (IQR) fatigue score was 3 (2– 4) at recovery room discharge. A significant correlation was observed between the MOAA/S scores and PSI values (Spearman correlation coefficient ρ = 0.742, P < 0.001). When patients were at the MOAA/S scores of 1 and 2, the median PSI was 50 (95% CI: 48 to 52).Conclusion: PSI provides a useful and real-time monitoring of sedation for elderly patients undergoing ERCP. Our results showed a significant correlation between the PSI values and MOAA/S scores and suggested a PSI value of 50 with a range of 48 to 52 for maintaining adequate sedation.Trial Registration: Chinese Clinical Trial Registry (ChiCTR2400079859).Keywords: endoscopic retrograde cholangiopancreatography, depth of sedation, elderly patients, Modified Observer’s Assessment of Alertness/Sedation, patient state indexhttps://www.dovepress.com/assessing-sedation-depth-with-psi-in-elderly-ercp-patients-a-prospecti-peer-reviewed-fulltext-article-CIAendoscopic retrograde cholangiopancreatographydepth of sedationelderly patientsmodified observer’s assessment of alertness/sedationpatient state index |
| spellingShingle | Huang L Liu LL Lu YD Zhuang MY Dou W Liu H Ji FH Peng K Assessing Sedation Depth with PSI in Elderly ERCP Patients: A Prospective Cohort Study Clinical Interventions in Aging endoscopic retrograde cholangiopancreatography depth of sedation elderly patients modified observer’s assessment of alertness/sedation patient state index |
| title | Assessing Sedation Depth with PSI in Elderly ERCP Patients: A Prospective Cohort Study |
| title_full | Assessing Sedation Depth with PSI in Elderly ERCP Patients: A Prospective Cohort Study |
| title_fullStr | Assessing Sedation Depth with PSI in Elderly ERCP Patients: A Prospective Cohort Study |
| title_full_unstemmed | Assessing Sedation Depth with PSI in Elderly ERCP Patients: A Prospective Cohort Study |
| title_short | Assessing Sedation Depth with PSI in Elderly ERCP Patients: A Prospective Cohort Study |
| title_sort | assessing sedation depth with psi in elderly ercp patients a prospective cohort study |
| topic | endoscopic retrograde cholangiopancreatography depth of sedation elderly patients modified observer’s assessment of alertness/sedation patient state index |
| url | https://www.dovepress.com/assessing-sedation-depth-with-psi-in-elderly-ercp-patients-a-prospecti-peer-reviewed-fulltext-article-CIA |
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