Gut and Liver, Vol. 5, No. 2, June 2011, pp. 160-164 ORiginal Article Efﬁcacy of Bispectral Index Monitoring for Midazolam and Meperidine Induced Sedation during Endoscopic Submucosal Dissection: A Prospective, Randomized Controlled Study Ki Joo Kang, Byung-Hoon Min, Mi Jung Lee, Hyun Sook Lim, Jin Yong Kim, Jun Haeng Lee, Dong Kyung Chang, Young-Ho Kim, Poong-Lyul Rhee, Jong Chul Rhee, and Jae J. Kim Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Background/Aims: Propofol induced sedation with bispec- tral index (BIS) monitoring has been reported to lead to higher satisfaction in patients and endoscopists during endo- scopic submucosal dissection (ESD) procedures. There are no data, however, regarding the efﬁcacy of midazolam and meperidine (M/M) induced sedation with BIS monitoring dur- ing ESD. The purpose of this study was to evaluate whether M/M induced sedation with BIS monitoring could improve satisfaction and reduce the dose of M/M required during ESD. Methods: Between September 2009 and January 2010, 56 patients were prospectively enrolled and randomly assigned to a BIS group (n=28) and a non-BIS group (n=28). Patient and endoscopist satisfaction scores were assessed using the visual analog scale (0 to 100) following the ESD. Results: The mean satisfaction scores did not significantly differ between the BIS and non-BIS groups (92.3±16.3 vs 93.3±15.5, p=0.53) or endoscopists (83.1±15.4 vs 80.0±16.7, p=0.52). Although the mean meperidine dose did not differ (62.5±27.6 vs 51.0±17.3, p=0.18) between the two groups, the mean dose of midazolam in the non-BIS group was lower than in the BIS group (6.8±2.0 vs 5.4±2.1, p=0.01). Conclusions: BIS monitoring during ESD did not increase the satisfaction of endoscopists or patients and did not lead to an M/M dose reduction. These results demon- strate that BIS monitoring provides no additional beneﬁt to M/M induced sedation during ESD. (Gut Liver 2011;5:160- 164) Key Words: Bispectral index monitoring; Satisfaction; Mid- azolam; Endoscopic submucosal dissection INTRODUCTION Recently, endoscopic submucosal dissection (ESD) has been widely used for the resection of early gastric cancers and gastric adenomas. ESD is useful for complete histological evaluation of the tumor as well as curative resections because of the en bloc resection.1 Although ESD is less invasive and safer method than surgery,2-4 it is a technically difficult procedure; it has a higher incidence of complications and requires a longer operation time than conventional endoscopic mucosal resection (EMR). Therefore, ESD must require the appropriate sedation of patients without increasing complications. The bispectral index (BIS) value is based on a calibrated number on the electroencephalograph of the frontal cortex cor- responding to varying levels of sedation, ranging from 0 to 100 (0, no cortical activity or coma; 40 to 60, unconscious; 70 to 90, varying levels of conscious sedation; 100, fully awake).5,6 BIS monitoring has been used to minimize complications that may occur during sedation and to evaluate by objective measures the level of sedation instead of using the conventional measures such as Modified Observer’s Assessment of Alertness and Sedation (MOAA/S).7-9 There were temporal correlations be- tween BIS levels and MOAA/S scores in previous studies.6,10,11 Although several studies showed no clinical role of BIS moni- toring during endoscopic sedation,12,13 BIS monitoring during ESD procedures with the propofol induced sedation lead to higher satisfaction scores among patients and endoscopists.14 Propofol has several advantages with regard to maintaining deep sedation and reducing patient anxiety, as well as pain and discomfort during the procedure.15,16 Recently, the number of gastroenterologists administering propofol directly for endo- Correspondence to: Jae J. Kim Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea Tel: +82-2-3410-3409, Fax: +82-2-3410-6983, E-mail: jjkim@skku.edu Received on October 11, 2010. Accepted on November 10, 2010. pISSN 1976-2283 eISSN 2005-1212 DOI: 10.5009/gnl.2011.5.2.160 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.