Closed loop control of sedation for colonoscopy using the Bispectral Index

Abstract

Sixteen patients undergoing colonoscopy were sedated with propofol using a closed-loop control system guided by the Bispectral Index (BIS). Propofol administration, via a target-controlled infusion, was controlled by a proportional-integral-differential control algorithm. The median (range) propofol target concentration during closed-loop control was 2.3 (1.7-3.6) μg.ml-1. The performance characteristics of the system were excellent, with a median absolute performance error of 7 (1-15)%. Patients were drowsy yet rousable, with a median (range) BIS set-point of 80 (75-85). No patient became apnoeic, required airway support or became haemodynamically unstable whilst sedated. Eight patients moaned or moved during colonoscopy and four had recall. Median (range) time to full consciousness was 4 (2-20) min after the end of closed-loop control. Patient and surgeon satisfaction were high. We conclude that BIS may be a suitable control variable for closed-loop control of sedation with propofol.