Assessing Sedation Depth with PSI in Elderly ERCP Patients: A Prospective Cohort Study

Area of Science:

• Anesthesiology
• Gastroenterology
• Geriatrics

Background:

• Adequate sedation is crucial for elderly patients undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP).
• Patient State Index (PSI) is a tool for real-time anesthesia depth monitoring.
• The Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale is commonly used to assess sedation levels.

Purpose of the Study:

• To evaluate the correlation between PSI and MOAA/S scores in elderly patients undergoing ERCP.
• To determine a target PSI range for adequate sedation during ERCP in this population.

Main Methods:

• Prospective cohort study of 57 elderly patients undergoing ERCP.
• Propofol infusion was titrated to achieve MOAA/S scores of 1 or 2.
• PSI and MOAA/S scores were recorded during the procedure and recovery.
• Oversedation, adverse events, and fatigue were monitored.

Main Results:

• A significant positive correlation (ρ = 0.742, P < 0.001) was found between PSI and MOAA/S scores.
• Median PSI was 50 (95% CI: 48-52) when patients were at MOAA/S scores of 1 and 2.
• Oversedation (PSI < 25) occurred in 8.8% of patients, with EEG burst suppression in 5.3%.
• No desaturation or intra-procedural awareness was reported; adverse events were uncommon.

Conclusions:

• PSI is a valuable tool for real-time sedation monitoring in elderly ERCP patients.
• A PSI range of 48-52 appears to correspond to adequate sedation levels (MOAA/S 1-2).
• This monitoring can help optimize sedation and potentially reduce oversedation during ERCP.