Impact of Bispectral Index- and Target-Controlled Infusion-Guided Sedation on Patient Comfort and Procedural Workflow...

Objectives: While a combination of the Target-Controlled Infusion (TCI) system and Bispectral Index (BIS) monitoring has emerged as an effective approach for sedation management during bronchoscopy, its benefits and potential risks remain insufficiently explored. In this study, we evaluated the impacts of the BIS- and TCI-guided sedation systems on patient comfort and procedural workflow during bronchoscopy. Methods: A prospective observational study was conducted at a single tertiary medical center. Patients scheduled for diagnostic bronchoscopy were assigned to either a sedation group or a control group, and the sedation group received BIS- and TCI-guided sedation using propofol and fentanyl. Objective time metrics such as the procedure time, observation time, and overall total time were recorded. Subjective outcomes including pain, discomfort, and fear levels were assessed using a visual analogue scale (range: 0-10). Operator-rated procedural difficulty was also assessed. Results: The use of a BIS- and TCI-guided sedation system did not significantly affect the procedure duration but led to prolonged observation and overall total times. Patients in the sedation group reported significantly lower pain, coughing, and breathlessness sensations and overall discomfort levels compared to the control group. Both pre- and post-procedural fear levels were lower in the sedation group. Operator-rated procedural difficulty was significantly lower in the sedation group, and operator-reported difficulty was significantly correlated with both endoscopic insertion and coughing sensations. Conclusions: These findings support that the BIS- and TCI-guided sedation system may improve patient experiences and optimize procedural workflow during bronchoscopy. Future randomized studies with larger and more-diverse populations are recommended to enhance the robustness and generalizability of the results.