Assessment of the correlation with eeg monitoring ('noninvasive hemodynamic monitoring platform with upgradeable parameter' tm) patient state index (psi) and ramsey sedation scale for measurement of sedation depth in the patients who underwent for procedural sedation and analgesia in emergency department

Assessment Of The Correlation With EEG Monitoring ('Noninvasive Hemodynamic Monitoring Platform With Upgradeable Parameter' TM) Patient State Index (PSI) And Ramsey Sedation Scale For Measurement Of Sedation Depth In The Patients Who Underwent For Procedural Sedation And Analgesia In Emergency Department Introduction: Painful operations are often used in emergency departments. Procedural sedation and analgesia(PSA) is frequently applied to make these procedures more comfortable and painless. The depth of sedation in patients undergoing PSA, to avoid complications that may occur and should be monitored for early intervention. In addition to clinical scale; level of sedation can also be determined with digital EEG monitoring like 'Patient State Index (PSI)'. In our study, the primary endpoint is the correlation of EEG monitoring (Patient State Index) with the Ramsey Sedation Scale who underwent the PSA due to extremity fractures or dislocations and secondary endpoints is the avaliability of determining posssible complications earlier. It is also aimed to assess whether it is suitable for emergency department use. Method: A total of 100 patients who underwent GSA for extremity fracture and dislocation between August 2016 and November 2017 to the Ege University Medical Faculty Emergency Service were included prospective, analytical study. Sociodemographic data, vital signs, GCS, PSI and RSS data before PSA, the start of procedure, 1, 5, 10, 15, 30. min. were recorded on data form. We also determine the corellation between PSI and RSS values. Results: The average age of the 54 patients enrolled in the study is 52,09±15,9, female/male ratio is 1. The lowest measurements PSI values at procedure start (87,4±3,9) and 1. min. (74,1±8,7) was recorded. Then 5-10-15- minutes (60,4±8,3- 56,4±7,1-70,6±10,1) and 30. minut (84,3±3,8) were measured respectively. Considering the basal, 10. and 30. min. PSI values and RSS of patients, there was no significant correlation between them (r: 0,051, r: 0,126 ve r: 0,026). Between the PSI and RSS values at procedure start, 1. 5. min. and 15.min. weak negative correlation was detected ( r-0,259, r-0,252 ve r-0,390 – p< 0,05). The relationship between ETCO2 and SATO2 in terms of the cases; Basal, 1 min. 5 min. 10 min. 15 min. and the correlation between ETCO2 and SATO2 in the 30th min. was statistically insignificant. Complications were detected in 15 patients (%15.6). Complications were observed at 5th and 10th minutes when the time of complication was evaluated, but no complications were observed at 1-15th 30th minutes. No difference were noted in patients PSI score means in between the groups of complications observed and not observed. In the majority of the patients in whom a complication of the procedure observed, PSI scores were decreased in comparision with the previous measurement (14/15 ; 95,3%). PSI scores were cumulated in between 75 – 55 for RSS values of 3-5. Conclusion: A poor correlation was found between the RSS and Patient State Index (PSI) monitoring at the 1st, 5th and 15th minutes in patients who underwent emergency PSA. A significant change in the development of PSI complications could not be addressed. The use of PSI in emergency department for monitorization of the patients underwent a procedural conscious sedation, can not help the clinician according to studies findings, also, larger scale studies are needed to determine the PSI thresholds for this use to be effective. Keywords: Ramsey Sedation Scale, Patient State Index (PSI), procedural sedation analgesia, emergency department, cerebral monitoring