Assessment of correlation with EEG monitoring (Bispectral Index™) and Ramsey Sedation Scale for measurement of sedation depth in the patients who was applied procedural sedation and analgesia in emergency department

Introduction: Procedural sedation and analgesia (PSA) is a common procedure for painful practices in emergency department.. This is provided with scaling and tracking of level of sedation. In addition to clinical scale; level of sedation can also be determined with digital EEG monitoring like 'Bispectral Index™'. In our study, the primary endpoint is the correlation of EEG monitoring (Bispectral Index™) with the Ramsey Sedation Scale who underwent the GSA due to extremity fractures or dislocations and secondary endpoints is the avaliability of determining posssible complications earlier. Method: In our prospective and analytical study 54 patients who were planned to underwent the GSA due to extremity fractures or dislocations in the emergency department of Dokuz Eylül University between the 01.12.2014-01.05.2015. sociodemographic data, vital signs, GCS, BIS and RSS data before GSA, the start of procedure, 5, 10, 15, 20. min. were recorded on data form. We also determine the corellation between BIS and RSS values. Results: The average age of the 54 patients enrolled in the study is 57.4±15.7, female/male ratio is 1.8. The lowest measurments at procedure start BIS values at procedure start (82.9±11.2) and 5 min. (82.1±8.9) was developed. Then 10-15-20. minutes (85.1 ± 9.8, 87.8 ± 10.1 and 91.8 ± 7.8) were measured. Considering the basal BIS values and RSS of patients, there was no significant correlation between them (r = 0.336, p = 0.016). Between the BIS and RSS values at procedure start, 5.min. and 15.min. moderate negative correlation was detected (r = -0634, r: -0637 and r: -0.665). Strong correlation was found between 10.min. and 20. Min. When the averages of the BIS and RSS values at all time intervals was compared, there were strong correlation was found between them (r = -0989, P <0.001). Complications were detected in 16 patients (%29.6). Hipoventilation/apne developed in two patients at procedure start, six patients at 5.min., two patients at 10. min. Hipotension developed one patient at 10 min. and 15. min. In patients with complications BIS values were lower at all time intervals. There was statistically significant difference between BIS values at only procedure start (p:0.018). Conclusion: There was a strong corellation between RSS and BIS monitoring in patients who underwent GSA in the emergency department. BIS monitoring can be used as an alternative to clinical scales which is people dependent and routinely used for GSA.