Comparison of Sedation Complications and Salivary Alpha-Amylase (sAA) Levels in Gastrointestinal Endoscopy Patients Under Total Intravenous Anesthesia (TIVA) Using BispectralIndex (BIS)

Introduction: Gastrointestinal endoscopy procedures are becoming increasingly common worldwide. These procedures require the assistance of anesthesiologists to ensure adequate sedation, reducing complications caused by patient movement during the procedure. However, sedation administration is not without risks. Additionally, gastrointestinal endoscopy falls under the category of Non-Operating Room Anesthesia (NORA) and is performed on patients across nearly all age groups, presenting unique challenges alongside potential complications due to underdosing or overdosing of sedation.
Objectives: This study compares sedation-related complications in respiratory, hemodynamic, anesthesia awareness, and salivary alpha-amylase (sAA) levels in patients monitored for anesthesia depth using either the Bispectral Index (BIS) or clinical parameters via the PRST score.
Methods: This quasy experimental study used a randomized allocation design. A total of 24 subjects, aged 22–65 years, were divided into two groups: BIS and non-BIS. Non-BIS group was monitored by using PRST score objective instrument to assure depth of sedation. Patients meeting the inclusion and exclusion criteria provided saliva samples before and after the procedure. Intraoperative events, such as sedation-related complications involving respiration, hemodynamics, and awareness, were recorded during the procedure.

Results: There were no respiratory complications in either group. However, there was a significant difference p=0.037 between the BIS and non-BIS groups towards hemodynamic complications that occurred more in the BIS group. Meanwhile, there was no difference in anesthesia awareness with a p=0.249. Likewise, no difference was found in sAA levels in both groups with p=0.679.
Conclusions: There was no difference in the incidence of awareness, and the level of sAA in the BIS and non-BIS groups. There was a significant difference in complications hemodynamic complications in the BIS group.