Assessment Of Computer Assisted Personalized Sedation: A Sedation Delivery System To Administer Propofol For Gastrointestinal Endoscopy

Main Category: GastroIntestinal / Gastroenterology
Article Date: 22 May 2006 - 0:00 PDT

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As computer programs become further integrated into the medical setting, researchers are looking for new ways to utilize these technologies to increase procedural effectiveness and accuracy. Scientists from Charlottesville Medical Research in Virginia, have continued this trend to monitor and deliver sedation during surgery with computer assisted personalized sedation (CAPS), which uses computer software to facilitate precise control of drug delivery.

Anesthesiologists and physician/nurse care teams in the study first injected 24 patients (12 colonoscopy and 12 endoscopy) with a single dose of fentanyl as pre-medication, then administered propofol using the CAPS system and its dosing algorithm and safety shell--a control safeguard software program. Data was downloaded from the sedation device to a laptop computer to measure patient response throughout the procedure and adjust the sedation dosage accordingly. Patient responsiveness was monitored by the anesthesiologist using the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale and the Automated Responsiveness Monitor (ARM) device. The MOAA scale assesses the patient's level of sedation from alert to only responding to a painful stimulus, and the ARM is a handheld device that the patient squeezes on command from a voice from an earpiece in the patient's ear. This response helps determine the level of sedation.

All procedures were completed successfully and six patients had at least one polyp removed. Of the 24 patients, 14 (7 colonoscopy and 7 endoscopy) lost responsiveness to ARM during the procedure. One subject experienced oxygen desaturation (level of breathing and sedation) below 90 percent (low=85 percent) and seven subjects experienced apnea for less than 30 seconds. However, the device automatically responded to these adverse physiological reactions by adjusting sedation amounts and all eight subjects recovered to normal respiratory parameters without intervention by the anesthesiologist.

"This new technology represents an exciting breakthrough in the use of computers to properly administer and monitor sedation in patients undergoing a variety of procedures," said Daniel Pambianco, M.D., Charlottesville Medical Research and lead study author. "When used with a trained anesthesiologist, this device may help manage the potential risks associated with sedation and ensure that each patient is cared for based on their own needs."

[Abstract T1304]

Digestive Disease WeekŪ (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA), the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW takes place May 20-25, 2006 in Los Angeles, California. The meeting showcases more than 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology.

Aimee Frank
newsroom@gastro.org
American Gastroenterological Association
http://www.gastro.org