Evaluation of the compliance between EEG monitoring (Bispectral IndexTM) and Ramsey Sedation Scale to measure the depth of sedation in the patients who underwent procedural sedation and analgesia in the emergency department.

BACKGROUND: This study aimed to investigate the compliance between electroencephalogram monitoring (Bispectral Index, BIS) and Ramsay Sedation Scale (RSS) to measure the depth of sedation in patients who underwent procedural sedation and analgesia (PSA) in an emergency department. This study also aimed to investigate the usefulness of this compliance for early diagnosis of complications. METHODS: A total of 54 consecutive patients during PSA in the emergency department were included in this study. The BIS and RSS scores at regular intervals and also all complications and interventions of these patients were evaluated. The compliance between the BIS and the RSS score was evaluated. The BIS scores of cases with complication and without complication were compared. RESULTS: The BIS and RSS scores exhibited a high correlation was detected between the average BIS and RSS scores at each time interval (r=-0.989, p<0.001). The BIS scores of the complicated and uncomplicated cases were different at 15 min after the procedure (p=0.019). The cases were divided into two groups according to the BIS scores <70 and ≥70; complication rates were higher in the BIS score <70 group during the procedure (p=0.037). CONCLUSION: In our study, a high correlation was detected between BIS monitoring and RSS scores. BIS monitoring for PSA can be used as a full-time, objective, and an alternative technique for person-dependent clinical scales and also as an indicator for early diagnosis of complications.

Successful Treatment of Propafenone Intoxication With Intravenous Lipid Emulsion.

Severe cardiac effects, including cardiac arrest, are a rare complication of high-dose propafenone intake. Among patients who experience cardiac arrest, the survival rate is low. This report presents the case of a young female patient who developed cardiac arrest linked to propafenone intake. While spontaneous circulation was restored with cardiopulmonary resuscitation, vital signs did not recover despite supportive treatment. However, after the administration of intravenous lipid emulsion (ILE), vital signs and cardiac functions resolved and the patient survived. This case is the second to describe the successful use of ILE for propafenone intoxication. However, as all of the findings of this patient were clearly linked to propafenone, we believe the benefits of ILE were more clearly defined in this case than in the other.