Clinical Aspects of Palliative Sedation in Prospective Studies. A Systematic Review

ContextNear the end of life when patients experience refractory symptoms, palliative sedation may be considered as a last treatment. Clinical guidelines have been developed, but they are mainly based on expert opinion or retrospective chart reviews. Therefore, evidence for the clinical aspects of palliative sedation is needed.ObjectivesTo explore clinical aspects of palliative sedation in recent prospective studies.MethodsSystematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered at PROSPERO. PubMed, CINAHL, Cochrane, MEDLINE, and EMBASE were searched (January 2014–December 2019), combining sedation, palliative care, and prospective. Article quality was assessed.ResultsTen prospective articles were included, involving predominantly patients with cancer. Most frequently reported refractory symptoms were delirium (41%–83%), pain (25%–65%), and dyspnea (16%–59%). In some articles, psychological and existential distress were mentioned (16%–59%). Only a few articles specified the tools used to assess symptoms. Level of sedation assessment tools were the Richmond Agitation Sedation Scale, Ramsay Sedation Scale, Glasgow Coma Scale, and Bispectral Index monitoring. The palliative sedation practice shows an underlying need for proportionality in relation to symptom intensity. Midazolam was the main sedative used. Other reported medications were phenobarbital, promethazine, and anesthetic medication—propofol. The only study that reported level of patient's discomfort as a palliative sedation outcome showed a decrease in patient discomfort.ConclusionAssessment of refractory symptoms should include physical evaluation with standardized tools applied and interviews for psychological and existential evaluation by expert clinicians working in teams. Future research needs to evaluate the effectiveness of palliative sedation for refractory symptom relief.     

吸入镇静在重症医学科的应用

重症医学科（ICU）镇静治疗已成为一项基本的治疗措施。最近文献报道ICU应用吸入镇静在唤醒时间、简单遵医嘱动作时间上要短于持续静脉注射镇静,而且有心脏、大脑等器官功能保护作用。目前国内ICU尚未见吸入镇静报道,本文将对吸入镇静在ICU中的应用做一综述。     

Pediatric Sedation: Using Secondary Data to Describe Registered Nurse Practice in Radiology

Children often require sedation for procedures because of their developmental level and difficulty complying with positioning. There are few studies that describe nurse sedation practices or adverse events. Studies of pediatric sedation care have small sample sizes that are inadequate to detect adverse events. This study reports practices and outcomes of sedation delivered to children from infancy up to 14 years of age, who were monitored only by registered nurses during diagnostic radiology procedures drawn from a sample of 12,584 cases from the Pediatric Sedation Research Consortium database. There were 727 adverse events (5.78%). However, no deaths, cardiac arrests, intubations, or aspirations were reported in this sample. The most common adverse event was inadequate sedation/agitation/delirium 196 (155.8/10,000) and desaturation below baseline for more than 30 s 173 (138/10,000). Further research comparing sedation practices and outcomes by type of providers, including nurses, is necessary to improve practice.     

Current sedation and monitoring practice for colonoscopy: an International Observational Study (EPAGE)

BACKGROUND AND STUDY AIMS: Sedation and monitoring practice during colonoscopy varies between centers and over time. Knowledge of current practice is needed to ensure quality of care and help focus future research. The objective of this study was to examine sedation and monitoring practice in endoscopy centers internationally. PATIENTS AND METHODS: This observational study included consecutive patients referred for colonoscopy at 21 centers in 11 countries. Endoscopists reported sedation and monitoring practice, using a standard questionnaire for each patient. RESULTS: 6004 patients were included in this study, of whom 53 % received conscious/moderate sedation during colonoscopy, 30 % received deep sedation, and 17 % received no sedation. Sedation agents most commonly used were midazolam (47 %) and opioids (33 %). Pulse oximetry was done during colonoscopy in 77 % of patients, blood pressure monitoring in 34 %, and electrocardiography in 24 %. Pulse oximetry was most commonly used for moderately sedated patients, while blood pressure monitoring and electrocardiography were used predominantly for deeply sedated patients. Sedation and monitoring use ranged from 0 % to 100 % between centers. Oxygen desaturation (相似文献   

Inter-Rater Reliability of the Tracking and Reporting Outcomes of Procedural Sedation Tool

Clinical guidelines recommend that procedural sedation outcomes should be audited. The Tracking and Reporting Outcomes of Procedural Sedation (TROOPS) tool, developed by the International Consortium for the Advancement of Procedural Sedation, is intended to be suitable for use in all locations by sedation providers. We evaluated the feasibility and reliability of using a modified version of the TROOPS tool for sedation that is administered by nurses in the cardiac catheterization laboratory. The version of TROOPS we used contained items in the minor, intermediate, and sentinel categories. Two nurses independently completed the TROOPS tool for 40 patients who underwent a procedure with sedation. A sedation-related adverse event was selected by at least one of the raters for 21 of the patients (52%; 95% confidence interval [CI] = 0.38 to 0.67). Most were minor events related to the airway and breathing category of the TROOPS tool (n = 17; 42%; 95% CI = 0.29 to 0.58). The remaining were intermediate-severity events related to sedation quality. No events for the other categories of the TROOPS tool were selected. The intraclass correlation coefficient between paired nurse ratings of the TROOPS tool was 0.78 (95% CI = 0.43 to 0.92). Most nurses (85%, 95% CI = 73% to 92%) reported that it took less than 1 minute to complete the tool. In summary, paired ratings of sedation-related adverse events by nurses achieved moderate consistency using a modified version of the TROOPS tool containing items from the minor category of the airway and breathing domain. Use of this tool in clinical practice is feasible and reliable.     

Adoption of a sedation scoring system and sedation guideline in an intensive care unit

AIM: The paper presents a study assessing the rate of adoption of a sedation scoring system and sedation guideline. BACKGROUND: Clinical practice guidelines including sedation guidelines have been shown to improve patient outcomes by standardizing care. In particular sedation guidelines have been shown to be beneficial for intensive care patients by reducing the duration of ventilation. Despite the acceptance that clinical practice guidelines are beneficial, adoption rates are rarely measured. Adoption data may reveal other factors which contribute to improved outcomes. Therefore, the usefulness of the guideline may be more appropriately assessed by collecting adoption data. METHOD: A quasi-experimental pre-intervention and postintervention quality improvement design was used. Adoption was operationalized as documentation of sedation score every 4 hours and use of the sedation and analgesic medications suggested in the guideline. Adoption data were collected from patients' charts on a random day of the month; all patients in the intensive care unit on that day were assigned an adoption category. Sedation scoring system adoption data were collected before implementation of a sedation guideline, which was implemented using an intensive information-giving strategy, and guideline adoption data were fed back to bedside nurses. After implementation of the guideline, adoption data were collected for both the sedation scoring system and the guideline. The data were collected in the years 2002-2004. FINDINGS: The sedation scoring system was not used extensively in the pre-intervention phase of the study; however, this improved in the postintervention phase. The findings suggest that the sedation guideline was gradually adopted following implementation in the postintervention phase of the study. Field notes taken during the implementation of the sedation scoring system and the guideline reveal widespread acceptance of both. CONCLUSION: Measurement of adoption is a complex process. Appropriate operationalization contributes to greater accuracy. Further investigation is warranted to establish the intensity and extent of implementation required to positively affect patient outcomes.     

Perspectives on sedation assessment in critical care

Multiple studies have been undertaken to show that neurofunction monitors can correlate to objective sedation assessments. Showing a correlation between these 2 patient assessments tools may not be the correct approach for validation of neurofunction monitors. Two different methods of assessing 2 different modes of the patient's response to sedation should not be expected to precisely correlate unless the desire is to replace one method with the other. We provide a brief summary of several sedation scales, physiologic measures and neurofunction monitoring tools, and correlations literature for bispectral index monitoring, and the Ramsay Scale and the Sedation Agitation Scale. Neurofunction monitors provide near continuous information about a different domain of the sedation response than intermittent observational assessments. Further research should focus on contributions from this technology to the improvement of patient outcomes when neurofunction monitoring is used as a complement, not a replacement, for observational methods of sedation assessment.     

Critical care nurses' decision making: sedation assessment and management in intensive care

Aims. This study was designed to examine the decision making processes that nurses use when assessing and managing sedation for a critically ill patient, specifically the attributes and concepts used to determine sedation needs and the influence of a sedation guideline on the decision making processes. Background. Sedation management forms an integral component of the care of critical care patients. Despite this, there is little understanding of how nurses make decisions regarding assessment and management of intensive care patients’ sedation requirements. Appropriate nursing assessment and management of sedation therapy is essential to quality patient care. Design. Observational study. Methods. Nurses providing sedation management for a critically ill patient were observed and asked to think aloud during two separate occasions for two hours of care. Follow‐up interviews were conducted to collect data from five expert critical care nurses pre‐ and postimplementation of a sedation guideline. Data from all sources were integrated, with data analysis identifying the type and number of attributes and concepts used to form decisions. Results. Attributes and concepts most frequently used related to sedation and sedatives, anxiety and agitation, pain and comfort and neurological status. On average each participant raised 48 attributes related to sedation assessment and management in the preintervention phase and 57 attributes postintervention. These attributes related to assessment (pre, 58%; post, 65%), physiology (pre, 10%; post, 9%) and treatment (pre, 31%; post, 26%) aspects of care. Conclusions. Decision making in this setting is highly complex, incorporating a wide range of attributes that concentrate primarily on assessment aspects of care. Relevance to clinical practice. Clinical guidelines should provide support for strategies known to positively influence practice. Further, the education of nurses to use such guidelines optimally must take into account the highly complex iterative process and wide range of data sources used to make decisions.     

The sedation practices of paediatric intensive care unit nurses and the influencing factors in China

Nurses play a key role in administering sedation to mechanically ventilated children, which impacts children's psychological, physiological and cognitive changes in the paediatric intensive care unit. This study aimed to survey the sedation practices of paediatric intensive care unit nurses on mechanically ventilated children in China and explored the influencing factors. A cross‐sectional survey was conducted based on electronic questionnaires comprised of the Nurse Sedation Practices Scale (Chinese version) in 14 different types of paediatric intensive care units of 11 academic hospitals in China from 15 February to 15 April 2017. A convenience sample of 495 nurses [73·4% response rate, (674)] completed the survey. Seven units applied Ramsay Sedation Scale as a sedative assessment tool. The majority of the nurses used observed behaviours and physiological changes of the ventilated children as indicators to assess the sedation level, and they had a positive attitude and intention, which may influence practice positively, whereas high clinical workload and the lack of communication between the nurses and families might hinder practice. The practice of sedation varied greatly in different regions, and the respondents of the northwest region scored lower. Paediatric nurses in China rarely used a validated paediatric instrument to assess sedation, and most nurses relied on physiological and behavioural cues. The quality of sedation training, nursing workload and regional economic disparity affected the sedation practice. The restricted visiting policy and lack of clearly defined nursing responsibilities around sedation may hinder effective sedation assessment and management. This study found that there was no paediatric‐validated tool popularized in paediatric intensive care units in China and explored influencing factors. We suggest that a validated tool, high‐quality training and hospital's policy, such as visiting regulation, should be promoted to improve the sedation practice.     

Depth of anaesthesia monitoring during procedural sedation and analgesia: A systematic review and meta-analysis

ObjectivesProcessed electroencephalogram-based depth of anaesthesia monitoring devices provide an additional method to monitor level of consciousness during procedural sedation and analgesia. The objective of this systematic review was to determine whether using a depth of anaesthesia monitoring device improves the safety and efficacy of sedation.DesignSystematic review and meta-analysis.Data sourcesElectronic databases (CENTRAL; Medline; CINAHL) were searched up to May 2015.Review methodsRandomised controlled trials that compared use of a depth of anaesthesia monitoring device to a control group who received standard monitoring during procedural sedation and analgesia were included. Study selection, data extraction and risk of bias assessment (Cochrane risk of bias tool) were performed by two reviewers. Safety outcomes were hypoxaemia, hypotension and adverse events. Efficacy outcomes were amount of sedation used, duration of sedation recovery and rate of incomplete procedures.ResultsA total of 16 trials (2138 participants) were included. Evidence ratings were downgraded to either low or moderate quality due to study limitations and imprecision. Meta-analysis of 8 trials (766 participants) found no difference in hypoxaemia (RR 0.87; 95% CI = 0.67–1.12). No statistically significant difference in hypotension was observed in meta-analysis of 8 trials (RR 0.96; 95% CI = 0.54–1.7; 942 participants). Mean dose of propofol was 51 mg lower for participants randomised to depth of anaesthesia monitoring (95% CI = −88.7 to −13.3 mg) in meta-analysis of results from four trials conducted with 434 participants who underwent interventional endoscopy procedures with propofol infusions to maintain sedation. The difference in recovery time between depth of anaesthesia and standard monitoring groups was not clinically significant (standardised mean difference −0.41; 95% CI = −0.8 to −0.02; I² = 86%; 8 trials; 809 participants).ConclusionsDepth of anaesthesia monitoring did impact sedation titration during interventional procedures with propofol infusions. For this reason, it seems reasonable for anaesthetists to utilise a depth of anaesthesia monitoring device for select populations of patients if it is decided that limiting the amount of sedation would be beneficial for the individual patient. However, there is no need to invest in purchasing extra equipment or training staff who are not familiar with this technology (e.g. nurses who do not routinely use a depth of anaesthesia monitoring device during general anaesthesia) because there is no high quality evidence suggestive of clear clinical benefits for patient safety or sedation efficacy.     

The Complexity of Nurses' Attitudes and Practice of Sedation at the End of Life: A Systematic Literature Review

ContextSedation is administered to some palliative care patients at the end of their life. Nurses play an important role in this practice.ObjectivesTo systematically review the evidence on nurses' attitudes and practice of end-of-life sedation.MethodsWe searched eight electronic databases, four key palliative care journals, and reference lists for empirical studies published in English, between 1990 and 2012, on nurses and their attitudes toward and practice of sedation until a patient's death. A total of 10 studies met the inclusion criteria.ResultsData were generated from 7515 nurses in four main settings (specialized palliative care unit, home, nursing home, and acute hospital) from seven countries (Belgium, Canada, Japan, The Netherlands, Norway, U.K., and U.S.). On average, the quality of the evidence was good; hence, we analyzed all selected studies. Based on the findings from a previous review, we categorized the emerging themes into: 1) important factors leading to the patient receiving palliative sedation (PS), 2) nurses' attitudes toward PS, and 3) nurses' experience of PS at the end of a patient's life. In general, nurses had a positive but cautious attitude toward the practice of PS. Most saw it as a last resort treatment for relieving suffering and refractory symptoms, and its practice was often influenced by their level of education, expertise, and the roles they played per setting.ConclusionMost nurses administered sedation until death only within the given circumstances because of the anticipatory benefits in controlling refractory symptoms and suffering. Some of them experienced burdens during PS delivery; these could be supported by operational guidelines and task-related training.     

Conscious sedation in the critically ill ventilated patient

Purpose

The aim of sedation is to provide comfort and minimize anxiety. However, adverse effects are noteworthy, and the optimal end point of sedation in intensive care unit patients is still debated. We analyzed if a level 2 on the Ramsay Scale (ie, awake, cooperative, oriented, tranquil patient) is suitable for an invasive therapeutic approach.

Materials and Methods

Forty-two patients requiring respiratory support and sedation for at least 4 days were enrolled in a prospective interventional cohort study aiming at maintaining patients awake and collaborative. The Ramsay score was recorded 3 times a day. Once a day, the nurse in charge evaluated adequacy of sedation according to the compliance with nursing care and therapeutic maneuvers in the previous 24 hours. Data were collected until patients were ventilated.

Results

Overall, 264 of 582 days were classified as conscious. Sedation was adequate in 93.9% of them. In conscious days, a higher Simplified Acute Physiology Score II score and male sex significantly correlated with inadequate sedation.

Conclusions

In a population of severe intensive care unit patients, conscious sedation was achieved in almost half of the days spent on ventilation. The positive implications (eg, on length of weaning and cost of sedation) of a conservative sedation strategy may be highly relevant.     

Spectral Entropy as a Monitor of Depth of Propofol Induced Sedation

Objective The aim of this prospective, observational study was to evaluate State and Response entropy (Entropy^TM Monitor, GE Healthcare, Finland), indices as measures of moderate (“conscious”) sedation in healthy adult patients receiving a low dose propofol infusion. Sedation was evaluated using: (I) the responsiveness component of the OAA/S scale␣(Observer’s Assessment of Alertness/Sedation scale) and (II) multi-channel electroencephalogram (EEG) interpretation by a clinical expert. Methods 12 ASA I patients were recruited. A target-controlled infusion of propofol was administered (using Schnider’s pharmacokinetic model) with␣an initial effect site concentration set to 0.5 μg ml⁻¹. A␣4 minute equilibrium period was allowed. This concentration was increased at 4 minute intervals by 0.5 μg ml⁻¹ to a maximum of 2.0 μg ml⁻¹. State (SE) and Response (RE), entropy values were recorded for each 4 minute epoch together with clinical sedation scores (OAA/S) and continuous multi-channel EEG. The multi-channel EEG recorded during the final minute of each 4 minute epoch or “patient/time unit” was presented to a neurophysiologist who assigned a label “sedated/not sedated”. SE/RE values were compared in patient/time units with clinical or EEG evidence of sedation versus those without. Results Mean SE and RE values were less in patient/time units when clinical evidence of sedation was present, [mean = 86.8 (95% CI, 84.0–88.3) and 94.3 (95%CI, 92–96.1)], P = 0.002 and P = 0.001, respectively. In patient/time units assigned the label “sedated” by the clinical neurophysiologist assessing the multi-channel EEG, SE and RE values were less [mean = 87.5 (95% CI, 86.3–88.4) and 95.0 (95% CI, 93.8–96.1)] P = 0.001 and P < 0.001, respectively. Conclusions A statistically significant decrease in SE and RE values was demonstrated in patient/time units in which clinical or EEG evidence of sedation was present. We conclude that spectral entropy offers potential as a monitor of propofol induced sedation Mahon P, Kowalski RG, Fitzgerald AP, Lynch EM, Boylan GB, McNamara B, Shorten GD. Spectral entropy as a monitor of depth of propofol induced sedation. Ethical Approval The Clinical Research Ethics Committee of the Cork Teaching Hospitals, Cork, Ireland approved the study protocol on 1st March 2005. The Clinical Research Ethics Committee of the Cork Teaching Hospitals, is a recognised Ethics Committee under regulation 7 of the European Communities (Clinical Trials on Medicinal Products for Human Use) regulations 2004, and is authorised to carry out the ethical review of clinical trials of investigational medicinal products. Presentation This work was presented in part (poster format) at the European Society of Anaesthesia, Annual Congress, Munich, Germany, June 9–12 2007. (Monitoring: equipment and computers poster section).Abstract reference: 3AP9-9. European Journal of Anaesthesia 2007(24) Suppl. 39 p 37.     

The Administration of Moderate Sedation and the Role of the Radiology Nurse

BackgroundModerate sedation administration is an assumed role of the nurse in interventional radiology. There remains limited documentation to define this practice and its relationship to the radiology nurse. The use of moderate sedation is common for patients receiving interventional radiology procedures, and therefore, defining the administrative parameters for this variable will allow for the future study of outcomes for this patient population. The primary aim of this article is to describe moderate sedation parameters in interventional radiology in hospitals offering adult interventional radiology services. Parameters included total case volumes, presence of provider type during interventional radiology cases using moderate sedation, existence of moderate sedation privileges, and the total percentage of moderate sedation administration by provider type. The results of this study are part of a larger nationwide survey that described administratively mediated variables in interventional radiology.MethodsA 26-question survey was developed and sent to a sample of radiologic administrators (n = 510) across the United States. The survey was developed using the Minnick and Roberts Outcomes Production Model, which identifies the relationship among essential health services concepts and their influence on patient outcomes. Recipients could answer via paper survey or by electronic link. Completion of the survey constituted consent.ResultsA total of 82 individuals responded to the survey (response rate = 16.8%). Respondents reported a median value of 2656.5 (n = 74, IQR: 1175.0, 5833.0) interventional radiology cases completed in the last year and a median value of 1500 patients receiving moderate sedation (n = 82, IQR: 600.0, 2725.0). Respondents reported that the registered nurse was responsible for a median of 90.0% of the sedation administered for adult patients (IQR: 80.0, 98.0).ConclusionsBased on the results of the survey, it is determined that moderate sedation is primarily administered by the registered nurse in interventional radiology. Future studies can include relational designs that focus on aspects of the registered nurse as a highly influential factor in moderate sedation patient outcomes.     

Effectiveness of Transmucosal Sedation for Special Needs Populations in the Ambulatory Care Setting

Transmucosal is an alternative route for administering medications (ie, dexmedetomidine, midazolam, naloxone) that can be effective for procedural or moderate sedation in patients with special needs when other routes are not practical or are contraindicated. Special needs populations include children, older adults, pregnant and breast-feeding women, and people with disabilities or conditions that limit their ability to function and cope. Understanding the perioperative nurse’s role in the care of patients receiving medications via the transmucosal route can lead to better clinical outcomes. Successful use of the transmucosal route requires knowledge of when to administer a medication, how often and how much of a medication should be administered, the onset and duration of action, the adverse effects or contraindications, and the key benefits. In addition, a case study approach suggests that transmucosal sedation can decrease patient stress and anxiety related to undergoing medical procedures or surgery in the ambulatory care setting.     

Improving the acceptability of the atrial defibrillator: patient-activated cardioversion versus automatic night cardioversion with and without sedation (ADSAS 2)

Acceptability of the atrial defibrillator is partly limited by concerns about shock related anxiety and discomfort. Sedation and/or automatic cardioversion therapy during sleep may ease shock discomfort and improve patient acceptability. Three atrial cardioversion techniques were compared: patient-activated cardioversion with sedation, automatic night cardioversion with sedation, and automatic night cardioversion without sedation. Sedation was oral midazolam (15 mg). Fifteen patients aged 60 +/- 13 years were assigned each strategy randomly for three consecutive episodes of persistent atrial fibrillation requiring cardioversion. Patients completed questionnaires for multiple parameters immediately and again at 24 hours postcardioversion. Atrial cardioversion strategies with oral sedation (patient-activated and automatic) significantly reduced shock recall by 77% (P < 0.005), therapy dissatisfaction by 57%-71% (P < 0.03), shock discomfort by 61%-73% (P < 0.01), shock pain by 79%-83% (P < 0.001), and shock intensity by 73%-77% (P < 0.03), compared to automatic night cardioversion without sedation (P < 0.02). Atrial shock pain was short-lived and caused little disruption to the patients' daily routines. Automatic night cardioversion without sedation, resulted in sleep disturbances not seen with the other strategies (42% vs 0%, P < 0.001) as well as concerns about future pain or discomfort. Twelve patients (80%) chose patient-activated cardioversion with sedation as their preferred treatment, and three (20%) remainder chose automatic night cardioversion with sedation. Ninety percent of patients chose automatic night cardioversion without sedation as the least acceptable therapy. Sedation significantly increases atrial shock acceptability regardless of cardioversion method. Shocks without sedation are significantly less acceptable to patients using the atrial defibrillators.     

A pilot trial of BIS monitoring for procedural sedation in the emergency department

Objective: Procedural sedation is common in the ED. However, there is no objective physiologic parameter available to monitor a patient's conscious state. The Bispectral Index (BIS) monitor has been validated as an objective measure of depth of anaesthesia. We studied the BIS monitor for this role in procedural sedation. Methods: A prospective, observational study with convenience sampling of adult patients in ED who underwent procedural sedation. Patients were treated according to standard practice and sedated as determined by the treating physician. Treating physicians were blinded to the BIS value. BIS values were recorded and compared to the Observer's Assessment of Alertness/Sedation Scale (OAAS). Upon recovery, patients were asked about recall of events while they were sedated. Results: Twelve patients were enrolled and 110 paired readings from 11 patients (7 male) were obtained. It was not possible to obtain readings from one patient. The mean age was 58 years (range 20–94). The Spearman correlation between BIS and OAAS was 0.027 (95% CI ?0.582?0.617). For the three patients who received propofol, the correlation was 1.0. There were no episodes of explicit recall of events during the period of sedation. Conclusions: BIS monitoring is feasible in the ED. Our small study suggests that there is a poor correlation between BIS values and the OAAS scale. Larger studies are required to further explore this relationship. Further developments in brain monitoring technology are also needed before this form of monitoring becomes clinically useful for procedural sedation.     

The impact of bispectral index monitoring on rates of propofol administration

The purpose of this article is to examine the efficacy of Bispectral Index (BIS) monitoring as a tool for adjusting the amount of propofol patients receive to maintain a safe and adequate level of sedation in a neurocritical care setting. The BIS monitor is utilized as an adjunct for anesthesia monitoring in the operating room setting and is currently being investigated as a tool for objective sedation monitoring in the critical care setting. 1-6 Sedation is discussed in terms of patient safety and comfort. A secondary data analysis was used to test the hypothesis that BIS monitoring provides a more objective form of sedation assessment that will lead to a decrease in overall rates of propofol administration and fewer incidences of oversedation. Data were abstracted from a quality improvement study of propofol use adjusted to BIS values in patients whose sedation levels were previously adjusted to a goal Ramsay score. The results suggest that there are potential benefits to incorporating BIS into routine sedation assessment in the neurocritical care setting.