EVIDENCE LIBRARY
Bronchoscopy Trial Found No Added BIS Change With Remifentanil During Deep Midazolam-Based Sedation
A randomized ICU study tested additional remifentanil during bronchoscopy. A null difference in a processed EEG endpoint did not directly measure the absence of pain or awareness.
A randomized ICU study tested additional remifentanil during bronchoscopy. A null difference in a processed EEG endpoint did not directly measure the absence of pain or awareness.
The background regimen
Patients were already deeply sedated with midazolam and fentanyl and received atracurium for neuromuscular blockade. The trial compared an added remifentanil infusion with placebo during fiberoptic bronchoscopy.
The investigators found no between-group difference in BIS variation, and blood pressure and heart-rate measures were comparable during the procedure.
The endpoint sets the claim
Neuromuscular blockade limits movement, while BIS summarizes selected EEG features. Neither is identical to a patient’s report of pain, and background sedation and analgesia may reduce the opportunity to detect an added effect.
The result concerns this specific regimen and procedure. It cannot establish that midazolam is an analgesic, that paralyzed patients cannot experience pain, or that extra analgesia is unnecessary in all ICU procedures. Preserve the administered drugs, depth of sedation, monitoring limitations, and endpoint when explaining the trial.
Source paper
Original analysis of the supplied journal article, identified as PMC3487977.