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Bispectral index for improving anaesthetic delivery and postoperative recoveryPunjasawadwong Y, Phongchiewboon A, Bunchungmongkol N
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SummaryBispectral index for improving anaesthetic delivery and postoperative recoveryBispectral index has been shown to improve both anaesthetic delivery and postoperative recovery and to reduce the incidence of intraoperative recall awareness. The use of clinical signs, such as blood pressure and heart rate, for guiding doses of anaesthetic can result in either an overdosage or underdosage of anaesthetic agents. Bispectral index (BIS) is a scale derived from cerebral electrical activity to measure the effect of specific anaesthetic drugs on the brain. It may be useful to tailor doses of anaesthetic to achieve adequate depth of anaesthesia. This review of 20 trials found that anaesthesia guided by BIS, to keep it within the recommended range (40 to 60), could decrease the consumption of anaesthetic drugs and enhance recovery from relatively deep anaesthesia. Moreover, BIS could reduce the incidence of perioperative recall in surgical patients with high risk of awareness.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 2, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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October 17. 2007 AbstractBackgroundThe use of clinical signs may not be reliable to measure the hypnotic component of anaesthesia. The use of bispectral index to guide the dose of anaesthetics may have certain advantages over clinical signs. ObjectivesThe objective of this review was to assess whether bispectral index (BIS) reduced anaesthetic use, recovery times, recall awareness and cost. Search strategyWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 2), MEDLINE (1990 to May 2007), EMBASE (1990 to May 2007) and reference lists of articles. Selection criteriaWe included randomized controlled trials comparing BIS with clinical signs (CS) in titrating anaesthetic agents. Data collection and analysisTwo authors independently assessed trial quality, extracted data and analysed the data. We contacted study authors for further details. Main resultsWe included 20 studies with 4056 participants. Seven recent trials are still awaiting assessment. BIS-guided anaesthesia reduced the requirement for propofol by 1.30 mg/kg/hr (578 participants; 95% confidence interval (CI) -1.97 to -0.62) and for volatile anaesthetics (desflurane, sevoflurane, isoflurane) by 0.17 minimal alveolar concentration equivalents (MAC) (689 participants; 95% CI -0.27 to -0.07). Irrespective of the anaesthetic, BIS reduced the recovery times: time for eye opening by 2.43 min (996 participants; 95% CI -3.60 to -1.27), response to verbal command by 2.28 min (717 participants; 95% CI -3.47 to -1.09), time to extubation by 3.05 min (1057 participants; 95% CI -3.98 to -2.11) and orientation by 2.46 min (316 participants; 95% CI -3.21 to -1.71). BIS shortened the duration of postanaesthesia care unit stay by 6.83 min (584 participants; 95% CI -12.08 to -1.58) but did not reduce time to home readiness (329 participants; 95% CI -30.11 to 16.09). The BIS-guided anaesthesia significantly reduced the incidence of intraoperative recall awareness in surgical patients with high risk of awareness (OR 0.20, 95% CI 0.05 to 0.79). Authors' conclusionsAnaesthesia guided by BIS within the recommended range (40 to 60) could improve anaesthetic delivery and postoperative recovery from relatively deep anaesthesia. In addition, BIS-guided anaesthesia has a significant impact on reduction of the incidence of intraoperative recall in surgical patients with high risk of awareness.
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