Bispectral index for improving anaesthetic delivery and postoperative recovery

Chiang Mai University, Department of Anesthesiology, Faculty of Medicine, Chiang Mai, Thailand, 50200.
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 02/2007; DOI: 10.1002/14651858.CD003843.pub2
Source: PubMed

ABSTRACT The 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.
The objective of this review was to assess whether bispectral index (BIS) reduced anaesthetic use, recovery times, recall awareness and cost.
We 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.
We included randomized controlled trials comparing BIS with clinical signs (CS) in titrating anaesthetic agents.
Two authors independently assessed trial quality, extracted data and analysed the data. We contacted study authors for further details.
We 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).
Anaesthesia 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.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Anesthesiologists play a pivotal role in facilitating recovery of patients undergoing colorectal surgery, as many Enhanced Recovery After Surgery (ERAS) elements are under their direct control. Successful implementation of ERAS programs requires that anesthesiologists become more involved in perioperative care and more aware of the impact of anesthetic techniques on surgical outcomes and recovery. Key to achieving success is strict adherence to the principle of aggregation of marginal gains. This article reviews anesthetic and analgesic care of patients undergoing elective colorectal surgery in the context of an ERAS program, and also discusses anesthesia considerations for emergency colorectal surgery. Copyright © 2015 Elsevier Inc. All rights reserved.
    Anesthesiology Clinics 03/2015; 33(1):93-123. DOI:10.1016/j.anclin.2014.11.007
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Early postoperative cognitive dysfunction (POCD) is commonly associated with major surgery and anesthesia, occurring in 7 to 71% of patients [1-3]. Advanced age, degree of surgical trauma, depth of anesthesia and inflammatory activation are some of the risk factors for POCD [1,4-7]. It has been proposed that systemic inflammation may contribute to postoperative cognitive deficits and there could be a relationship between interleukin response and impaired postoperative cognition [8-10]. Monitoring the depth of anesthesia using digital processing of the EEG makes it possible to reduce anesthetic requirements and doses of opioids perioperatively, which can also influence POCD [5,11-14]. Inflammatory response and opioids are two risk factors for development of POCD [4,15]. The aim of this study was to evaluate the role of depth of anesthesia on POCD after major ENT surgery and to assess changes in postoperative inflammatory markers in patients undergoing major surgery. A selected group of experienced anesthesiologists or nurse anesthetists, specially trained in guiding anesthesia depth using auditory evoked potential (AEP, A-line), performed the anesthesia. The postoperative personnel were blinded to group assignment, and all data were processed independently of group allocation and were blinded to the investigator until the finalisation of the study. Randomisation procedure and baseline characteristics Patients were randomly assigned to one of two study groups: AEP group (group A): Anesthesia was guided by AEP: A-line  ARX index (AAI), version 1.6. Mid-latency auditory evoked potential (MLAEP) was calculated using the A-line monitor (Danmeter A/S, Odense, Denmark) [16,17], AAI between 15 and 25 was regarded as adequate [17]. Control group (group C): Anesthesia was guided by clinical signs of depth of anesthesia including blood pressure, heart rate, pupil reaction, sweating and lacrimation at the discretion of the attending anesthesiologist or nurse anesthetist. AEP was recorded in all patients in the control group but was blinded to the attending anesthesiologist or nurse anesthetist. After surgery, the data were transferred to storage media for later analysis of AAI. Citation: Jildenstål PK, Hallén JL, Rawal N, Berggren L (2012) Does Depth of Anesthesia Influence Postoperative Cognitive Dysfunction or Inflammatory Re-sponse Following Major ENT Surgery? J Anesth Clin Res 3:220. doi:10.4172/2155-6148.1000220 Copyright: © 2012 Jildenstål PK, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits un-restricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract The aim of this study was to evaluate the role of depth of anesthesia on POCD after major ENT surgery and to assess changes in postoperative inflammatory markers in patients undergoing major ENT surgery. Thirty two patients aged 40 to 94 yrs, scheduled for surgery under general anesthesia were randomly assigned to one of two groups. In group A (AEP group) depth of anesthesia (DOA) was measured with auditory evoked potential (AEP). In the control group (group C) DOA was monitored according to clinical signs. Cognitive function was evaluated using Mini-Mental State Examination (MMSE), Confusion Assessment Method (CAM) and Cognitive Failure Questionnaire (CFQ). Inflammatory markers were measured before and after anesthesia. Perioperative requirements for desflurane and fentanyl were significantly lower in group A. On the first postoperative day MMSE changes indicating POCD were noted in 1 patient in group A and 7 patients in group C (P<0.03). One month follow up did not show any difference between the groups regarding POCD. Our study indicates that AEP-guided anesthesia allows dose reduction of anesthetic agents including opioids leading to better cardiovascular stability and less early POCD. Anesthesia depth did not influence the inflammatory response to surgery.
    Journal of Clinical Anesthesia 07/2012; 3(6):1000220. · 1.21 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: La escoliosis es una compleja deformidad rotacional tridimensional que afecta la columna en el plano sagital, coronal y axial, y puede ser de origen congénito, neuromuscular o idiopática. Su síntoma principal en el 90% de los casos es el dolor, y su manejo inicial es conservador. Sin embargo, puede ser tan grave que genere otros síntomas, déficit neurológico o que se requiera intervención quirúrgica. En estos casos es una cirugía de alto riesgo por el tipo de complicaciones reportadas, entre ellas sangrado severo y lesión nerviosa, por lo cual es necesaria una evaluación prequirúrgica detallada y un plan intraoperatorio enfocado a disminuir el riesgo de complicaciones. Adicionalmente, el paciente puede tener otras comorbilidades que aumenten los riesgos o creencias religiosas que prohíban el uso de hemoderivados, generando una complejidad mayor.El presente artículo es una revisión de la literatura científica sobre cirugía mayor de columna en testigos de Jehová, con énfasis en técnicas de ahorro sanguíneo, aprovechando el caso de un paciente con diagnóstico de escoliosis idiopática severa, practicante de esta religión, con compromiso pulmonar severo en el último año y deterioro de su clase funcional, que fue llevado a cirugía de corrección de escoliosis. La intervención fue realizada en la Clínica CES de la ciudad de Medellín (Colombia), con resultados exitosos y respetando las creencias religiosas del paciente.
    Revista Colombiana de Anestesiologia 11/2012; 40(4):323-331. DOI:10.1016/j.rca.2012.04.002


Available from