Article

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; 4(4):CD003843. 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.

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    • "There was a reduction in awareness in high-risk patients. However, all the data regarded the use of the BIS index in the adult population alone [26] "
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    ABSTRACT: » Eine Allgemeinanästhesie, die durch eine Kombination verschiedener Anästhetika mit synergistischen pharmakologischen Eigenschaften aufrechterhalten wird, bezeichnet man als balancierte Anästhesie. « Mononästhesien, d. h. Anästhesien unter Verwendt von nur einem Anästhetikum, werden heute praktinicht mehr durchgeführt. Eine Allgemeinanästhesie wird heute meist aus einer Kombination von mindestens 2.oder mehr Anästhetika aufrechterhalten [41]. Eine Inhalaticanästhesie wird ausschließlich als eine Kombinationsästhesie aus Lachgas (Stickoxydul, N2O), Sauerstoffieinem Inhalationsanästhetikum durchgeführt [5][9][12][ [45][49]. Auch bei einer totalen intravenösen Anästhesie (TIVA) wird ein Hypnotikum (Propofol) mit einem Analge-tikum (z. B. Remifentanil) kombiniert [10]. In der balancierten Anästhesie werden Inhalationsanästhetika mit i.v.-An-ästhetika kombiniert [40]. Heute wird mit dem Begriffder balancierten Anästhesie meistens eine Kombination aus intravenöser Opioidgäbe (Analgesie) und Inhalationsanästhesie (Hypnose) verbunden [47]. Der Begriffist jedoch wie oben bereits erwähnt nicht eng definiert und wurde auch schon für andere Kombinationen von Anästhetika wie z. B. Regionalan-algesie und Inhalationsanästhesie verwendet [44].
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