Benefit of general anesthesia monitored by bispectral index compared with monitoring guided only by clinical parameters. Systematic review and meta-analysis

Oliveira, Carlos Rogério Degrandi; Bernardo, Wanderley Marques; Nunes, Victor Moisés

doi:10.1016/j.bjane.2015.09.001

Cited by 76 publications

(59 citation statements)

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“…Three previous meta-analyses [15][16][17] and two systematic reviews [18,19] have investigated the association between the depth of anaesthesia and cognitive impairment. Lu et al [15] compared low BIS and high BIS groups in four studies and concluded that the depth of anaesthesia did not correlate with the risk of POCD, but deep anaesthesia carried a significantly increased risk of POD.…”

Section: Discussionmentioning

confidence: 99%

“…In their meta-analysis, the number of eligible studies was relatively low and the merged results on the outcomes were inconsistent. Oliveira et al [16] demonstrated that BIS monitoring is favourable for POD and POCD at 1 month, as opposed to POCD at 1 week. However, in the latter case, data collection might be compromised since neither event numbers nor total number of patients included in analyses match that reported by the original Chan et al article for POCD [30].…”

Section: Discussionmentioning

confidence: 99%

“…Prevention of postoperative cognitive disturbances is a top priority, with one potential tool being the application of bispectral index (BIS) monitoring [2,6,7,9,[12][13][14]. Previous systematic reviews have yielded discrepant results, although the methods applied in data collection, selection and pooling have been varied and, sometimes, incomplete as well [15][16][17][18][19]. These reviews have left the question open on how BIS monitor-guided anaesthesia influences the incidence of POD and POCD.…”

Section: Introductionmentioning

confidence: 99%

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Is the bispectral index monitoring protective against postoperative cognitive decline? A systematic review with meta-analysis

et al. 2020

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Background Several studies have suggested that monitoring the depth of anaesthesia might prevent the development of postoperative cognitive decline. We aimed to conduct a meta-analysis to investigate the effects of bispectral index (BIS) monitoring in anaesthesia. Methods We searched in six major electronic databases. Trials were included if they discussed anaesthesia with and without BIS monitoring or low (<50) and high (�50) BIS levels and which measured the risk of postoperative delirium (POD) and/or postoperative cognitive dysfunction (POCD). Results We included fourteen studies in the systematic review, eight of which were eligible for metaanalysis. BIS proved to be protective against POD at 1 day postoperatively in a cohort of 2138 patients (16.1% vs. 22.8% for BIS vs. no BIS groups, respectively; relative risk [RR] 0.71; 95% confidence interval [CI] 0.59 to 0.85, without significant between-study heterogeneity I 2 = 0.0%, P = 0.590). The use of BIS was neutral for POCD at 1 week but protective for POCD at 12 weeks (15.8% vs. 18.8% for BIS vs. no BIS groups, respectively; RR = 0.84, CI: 0.66 to 1.08), without significant between-study heterogeneity (I 2 = 25.8%, P = 0.260). The neutral association at 1 week proved to be underpowered with trial sequential analysis. In the comparison of low BIS versus high BIS, the incidence of POD at 1 day was similar in the groups.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is the bispectral index monitoring protective against postoperative cognitive decline? A systematic review with meta-analysis

et al. 2020

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“…Глубокая анестезия на фоне атеросклероза может сопровождаться выраженной гипотензией, что является весомым фактором в развитии послеоперационных осложнений [32]. Использование мониторинга глубины анестезии с помощью биспектрального индекса (BIS) позволяет контролировать интраоперационное применение гипнотиков и анестетиков, избегая излишней седации, что способствует сокращению времени пробуждения и сроков экстубации без повышения риска присутствия и неблагоприятных событий [33].…”

Section: Discussionunclassified

Ways to reduce respiratory complications in patients with esophageal cancer after esophagectomy

Хасанов¹,

Хороненко²,

Сигал³

et al. 2018

Onkol. Z. im. P.A. Gercena

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Цель исследования-изучение факторов риска отсроченного пробуждения, поздней экстубации трахеи и длительной послеоперационной ИВЛ, а также определение их прогностического значения для больных раком пищевода, подверженных эзофагэктомии. Материал и методы. Исследованы 177 больных плоскоклеточным раком грудного отдела пищевода, которым в условиях сочетанной общей ингаляционной и эпидуральной анестезии выполнена одномоментная экстирпация пищевода и эзофагопластика стеблем желудка. Послеоперационное обезболивание осуществлялось продленной эпидуральной блокадой в течение 3-6 дней. Промежуточными точками исследования было выявление взаимосвязей периода постнаркозного пробуждения с переменными, отражающими послеоперационные осложнения и результаты лечения. Конечными точками исследования было выявление взаимосвязей периода пробуждения с периоперационными переменными больного. Проведен многомерный анализ для выявления факторов, влияющих на длительность периода послеоперационного пробуждения. Результаты. Установлено, что увеличение этапа постнаркозного пробуждения больного раком пищевода после эзофагэктомии может способствовать развитию послеоперационных осложнений (OR=0,187; p=0,013) и длительному пребыванию в отделении реанимации (OR=0,369; p<0,001). На основании многофакторного анализа, показано, что время постнаркозного пробуждения у пожилых (OR=5,844; Cl 2,848-8,840) и пациентов с низкой массой тела (OR=-3,917; Cl-6,267-1,567) будет замедлено, а применение ГЭА как компонента анестезии (OR=-137,261; Cl-205,622-68,901) и контроль ее глубины с помощью BIS-монитора (OR=-161,145; Cl-20,635-101,655) позволит существенно сократить длительность постнаркозного пробуждения после эзофагэктомии. Заключение. На современном этапе контроль течения и глубины анестезии позволяет оптимизировать кардиореспираторные показатели больных раком пищевода и решить проблемы послеоперационной боли. Это создает предпосылки для ранней и несколько «агрессивной» активизации больных, что позволяет снизить риск развития послеоперационных осложнений после эзофагэктомии и облегчает широкое внедрение протоколов ERAS в отечественную онкологическую хирургию. Ключевые слова: рак пищевода, эзофагэктомия, анестезия, продленная аналгезия, послеоперационная респираторная поддержка, ранняя экстубация трахеи, раннее постнаркозное пробуждение, enhanced recovery after surgery (ERAS).

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“…Cortical electroencephalography (EEG) is commonly used to monitor the cerebral effects of general anesthetics. [1] The popular commercial device for monitoring anesthesia depth/sedation might be the bispectral index (BIS) and was developed using EEG data collected from adult volunteers. [2] Although BIS was developed with adult EEG data, many studies have utilized the BIS to monitor anesthesia depth in children.…”

Section: Introductionmentioning

confidence: 99%

Comparison of bispectral index and patient state index during sevoflurane anesthesia in children: a prospective observational study

Jang

Kim

et al. 2020

Preprint

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Background: Cortical electroencephalography (EEG)-based devices are used to monitor the depth of anesthesia. In this study, we compared the values of bispectral index (BIS) and patient state index (PSI) during sevoflurane anesthesia in children. The ability/accuracy of BIS and PSI to predict the steady and recovery state of anesthesia was evaluated based on prediction probability (Pk) values and the secondary outcomes were agreement and correlation of two monitors. Methods: Fifty children (3-12 years old) were enrolled and the patients received sevoflurane anesthesia with remifentanil. Before the induction of anesthesia, BIS and PSI sensors were simultaneously placed on the forehead, and data were collected until the end of anesthesia. Steady state was defined as the period following intubation until the cessation of sevoflurane, while recovery state was defined as the period following the cessation of sevoflurane until awake. The prediction probability (Pk), agreement or correlation of BIS and PSI in different anesthesia state were calculated. Results: Anesthesia reduced mean BIS and PSI values. Pk of BIS (95% confidential interval (CI) [0.78-0.91])) and PSI (95% CI [0.82-0.91]) for anesthesia were 0.85 and 0.87, respectively. Agreement was 0.79 for recovery state and 0.73 for steady state. Conclusions: Pk values were comparable for BIS and PSI. Agreement between BIS and PSI measurements in the same state was relatively good. Therefore, these monitors are appropriate for monitoring for different state of anesthesia in pediatric population. Trial Registry Number: Clinical Trials.gov NCT03792334.

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Benefit of general anesthesia monitored by bispectral index compared with monitoring guided only by clinical parameters. Systematic review and meta-analysis

Abstract: Clinically, anesthesia monitoring with the BIS can be justified because it allows advantages from reducing the recovery time after waking, mainly by reducing the administration of general anesthetics as well as the risk of adverse events.

Cited by 76 publications

References 46 publications

Is the bispectral index monitoring protective against postoperative cognitive decline? A systematic review with meta-analysis

Is the bispectral index monitoring protective against postoperative cognitive decline? A systematic review with meta-analysis

Ways to reduce respiratory complications in patients with esophageal cancer after esophagectomy

Comparison of bispectral index and patient state index during sevoflurane anesthesia in children: a prospective observational study

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