Bispectral index for improving anaesthetic delivery and postoperative recovery

© 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Background: The use of clinical signs may not be reliable in measuring the hypnotic component of anaesthesia. The use of bispectral index (BIS) to guide the dose of anaesthetic may have certain advantages over clinical sig...

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Main Authors: Yodying Punjasawadwong, Aram Phongchiewboon, Nutchanart Bunchungmongkol
Format: Journal
Published: 2018
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http://cmuir.cmu.ac.th/jspui/handle/6653943832/53730
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Institution: Chiang Mai University
id th-cmuir.6653943832-53730
record_format dspace
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
topic Medicine
spellingShingle Medicine
Yodying Punjasawadwong
Aram Phongchiewboon
Nutchanart Bunchungmongkol
Bispectral index for improving anaesthetic delivery and postoperative recovery
description © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Background: The use of clinical signs may not be reliable in measuring the hypnotic component of anaesthesia. The use of bispectral index (BIS) to guide the dose of anaesthetic may have certain advantages over clinical signs. This is the second update of a review originally published in 2007 and updated in 2014. Objectives: The primary objective of this review focused on whether the incorporation of BIS into the standard practice for management of anaesthesia can reduce the risk of intraoperative awareness, consumption of anaesthetic agents, recovery time and total cost of anaesthesia in surgical patients undergoing general anaesthesia. Search methods: In this updated version, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 1), MEDLINE (1990 to 31 January 2013), Embase (1990 to 31 January 2013) and reference lists of articles. Previously, we searched to May 2009. We reran the searches on 27 February 2017. We identified 14 potential new studies of interest which were added to a list of 'Studies awaiting Classification' and will be incorporated into the formal review findings during the review update. In total there are 17 studies awaiting classification. Selection criteria: We included randomized controlled trials comparing BIS with standard practice criteria for titration of anaesthetic agents. Data collection and analysis: Two authors independently assessed trial quality, extracted data and analysed the data. We contacted study authors for further details. Main results: We included 36 trials. In studies using clinical signs as standard practice, the results demonstrated a significant effect of the BIS-guided anaesthesia in reducing the risk of intraoperative awareness among surgical patients at high risk for awareness (7761 participants; odds ratio (OR) 0.24, 95% confidence interval (CI) 0.12 to 0.48). This effect was not demonstrated in studies using end tidal anaesthetic gas (ETAG) monitoring as standard practice (26,530 participants; OR 1.13, 95% CI 0.56 to 2.26). BIS-guided anaesthesia reduced the requirement for propofol by 1.32 mg/kg/hr (672 participants; 95% CI -1.91 to -0.73) and for volatile anaesthetics (desflurane, sevoflurane, isoflurane) by 0.65 standardized mean difference of minimal alveolar concentration equivalents (MAC SMD equivalences) (95% CI -1.01 to -0.28) in 985 participants. Irrespective of the anaesthetics used, BIS reduced the following recovery times: time for eye opening (2557 participants; by 1.93 min, 95% CI -2.70 to -1.16), response to verbal command (777 participants; by 2.73 min, 95% CI -3.92 to -1.54), time to extubation (1501 participants; by 2.62 min, 95% CI -3.46 to -1.78), and time to orientation (373 participants; by 3.06 min, 95% CI -3.63 to -2.50). BIS shortened the duration of postanaesthesia care unit stay by 6.75 min (1953 participants; 95% CI -11.20 to -2.31) but did not significantly reduce the time to home readiness (329 participants; -7.01 min, 95% CI -30.11 to 16.09). Authors' conclusions: BIS-guided anaesthesia can reduce the risk of intraoperative awareness in surgical patients at high risk for awareness in comparison to using clinical signs as a guide for anaesthetic depth. BIS-guided anaesthesia and ETAG-guided anaesthesia may be equivalent in protection against intraoperative awareness but the evidence for this is inconclusive. In addition, anaesthesia guided by BIS kept within the recommended range improves anaesthetic delivery and postoperative recovery from relatively deep anaesthesia.
format Journal
author Yodying Punjasawadwong
Aram Phongchiewboon
Nutchanart Bunchungmongkol
author_facet Yodying Punjasawadwong
Aram Phongchiewboon
Nutchanart Bunchungmongkol
author_sort Yodying Punjasawadwong
title Bispectral index for improving anaesthetic delivery and postoperative recovery
title_short Bispectral index for improving anaesthetic delivery and postoperative recovery
title_full Bispectral index for improving anaesthetic delivery and postoperative recovery
title_fullStr Bispectral index for improving anaesthetic delivery and postoperative recovery
title_full_unstemmed Bispectral index for improving anaesthetic delivery and postoperative recovery
title_sort bispectral index for improving anaesthetic delivery and postoperative recovery
publishDate 2018
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84916619825&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/53730
_version_ 1681424189537386496
spelling th-cmuir.6653943832-537302018-09-04T09:56:45Z Bispectral index for improving anaesthetic delivery and postoperative recovery Yodying Punjasawadwong Aram Phongchiewboon Nutchanart Bunchungmongkol Medicine © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Background: The use of clinical signs may not be reliable in measuring the hypnotic component of anaesthesia. The use of bispectral index (BIS) to guide the dose of anaesthetic may have certain advantages over clinical signs. This is the second update of a review originally published in 2007 and updated in 2014. Objectives: The primary objective of this review focused on whether the incorporation of BIS into the standard practice for management of anaesthesia can reduce the risk of intraoperative awareness, consumption of anaesthetic agents, recovery time and total cost of anaesthesia in surgical patients undergoing general anaesthesia. Search methods: In this updated version, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 1), MEDLINE (1990 to 31 January 2013), Embase (1990 to 31 January 2013) and reference lists of articles. Previously, we searched to May 2009. We reran the searches on 27 February 2017. We identified 14 potential new studies of interest which were added to a list of 'Studies awaiting Classification' and will be incorporated into the formal review findings during the review update. In total there are 17 studies awaiting classification. Selection criteria: We included randomized controlled trials comparing BIS with standard practice criteria for titration of anaesthetic agents. Data collection and analysis: Two authors independently assessed trial quality, extracted data and analysed the data. We contacted study authors for further details. Main results: We included 36 trials. In studies using clinical signs as standard practice, the results demonstrated a significant effect of the BIS-guided anaesthesia in reducing the risk of intraoperative awareness among surgical patients at high risk for awareness (7761 participants; odds ratio (OR) 0.24, 95% confidence interval (CI) 0.12 to 0.48). This effect was not demonstrated in studies using end tidal anaesthetic gas (ETAG) monitoring as standard practice (26,530 participants; OR 1.13, 95% CI 0.56 to 2.26). BIS-guided anaesthesia reduced the requirement for propofol by 1.32 mg/kg/hr (672 participants; 95% CI -1.91 to -0.73) and for volatile anaesthetics (desflurane, sevoflurane, isoflurane) by 0.65 standardized mean difference of minimal alveolar concentration equivalents (MAC SMD equivalences) (95% CI -1.01 to -0.28) in 985 participants. Irrespective of the anaesthetics used, BIS reduced the following recovery times: time for eye opening (2557 participants; by 1.93 min, 95% CI -2.70 to -1.16), response to verbal command (777 participants; by 2.73 min, 95% CI -3.92 to -1.54), time to extubation (1501 participants; by 2.62 min, 95% CI -3.46 to -1.78), and time to orientation (373 participants; by 3.06 min, 95% CI -3.63 to -2.50). BIS shortened the duration of postanaesthesia care unit stay by 6.75 min (1953 participants; 95% CI -11.20 to -2.31) but did not significantly reduce the time to home readiness (329 participants; -7.01 min, 95% CI -30.11 to 16.09). Authors' conclusions: BIS-guided anaesthesia can reduce the risk of intraoperative awareness in surgical patients at high risk for awareness in comparison to using clinical signs as a guide for anaesthetic depth. BIS-guided anaesthesia and ETAG-guided anaesthesia may be equivalent in protection against intraoperative awareness but the evidence for this is inconclusive. In addition, anaesthesia guided by BIS kept within the recommended range improves anaesthetic delivery and postoperative recovery from relatively deep anaesthesia. 2018-09-04T09:56:45Z 2018-09-04T09:56:45Z 2014-06-17 Journal 1469493X 2-s2.0-84916619825 10.1002/14651858.CD003843.pub3 https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84916619825&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/53730