Clinical impact of hypnotic-titration guidelines based on EEG bispectral index (BIS) monitoring during routine anesthetic care

Journal of Clinical Anesthesia
J W JohansenJ Sigl


To examine the impact on perioperative care of routine Bispectral Index (BIS) monitoring during general anesthesia throughout an entire operating room (OR) suite. Open, observational trial with retrospective analysis of guideline performance. Data were analyzed from 1,552 adult patients receiving general anesthesia with surgical times of at least 1 hour and who were extubated by postanesthesia care unit (PACU) discharge. Staff were trained using a simple decision matrix, which integrated BIS titration goals with anesthetic management. Unmonitored patients were compared to either BIS-monitored patients or to performance subgroups based on BIS measurements recorded during anesthetic maintenance ("deep", BIS < 50; "target", 50-65; "light", >65). Large, urban academic/trauma center. Demographic profiles of all groups and subgroups were similar. Anesthetic emergence, recovery times, and volatile drug use were significantly shortened or reduced only when BIS values were maintained between 50 and 65. Extubation time from end of surgery decreased by 2.1 minutes from 5.7+/-7 (37%); OR exit time decreased by 2.2 minutes from 9.3+/-6 (24%); eligibility for phase 1 PACU discharge decreased by 4 minutes from 22+/-42 (23%); and actual PACU d...Continue Reading


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