Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2015.09.001
Brazilian Journal of Anesthesiology
Review Article

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

Benefício da anestesia geral com monitoração do índice bispectral em comparação com o monitoramento guiado apenas por parâmetros clínicos. Revisão sistemática e metanálise

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

Downloads: 2
Views: 689

Abstract

Abstract Background: The bispectral index parameter is used to guide the titration of general anesthesia; however, many studies have shown conflicting results regarding the benefits of bispectral index monitoring. The objective of this systematic review with meta-analysis is to evaluate the clinical impact of monitoring with the bispectral index parameter. Methods: The search for evidence in scientific information sources was conducted during December 2013 to January 2015, the following primary databases: Medline/PubMed, LILACS, Cochrane, CINAHL, Ovid, SCOPUS and TESES. The criteria for inclusion in the study were randomized controlled trials, comparing general anesthesia monitored, with bispectral index parameter with anesthesia guided solely by clinical parameters, and patients aged over 18 years. The criteria for exclusion were studies involving anesthesia or sedation for diagnostic procedures, and intraoperative wake-up test for surgery of the spine. Results: The use of monitoring with the bispectral index has shown benefits reducing time to extubation, orientation in time and place, and discharge from both the operating room and post anesthetic care unit. The risk of nausea and vomiting after surgery was reduced by 12% in patients monitored with bispectral index. Occurred a reduction of 3% in the risk of cognitive impairment postoperatively at 3 months postoperatively and 6% reduction in the risk of postoperative delirium in patients monitored with bispectral index. Furthermore, the risk of intraoperative memory has been reduced by 1%. Conclusion: 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.

Keywords

General anesthesia, Anesthetics, Inhalation, Intravenous anesthesia, Bispectral index-monitoring

Resumo

Resumo Justificativa: O parâmetro índice bispectral (BIS) é usado para guiar a titulação da anestesia geral; no entanto, muitos estudos têm mostrado resultados conflitantes quanto aos benefícios da monitoração do BIS. O objetivo desta revisão sistemática com metanálise foi avaliar o impacto clínico da monitoração do parâmetro BIS. Métodos: A busca por evidências em fontes de informação científicas foi conduzida de dezembro de 2013 a janeiro de 2015 nas seguintes bases de dados: Medline/PubMed, Lilacs, Cochrane, Cinahl, Ovid, Scopus e Teses. Os critérios de inclusão foram estudos randomizados e controlados, que compararam anestesia geral monitorada com o parâmetro BIS com anestesia guiada apenas por parâmetros clínicos em pacientes com mais de 18 anos. Os critérios de exclusão foram estudos que envolveram anestesia ou sedação para procedimentos de diagnóstico e teste de despertar no intraoperatório de cirurgia da coluna vertebral. Resultados: O uso de monitoração com o BIS mostrou benefícios como a redução do tempo de extubação, orientação no tempo e no espaço, alta da sala de cirurgia e da sala de recuperação pós-anestesia. O risco de náuseas e vômitos no pós-operatório foi reduzido em 12% em pacientes monitorados com o BIS. Ocorreu uma redução de 3% no risco de disfunção cognitiva em três meses do pós-operatório e 6% no risco de delírio pós-operatório em pacientes monitorados com o BIS. Além disso, o risco de despertar com memória intraoperatória foi reduzido em 1%. Conclusão: Clinicamente, a monitoração com o BIS pode ser justificada, pois permite vantagens como reduzir o tempo de recuperação, principalmente, a administração de anestésicos gerais e o risco de eventos adversos.

Palavras-chave

Anestesia geral, Anestésicos, Inalação, Anestesia intravenosa, Monitoração do índice bispectral

References

Nelskylä KA, Yli-Hankala AM, Puro PH. Sevoflurane titration using bispectral index decreases postoperative vomiting in phase II recovery after ambulatory surgery. Anesth Analg. 2001;93:1165-9.

Wong J, Song D, Blanshard H. Titration of isoflurane using BIS index improves early recovery of elderly patients undergoing orthopedic surgeries. Can J Anaesth. 2002;49:13-8.

Luginbühl M, Wüthrich S, Petersen-Felix S. Different benefit of bispectal index (BIS) in desflurane and propofol anesthesia. Acta Anaesthesiol Scand. 2003;47:165-73.

Ahmad S, Yilmaz M, Marcus RJ. Impact of bispectral index monitoring on fast tracking of gynecologic patients undergoing laparoscopic surgery. Anesthesiology. 2003;98:849-52.

Başar H, Ozcan S, Buyukkocak U. Effect of bispectral index monitoring on sevoflurane consumption. Eur J Anaesthesiol. 2003;20:396-400.

Puri GD, Murthy SS. Bispectral index monitoring in patients undergoing cardiac surgery under cardiopulmonary bypass. Eur J Anaesthesiol. 2003;20:451-6.

Kreuer S, Biedler A, Larsen R. Narcotrend monitoring allows faster emergence and a reduction of drug consumption in propofol-remifentanil anesthesia. Anesthesiology. 2003;99:34-41.

Myles PS, Leslie K, McNeil J. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet. 2004;363:1757-63.

Bruhn J, Kreuer S, Bischoff P. Bispectral index and A-line AAI index as guidance for desflurane-remifentanil anaesthesia compared with a standard practice group: a multicentre study. Br J Anaesth. 2005;94:63-9.

Kreuer S, Bruhn J, Stracke C. Narcotrend or bispectral index monitoring during desflurane-remifentanil anesthesia: a comparison with a standard practice protocol. Anesth Analg. 2005;101:427-34.

Vretzakis G, Ferdi E, Argiriadou H. Influence of bispectral index monitoring on decision making during cardiac anesthesia. J Clin Anesth. 2005;17:509-16.

Aimé I, Verroust N, Masson-Lefoll C. Does monitoring bispectral index or spectral entropy reduce sevoflurane use?. Anesth Analg. 2006;103:1469-77.

Ibraheim O, Alshaer A, Mazen K. Effect of bispectral index (BIS) monitoring on postoperative recovery and sevoflurane consumption among morbidly obese patients undergoing laparoscopic gastric banding. Middle East J Anesthesiol. 2008;19:819-30.

Kamal NM, Omar SH, Radwan KG. Bispectral index monitoring tailors clinical anesthetic delivery and reduces anesthetic drug consumption. J Med Sci. 2009;9:10-6.

Zhang C, Xu L, Ma YQ. Bispectral index monitoring prevent awareness during total intravenous anesthesia: a prospective, randomized, double-blinded, multi-center controlled trial. Chin Med J (Engl). 2011;124:3664-9.

Chan MT, Cheng BC, Lee TM. BIS-guided anesthesia decreases postoperative delirium and cognitive decline. J Neurosurg Anesthesiol. 2013;25:33-42.

Radtke FM, Franck M, Lendner J. Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction. Br J Anaesth. 2013;110(Suppl. 1):i98-i105.

Sebel PS, Lang E, Rampil IJ. A multicenter study of bispectral electroencephalogram analysis for monitoring anesthetic effect. Anesth Analg. 1997;84:891-9.

Yli-Hankala A, Vakkuri A, Annila P. EEG bispectral index monitoring in sevoflurane or propofol anaesthesia: analysis of direct costs and immediate recovery. Acta Anaesthesiol Scand. 1999;43:545-9.

Mi WD, Sakai T, Singh H. Hypnotic endpoints vs. the bispectral index, 95% spectral edge frequency and median frequency during propofol infusion with or without fentanyl. Eur J Anaesthesiol. 1999;16:47-52.

Nakayama M, Ichinose H, Yamamoto S. The effect of fentanyl on hemodynamic and Bispectral Index changes during anesthesia induction with propofol. J Clin Anesth. 2002;14:146-9.

Lehmann A, Boldt J, Thaler E. Bispectral Index in patients with target-controlled or manually-controlled infusion of propofol. Anesth Analg. 2002;95:639-44.

Paventi S, Santevecchi A, Perilli V. Effects of remifentanil infusion BIS-titrated on early recovery for obese outpatients undergoing laparoscopic cholecystectomy. Minerva Anestesiol. 2002;68:651-7.

Lehmann A, Karzau J, Boldt J. Bispectral Index-guided anesthesia in patients undergoing aortocoronary bypass grafting. Anesth Analg. 2003;96:336-43.

Yamaguchi S, Egawa H, Mishio M. Bispectral monitoring during vital capacity rapid inhalation induction with sevoflurane. J Clin Anesth. 2003;15:24-8.

Buyukkocak U, Ozcan S, Daphan C. A comparison of four intravenous sedation techniques and Bispectral Index monitoring in sinonasal surgery. Anaesth Intensive Care. 2003;31:164-71.

Forestier F, Hirschi M, Rouget P. Propofol and sufentanil titration with the Bispectral Index to provide anesthesia for coronary artery surgery. Anesthesiology. 2003;99:334-46.

Schneider G, Gelb AW, Schmeller B. Detection of awareness in surgical patients with EEG-based indices-bispectral index and patient state index. Br J Anaesth. 2003;91:329-35.

Schneider G, Elidrissi C, Sebel PS. Bispectral index-guided administration of anaesthesia: comparison between remifentanil/propofol and remifentanil/isoflurane. Eur J Anaesthesiol. 2003;20:624-30.

Liu SS. Effects of Bispectral Index monitoring on ambulatory anesthesia. Anesthesiology. 2004;101:311-5.

Bauer M, Wilhelm W, Kraemer T. Impact of Bispectral Index monitoring on stress response and propofol consumption in patients undergoing coronary artery bypass surgery. Anesthesiology. 2004;101:1096-104.

Bestas A, Yasar MA, Bayar MK. The effects of two different anaesthesia techniques on bispectral index values and awareness during off-pump coronary artery bypass grafting. J Clin Monit Comput. 2004;18:347-51.

Boztug N, Bigat Z, Akyüz M. Does using the Bispectral Index (BIS) during craniotomy affect the quality of recovery?. J Neurosurg Anesthesiol. 2006;18:1-4.

Puri GD, Kumar B, Aveek J. Closed-loop anaesthesia delivery system (CLADS) using bispectral index: a performance assessment study. Anaesth Intensive Care. 2007;35:357-62.

Lindholm ML, Brudin L, Sandin RH. Bispectral index monitoring: appreciated but does not affect drug dosing and hypnotic levels. Acta Anaesthesiol Scand. 2008;52:88-94.

Avidan MS, Zhang L, Burnside BA. Anesthesia awareness and the Bispectral Index. N Engl J Med. 2008;358:1097-108.

Bejjani G, Lequeux PY, Schmartz D. No evidence of memory processing during propofol-remifentanil target-controlled infusion anesthesia with Bispectral Index monitoring in cardiac surgery. J Cardiothorac Vasc Anesth. 2009;23:175-81.

Delfino AE, Cortinez LI, Fierro CV. Propofol consumption and recovery times after bispectral index or cerebral state index guidance of anaesthesia. Br J Anaesth. 2009;103:255-9.

Kerssens C, Gaither JR, Sebel PS. Preserved memory function during Bispectral Index-guided anesthesia with sevoflurane for major orthopedic surgery. Anesthesiology. 2009;111:518-24.

Mashour GA, Tremper KK, Avidan MS. Protocol for the "Michigan Awareness Control Study": a prospective, randomized, controlled trial comparing electronic alerts based on bispectral index monitoring or minimum alveolar concentration for the prevention of intraoperative awareness. BMC Anesthesiol. 2009;9:7.

Satisha M, Sanders GM, Badrinath MR. Introduction of bispectral index monitoring in a district general hospital operating suite: a prospective audit of clinical and economic effects. Eur J Anaesthesiol. 2010;27:196-220.

Meybohm P, Gruenewald M, Höcker J. Correlation and agreement between the bispectral index vs. state entropy during hypothermic cardio-pulmonary bypass. Acta Anaesthesiol Scand. 2010;54:169-75.

Leslie K, Myles PS, Forbes A. The effect of Bispectral Index monitoring on long-term survival in the B-Aware trial. Anesth Analg. 2010;110:816-22.

Avidan MS, Palanca BJ, Glick D. Protocol for the BAG-RECALL clinical trial: a prospective, multi-center, randomized, controlled trial to determine whether a bispectral index-guided protocol is superior to an anesthesia gas-guided protocol in reducing intraoperative awareness with explicit recall in high risk surgical patients. BMC Anesthesiol. 2009;9:8.

Ellerkmann RK, Soehle M, Riese G. The Entropy Module and Bispectral Index as guidance for propofol-remifentanil anaesthesia in combination with regional anaesthesia compared with a standard clinical practice group. Anaesth Intensive Care. 2010;38:159-66.

Yufune S, Takamatsu I, Masui K. Effect of remifentanil on plasma propofol concentration and bispectral index during propofol anaesthesia. Br J Anaesth. 2011;106:208-14.

Liu N, Chazot T, Hamada S. Closed-loop coadministration of propofol and remifentanil guided by Bispectral Index: a randomized multicenter study. Anesth Analg. 2011;112:546-57.

Avidan MS, Jacobsohn E, Glick D. Prevention of intraoperative awareness in a high-risk surgical population. N Engl J Med. 2011;365:591-600.

Aimé I, Gayat E, Fermanian C. Effect of age on the comparability of bispectral and state entropy indices during the maintenance of propofol-sufentanil anaesthesia. Br J Anaesth. 2012;108:638-43.

Mashour GA, Shanks A, Tremper KK. Prevention of intraoperative awareness with explicit recall in an unselected surgical population. Anesthesiology. 2012;117:717-25.

Persec J, Persec Z, Kopljar M. Effect of bispectral index monitoring on extubation time and analgesic consumption in abdominal surgery: a randomised clinical trial. Swiss Med Wkly. 2012;142:w13689.

Fritz BA, Rao P, Mashour GA. Postoperative recovery with Bispectral Index versus anesthetic concentration-guided protocols. Anesthesiology. 2013;118:1113-22.

Villafranca A, Thomson IA, Grocott HP. The impact of Bispectral Index versus end-tidal anesthetic concentration-guided anesthesia on time to tracheal extubation in fast-track cardiac surgery. Anesth Analg. 2013;116:541-8.

5dcd9fd00e8825ff72bf58f2 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections