title: Titration of isoflurane using BIS index improves early recovery of elderly patients undergoing orthopedic surgeries.
abstract: OBJECTIVE
  This study was designed to investigate the effect of bispectral index (BIS) monitoring on the recovery profiles, level of postoperative cognitive dysfunction, and anesthetic drug requirements of elderly patients undergoing elective orthopedic surgery with general anesthesia.
  
  
  METHODS
  Sixty-eight patients over the age of 60 were randomized into one of two groups. In the standard practice (SP) group, the anesthesiologists were blinded to the BIS value, and isoflurane was titrated according to standard clinical practice. In the BIS group, isoflurane was titrated to maintain a BIS value between 50-60.
  
  
  RESULTS
  The total isoflurane usage was 30% lower in the BIS group compared to the SP group (5.6 +/- 3 vs 7.7 +/- 3 mL, P <0.05). The time to orientation was faster in the BIS group compared to the SP group (9.5 +/- 3 vs 13.1 +/- 4 min, P <0.001). There were no differences in the postoperative psychometric tests between the two groups.
  
  
  CONCLUSIONS
  There was no difference in the level of postoperative cognitive dysfunction between the two groups. However, titration of isoflurane using the BIS index decreased utilization of isoflurane and contributed to faster emergence of elderly patients undergoing elective knee or hip replacement surgery.
authors.affiliation: Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. jean_wong@yahoo.com
authors.forename: Jean
authors.initials: J
authors.lastname: Wong
authors.forename: Dajun
authors.initials: D
authors.lastname: Song
authors.forename: Hannah
authors.initials: H
authors.lastname: Blanshard
authors.forename: Deidre
authors.initials: D
authors.lastname: Grady
authors.forename: Frances
authors.initials: F
authors.lastname: Chung
mesh_terms: D000368:Aged; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation / Q000008:administration & dosage* / Q000009:adverse effects; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D004311:Double-Blind Method; D004569:Electroencephalography / Q000187:drug effects*; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009483:Neuropsychological Tests; D019637:Orthopedic Procedures; D011184:Postoperative Period
chemical_list: D018685:Anesthetics, Inhalation; D007530:Isoflurane