Impact of bispectral index monitoring on fast tracking of gynecologic patients undergoing laparoscopic surgery.
BACKGROUND
The need for increasing operating room efficiency has led to various initiatives, one of which is the elimination of mandatory admission to the phase I recovery area postoperatively, also referred to as fast tracking of ambulatory surgery patients. This Institutional Review Board-approved study was conducted to evaluate the effect of Bispectral Index (BIS) monitoring on the ability of patients to successfully bypass the phase I recovery area following gynecologic laparoscopy during general anesthesia.


METHODS
Ninety-nine consenting patients were randomly assigned to one of two groups: group one, in which the BIS monitor (Aspect Medical Systems, Natick, MA) was used, and group two, in which no BIS monitor was used. All patients received a standardized anesthetic that included 1 microg/kg sufentanil and sevoflurane in oxygen, titrated in group one to a BIS value of 50-60 and in group two to maintain vital signs within 20% of preoperative values. All patients received prophylactic nonsteroidal antiinflammatory drugs and antiemetics. Postoperatively, patients were evaluated using the modified Aldrete scoring system, and those who achieved a score of 9 or higher within 10 min were permitted to bypass the phase I recovery area.


RESULTS
There was no statistically significant difference between the two groups with respect to the number of patients who successfully bypassed the phase I recovery area, postoperative length of hospital stay, or cost of hospitalization.


CONCLUSIONS
With a standardized anesthetic regimen and a strict discharge scoring system, BIS monitoring does not have a significant effect on the ability to fast track outpatients.
Ahmad
Shireen
S
Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, F5-704, Chicago, Illinois 60611, USA. sah704@northwestern.edu
Yilmaz
Meltem
M
Marcus
R-Jay
RJ
Glisson
Silas
S
Kinsella
Annette
A
D000328:Adult; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D004569:Electroencephalography / Q000187:drug effects*; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008738:Methyl Ethers; D016343:Monitoring, Intraoperative; D010147:Pain Measurement; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D012121:Respiration, Artificial; D000077149:Sevoflurane; D017409:Sufentanil
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D017409:Sufentanil