title: Impact of bispectral index monitoring on fast tracking of gynecologic patients undergoing laparoscopic surgery.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, F5-704, Chicago, Illinois 60611, USA. sah704@northwestern.edu
authors.forename: Shireen
authors.initials: S
authors.lastname: Ahmad
authors.forename: Meltem
authors.initials: M
authors.lastname: Yilmaz
authors.forename: R-Jay
authors.initials: RJ
authors.lastname: Marcus
authors.forename: Silas
authors.initials: S
authors.lastname: Glisson
authors.forename: Annette
authors.initials: A
authors.lastname: Kinsella
mesh_terms: 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
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D017409:Sufentanil