Postoperative recovery with bispectral index versus anesthetic concentration-guided protocols.
BACKGROUND
Use of the bispectral index (BIS) monitor has been suggested to decrease excessive anesthetic drug administration, leading to improved recovery from general anesthesia. The purpose of this substudy of the B-Unaware and BAG-RECALL trials was to assess whether a BIS-based anesthetic protocol was superior to an end-tidal anesthetic concentration-based protocol in decreasing recovery time and postoperative complications.


METHODS
Patients at high risk for awareness were randomized to either BIS-guided or end-tidal anesthetic concentration-guided general anesthesia in the original trials. Outcomes included time to postanesthesia care unit discharge readiness, time to achieve a postoperative Aldrete score of 9-10, intensive care unit length of stay, postoperative nausea and vomiting, and severe postoperative pain. Univariate Cox regression and chi-square tests were used for statistical analyses.


RESULTS
The BIS cohort was not superior in time to postanesthesia care unit discharge readiness (hazard ratio, 1.0; 95% CI, 1.0-1.1; n = 2,949), time to achieve an Aldrete score of 9-10 (hazard ratio, 1.2; 95% CI, 1.0-1.4; n = 706), intensive care unit length of stay (hazard ratio, 1.0; 95% CI, 0.9-1.1; n = 2,074), incidence of postoperative nausea and vomiting (absolute risk reduction, -0.5%; 95% CI, -5.8 to 4.8%; n = 789), or incidence of severe postoperative pain (absolute risk reduction, 4.4%; 95% CI, -2.3 to 11.1%; n = 759).


CONCLUSIONS
In patients at high risk for awareness, the BIS-guided protocol is not superior to an anesthetic concentration-guided protocol in time needed for postoperative recovery or in the incidences of common postoperative complications.
Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA.
Bradley A
BA
Fritz
Preetika
P
Rao
George A
GA
Mashour
Arbi Ben
AB
Abdallah
Beth A
BA
Burnside
Eric
E
Jacobsohn
Lini
L
Zhang
Michael S
MS
Avidan
D000368:Aged; D000762:Anesthesia Recovery Period; D000777:Anesthetics / Q000008:administration & dosage*; D002985:Clinical Protocols; D056805:Consciousness Monitors; D003422:Critical Care; D005260:Female; D006801:Humans; D058926:Intraoperative Awareness / Q000453:epidemiology / Q000523:psychology; D007902:Length of Stay; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D016016:Proportional Hazards Models; D012129:Respiratory Function Tests; D012907:Smoking / Q000009:adverse effects; D016896:Treatment Outcome
D000777:Anesthetics