title: Intraoperative bispectral index monitoring and time to extubation after cardiac surgery: secondary analysis of a randomized controlled trial.
abstract: BACKGROUND
  Fast track recovery is a care process goal after cardiac surgery. Intraoperative anesthetic depth may impact recovery, but the impact of brain monitoring on time to extubation and intensive care unit (ICU) length of stay after cardiac surgery has not been extensively studied. Our goal was to determine if BIS-guided anesthesia improves time to extubation compared to MAC-guided anesthesia in a cardiac surgery population.
  
  
  METHODS
  In this secondary outcome analysis of a randomized controlled study, we analyzed 294 patients undergoing elective coronary bypass grafting, valve replacements, and bypass plus valve replacements at a single tertiary referral center between February 1, 2009 and April 30, 2010. We analyzed cardiac surgery patients that had been randomized to BIS-guided anesthesia alerts (n = 131) or MAC-guided anesthesia alerts (n = 163). The primary outcome measure was time to extubation in the BIS-guided and anesthetic concentration-guided groups. Secondary outcomes were length of stay in the ICU and total postoperative hospital length of stay.
  
  
  RESULTS
  Valid extubation time data were available for 247 of 294 patients. The median [IQR] time to extubation was 307 [215 to 771] minutes in the BIS group and 323 [196 to 730] minutes in the anesthetic concentration group (p = 0.61). The median [IQR] ICU length of stay was 54 [29 to 97] hours versus 70 [44 to 99] hours (p = 0.11). In terms of postoperative hospital length of stay, there was no difference between the groups with median [IQR] times of 6 [5-8] days (p = 0.69) in each group.
  
  
  CONCLUSIONS
  The use of intraoperative BIS monitoring during cardiac surgery did not change time to extubation, ICU length of stay or hospital length of stay. Data regarding BIS monitoring and recovery in an exclusively cardiac surgery population are consistent with recent effectiveness studies in the general surgical population.
  
  
  BACKGROUND
  ClinicalTrials.gov number NCT00689091.
authors.affiliation: Department of Anesthesiology, University of Michigan Medical School, 1H247 UH Box 5048, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Vance
authors.affiliation: Department of Anesthesiology, University of Michigan Medical School, 1H247 UH Box 5048, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Shanks
authors.affiliation: Department of Anesthesiology, University of Michigan Medical School, 1H247 UH Box 5048, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
authors.forename: Derek T
authors.initials: DT
authors.lastname: Woodrum
mesh_terms: D060666:Airway Extubation / Q000379:methods*; D000758:Anesthesia; D006348:Cardiac Surgical Procedures / Q000379:methods*; D015331:Cohort Studies; D056805:Consciousness Monitors; D003422:Critical Care; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents
keywords: BIS; Cardiac surgery; Fast-track extubation