Intraoperative brain activity monitoring and post-anesthesia care length of stay: A systematic review.
BACKGROUND
The use of intraoperative brain activity monitoring helps to guide the administration of general anesthesia. Additional benefits of brain activity monitoring in the face of general anesthesia include increased patient satisfaction, decreased nausea and vomiting, decreased pain, and decreased risk of intraoperative recall. Conflicting reports in the literature exist concerning the efficacy of brain activity monitoring at reducing the post-anesthesia care unit length of stay.


OBJECTIVE
The objective of this systematic review was to determine the effect of intraoperative brain activity monitoring on post-anesthesia care unit length of stay.


METHODS
The review considered studies that included all patients over eight years of age receiving general anesthesia for any medical procedure.The review included studies that compared the use of intraoperative brain activity monitoring to standard clinical practice and reported post-anesthesia care unit length of stay data.This review included randomized controlled trials which met all inclusion criteria.The review considered studies that included as outcome the length of stay in the post-anesthesia care unit following general anesthesia.


METHODS
A three-step search strategy was utilized to find both published and unpublished studies in English language only. The search time frame was January 1990 through December 2010. An initial limited MEDLINE search was completed followed by analysis of the text words contained in the title and abstract, and the index terms used to describe the article. A second search using all identified terms was then undertaken across all included databases. Finally, the reference list for all identified studies was searched for additional studies.


METHODS
The reviewers utilized the Joanna Briggs Institute Critical Appraisal Checklist for Randomized Controlled Trials to assess methodological quality.


METHODS
Data was extracted using the Joanna Briggs Institute Data Extraction Form for Observational/Experimental Studies.


RESULTS
Results were analyzed using SUMARI software from the Joanna Briggs Institute. Nine randomized control trials were included in the final analysis. Results indicated a statistically insignificant 3.47 minute (p=0.14) reduction in post-anesthesia care unit length of stay when intraoperative brain activity monitoring was utilized.


RESULTS
Pooling of data indicated a statistically nonsignificant 3.47 minute (p=0.14) reduction in post-anesthesia care unit length of stay when general anesthesia administration was guided by intraoperative brain activity monitoring.


CONCLUSIONS
Based on the results of this review, the use of intraoperative brain activity monitoring can be recommended to help decrease the post-anesthesia care unit length of stay in patients receiving general anesthesia. Although statistically insignificant, any reduction in post-anesthesia care unit length of stay will decrease cost to the patient, decrease burden to the post-anesthesia care unit, and expedite patient throughput thereby reducing cost and impact on the healthcare system as a whole.


CONCLUSIONS
Anesthesia providers utilizing intraoperative brain activity monitoring will realize a clinically relevant reduction in post-anesthesia care unit length of stay for their patients receiving general anesthesia. Impact on practice includes increased efficiency and decreased patient and health care system cost. Although not necessarily realized in small surgical settings, the cumulative reduction in post-anesthesia care unit length of stay in larger facilities will be significant.


CONCLUSIONS
Additional work to quantify the range of depth of general anesthesia to produce the best reduction in post-anesthesia care unit length of stay is needed. This review simply looked at the use of the technology and did not stratify the range or level of general anesthesia, as determined by intraoperative brain activity monitoring, that would result in the greatest reduction in post-anesthesia care unit length of stay.
1 Doctoral Student Texas Christian University Center for Evidence Based Practice and Research. 2 Associate Professor of Professional Practice Texas Christian University Harris College of Nursing and Health Science School of Nurse Anesthesia, h.nugent@tcu.edu.
Dru
D
Riddle
Hylda
H
Nugent