title: Benefit of general anesthesia monitored by bispectral index compared with monitoring guided only by clinical parameters. Systematic review and meta-analysis.
abstract: BACKGROUND
  The bispectral index parameter is used to guide the titration of general anesthesia; however, many studies have shown conflicting results regarding the benefits of bispectral index monitoring. The objective of this systematic review with meta-analysis is to evaluate the clinical impact of monitoring with the bispectral index parameter.
  
  
  METHODS
  The search for evidence in scientific information sources was conducted during December 2013 to January 2015, the following primary databases: Medline/PubMed, LILACS, Cochrane, CINAHL, Ovid, SCOPUS and TESES. The criteria for inclusion in the study were randomized controlled trials, comparing general anesthesia monitored, with bispectral index parameter with anesthesia guided solely by clinical parameters, and patients aged over 18 years. The criteria for exclusion were studies involving anesthesia or sedation for diagnostic procedures, and intraoperative wake-up test for surgery of the spine.
  
  
  RESULTS
  The use of monitoring with the bispectral index has shown benefits reducing time to extubation, orientation in time and place, and discharge from both the operating room and post anesthetic care unit. The risk of nausea and vomiting after surgery was reduced by 12% in patients monitored with bispectral index. Occurred a reduction of 3% in the risk of cognitive impairment postoperatively at 3 months postoperatively and 6% reduction in the risk of postoperative delirium in patients monitored with bispectral index. Furthermore, the risk of intraoperative memory has been reduced by 1%.
  
  
  CONCLUSIONS
  Clinically, anesthesia monitoring with the BIS can be justified because it allows advantages from reducing the recovery time after waking, mainly by reducing the administration of general anesthetics as well as the risk of adverse events.
authors.affiliation: Hospital Guilherme Alvaro, Departamento de Anestesiologia, Santos, SP, Brazil; Hospital Ana Costa, Departamento de Anestesiologia, Santos, SP, Brazil. Electronic address: degrandi@gmail.com.
authors.forename: Carlos Rogério Degrandi
authors.initials: CR
authors.lastname: Oliveira
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, Medicina Baseada em Evidência, São Paulo, SP, Brazil; Centro Universitário Lusíada, Faculdade de Medicina de Santos, Santos, SP, Brazil; Programa Diretrizes da Associação Médica Brasileira, Santos, SP, Brazil.
authors.forename: Wanderley Marques
authors.initials: WM
authors.lastname: Bernardo
authors.affiliation: Centro Universitário Lusíada, Faculdade de Medicina de Santos, Santos, SP, Brazil.
authors.forename: Victor Moisés
authors.initials: VM
authors.lastname: Nunes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000379:methods*; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D056805:Consciousness Monitors; D006801:Humans; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D055815:Young Adult
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous
keywords: Anestesia geral; Anestesia intravenosa; Anesthetics; Anestésicos; Bispectral index-monitoring; General anesthesia; Inalação; Inhalation; Intravenous anesthesia; Monitoração do índice bispectral