The efficacy of bispectral index monitoring on anesthesia recovery time after gastrointestinal surgeries under general anesthesia: a retrospective cohort study_Chinese Journal of Evidence-Based Medicine

Authors：

ZHOU Puzhen ,  ZUO Yunxia

Department of Anesthesia, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

ZUO Yunxia, Email: zuoyunxiahxa@qq.com

Keywords：

Bispectral index; Anesthesia depth; Gastrointestinal surgery; Anesthesia recovery

DOI：

10.7507/1672-2531.201803105

Video：

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Objectives To investigate the association of anesthesia recovery time and bispectral index (BIS) monitoring after gastrointestinal surgeries under general anesthesia. Methods A total of 404 cases of selective gastrointestinal surgeries under general anesthesia with BIS monitoring in West China Hospital of Sichuan University from January 2016 to June 2016 were retrieved from anesthesia medical record system as BIS monitoring exposure cohort (group BIS). In addition, 404 cases of selective gastrointestinal surgeries without BIS monitoring were matched as none BIS monitoring exposure cohort (group non-BIS). The primary outcome was the anesthesia recovery time, including the time from the end of surgery to endotracheal extubation (t₁) and exiting the operation room (t₂). A sub-group analysis was conducted based on patients’ age, length of operation time (t₀) and type of surgery(open surgeries vs laparoscopic surgeries). Results The gender, age, body weight and ASA categories between two groups had no significant differences (P>0.05). The length of operation time also had no significant differences between two groups (P>0.05). The extubation time (10.1±4.4vs. 16.4±6.8) and OR exiting time (21.7±12.3 vs. 27.4±14.6) in group BIS were shorter than those in group non-BIS (P<0.05). This difference was markedly significant among elderly patients (age>60) or patients undergoing long operations (operation time>5hours). Among each group, the recovery time had no significant difference between open surgeries and laparoscopic surgeries. Conclusions There is an association between BIS monitoring and shorter anesthesia recovery time in gastrointestinal surgery, including the time of endotracheal extubation and exiting the operation room. BIS monitoring enhances anesthesia recovery among elderly patients and patients undergoing long-lasting operations in particular. There is no significant difference in anesthesia recovery time between open surgeries and laparoscopic surgeries.

Citation： ZHOU Puzhen, ZUO Yunxia. The efficacy of bispectral index monitoring on anesthesia recovery time after gastrointestinal surgeries under general anesthesia: a retrospective cohort study. Chinese Journal of Evidence-Based Medicine, 2018, 18(6): 565-569. doi: 10.7507/1672-2531.201803105 Copy

1.	Faraz S, Iqil NH, Aliya A. Effects of bispectral index monitoring on isoflurane consumption and recovery profiles for anesthesia in an elderly Asian population. J Anaesthesiol Clin Pharmacol, 2012, 28(3): 348-52.
2.	Nandi S, Harvey WF, Saillant J, et al. Pharmacologic risk factors for post-operative delirium in total joint arthroplasty patients: a case-control study. J Arthroplasty, 2014, 29(2): 268-271.
3.	Radtke FM, Franck M, Lendner J, et al. Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction. Br J Anaesth, 2013, 110(3):98-105.
4.	Jr DOG, Kendall MC, Marcus RJ, et al. The relationship between the bispectral index (BIS) and the observer alertness of sedation scale (OASS) scores during propofol sedation with and without ketamine: a randomized, double blinded, placebo controlled clinical trial. J Clin Monit Comput, 2016, 30(4): 495-501.
5.	Song D, Joshi GP, White PF. Titration of volatile anesthetics using bispectral index facilitates recovery after ambulatory anesthesia. Anesthesiology, 1997, 87(4): 842-8.
6.	Gupta M, Shri I, Sakia P, et al. Comparison of equi-minimum alveolar concentration of sevoflurane and isoflurane on bispectral index values during both wash in and wash out phases: a prospective randomized study. Indian J Anaesth, 2015, 59(2): 79-84.
7.	赵小娟, 张迎, 鲁晓红, 等. BIS 监测麻醉深度对老年腹腔镜胆囊切除术患者苏醒质量的影响. 重庆医学, 2016, 45(24): 3364-3365.
8.	Kamali A, Rostami A, Modir H, et al. Studying the effects of bis monitoring (Depth of Anesthesia) in early extubation of patients candidated for non-emergency CABG. Biomed Pharmacol J, 2017, 10(1): 199-206.
9.	Chiang MH, Wu SC, Hsu SW, et al. Bispectral index and non-bispectral index anesthetic protocols on postoperative recovery outcomes. Minerva Anestesiol, 2018, 84(2): 216-228.
10.	Pavlin JD, Souter KJ, Hong JY, et al. Effects of bispectral index monitoring on recovery from surgical anesthesia in 1 580 inpatients from an academic medical center. Anesthesiology, 2005, 102(3): 566-573.
11.	Aurini L, White PF. Anesthesia for the elderly outpatient. Curr Opin Anaesthesiol, 2014, 27(6): 563-75.
12.	张旭东, 张可贤, 陈一丁, 等. 不同年龄患者在同一麻醉深度下呼气末七氟烷浓度的比较. 东南大学学报 (医学版), 2013(6): 703-707.
13.	郑荃菁, 杜小宜, 陈虹宇, 等. BIS 监测下丙泊酚闭环靶控输注用于胆胰手术麻醉的临床效果. 临床麻醉学杂志, 2017, 33(6): 529-533.
14.	Heavner JE, Kaye AD, Lin BK, et al. Recovery of elderly patients from two or more hours of desflurane or sevoflurane anaesthesia. Br J Anaesth, 2003, 91(4): 502.
15.	Tabet J, Hong D, Kim CW, et al. Laparoscopic versus open bowel resection for Crohn's disease. Can J Gastroenterol, 2016, 15(4): 237-242.
16.	Ezri T, Muzikant G, Medalion B, et al. Anesthesia for restrictive bariatric surgery (gastric bypass not included): laparoscopic vs open procedures. Int J Obesity, 2004, 28(9): 1157-1162.
17.	朱小冬. 影响手术室使用效率原因与对策. 中国护理管理, 2009, 9(6): 68-70.

1. Faraz S, Iqil NH, Aliya A. Effects of bispectral index monitoring on isoflurane consumption and recovery profiles for anesthesia in an elderly Asian population. J Anaesthesiol Clin Pharmacol, 2012, 28(3): 348-52.
2. Nandi S, Harvey WF, Saillant J, et al. Pharmacologic risk factors for post-operative delirium in total joint arthroplasty patients: a case-control study. J Arthroplasty, 2014, 29(2): 268-271.
3. Radtke FM, Franck M, Lendner J, et al. Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction. Br J Anaesth, 2013, 110(3):98-105.
4. Jr DOG, Kendall MC, Marcus RJ, et al. The relationship between the bispectral index (BIS) and the observer alertness of sedation scale (OASS) scores during propofol sedation with and without ketamine: a randomized, double blinded, placebo controlled clinical trial. J Clin Monit Comput, 2016, 30(4): 495-501.
5. Song D, Joshi GP, White PF. Titration of volatile anesthetics using bispectral index facilitates recovery after ambulatory anesthesia. Anesthesiology, 1997, 87(4): 842-8.
6. Gupta M, Shri I, Sakia P, et al. Comparison of equi-minimum alveolar concentration of sevoflurane and isoflurane on bispectral index values during both wash in and wash out phases: a prospective randomized study. Indian J Anaesth, 2015, 59(2): 79-84.
7. 赵小娟, 张迎, 鲁晓红, 等. BIS 监测麻醉深度对老年腹腔镜胆囊切除术患者苏醒质量的影响. 重庆医学, 2016, 45(24): 3364-3365.
8. Kamali A, Rostami A, Modir H, et al. Studying the effects of bis monitoring (Depth of Anesthesia) in early extubation of patients candidated for non-emergency CABG. Biomed Pharmacol J, 2017, 10(1): 199-206.
9. Chiang MH, Wu SC, Hsu SW, et al. Bispectral index and non-bispectral index anesthetic protocols on postoperative recovery outcomes. Minerva Anestesiol, 2018, 84(2): 216-228.
10. Pavlin JD, Souter KJ, Hong JY, et al. Effects of bispectral index monitoring on recovery from surgical anesthesia in 1 580 inpatients from an academic medical center. Anesthesiology, 2005, 102(3): 566-573.
11. Aurini L, White PF. Anesthesia for the elderly outpatient. Curr Opin Anaesthesiol, 2014, 27(6): 563-75.
12. 张旭东, 张可贤, 陈一丁, 等. 不同年龄患者在同一麻醉深度下呼气末七氟烷浓度的比较. 东南大学学报 (医学版), 2013(6): 703-707.
13. 郑荃菁, 杜小宜, 陈虹宇, 等. BIS 监测下丙泊酚闭环靶控输注用于胆胰手术麻醉的临床效果. 临床麻醉学杂志, 2017, 33(6): 529-533.
14. Heavner JE, Kaye AD, Lin BK, et al. Recovery of elderly patients from two or more hours of desflurane or sevoflurane anaesthesia. Br J Anaesth, 2003, 91(4): 502.
15. Tabet J, Hong D, Kim CW, et al. Laparoscopic versus open bowel resection for Crohn's disease. Can J Gastroenterol, 2016, 15(4): 237-242.
16. Ezri T, Muzikant G, Medalion B, et al. Anesthesia for restrictive bariatric surgery (gastric bypass not included): laparoscopic vs open procedures. Int J Obesity, 2004, 28(9): 1157-1162.
17. 朱小冬. 影响手术室使用效率原因与对策. 中国护理管理, 2009, 9(6): 68-70.

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The efficacy of bispectral index monitoring on anesthesia recovery time after gastrointestinal surgeries under general anesthesia: a retrospective cohort study

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