Effect of bispectral index on intra-operative awareness: A meta-analysis of randomized controlled studies

Thomas Cheriyan, Kevin Bai, Shreya Bayyapureddy, Anterpreet Dua, Paramvir Singh, Zhuo Sun, Chhaya Patel, Vikas Kumar

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Randomized controlled trials (RCTs) investigating the efficacy of bispectral index (BIS) to reduce intra-operative awareness (IOA) have reported conflicting results. The purpose of this meta-analysis is to consolidate results from RCTs to assess the efficacy of BIS in reducing IOA when compared to controls. Secondary outcomes included time to extubation, time to spontaneous and/or verbal eye opening, PACU discharge time, and utilization of inhaled anesthetics. Methods: RCTs which reported on one of the primary and/or secondary outcomes were included. Literature search utilized keywords 'randomized control trial' and 'intraoperative awareness.' Meta-analysis was performed using RevMan 5. Results: Twenty-seven RCTs were included in the study with a total of 35,585 patients, with 18,146 patients in the BIS and 17,439 in the control group. Eighteen of 14,062 patients (0.12%) and 42 of 16,765 (0.25%) reported definite IOA in the BIS and control group, respectively, with no statistically significant difference. BIS was effective in reducing the time to spontaneous eye opening by an average of 1.3 minutes and the time to extubation by an average of 1.97 minutes. There was no difference in PACU discharge times among the groups. There was a significant decrease in consumption of sevoflurane but no difference in desflurane and propofol compared to the control group. Conclusion: While BIS monitoring results in decreased incidence of intra-operative awareness by half, it was not statistically significant. BIS provides modest benefits with regard to reducing the time to extubation, the time to spontaneous eye opening, and consumption of sevoflurane. Level of evidence: I.

Original languageEnglish (US)
Pages (from-to)360-370
Number of pages11
JournalSaudi Journal of Anaesthesia
Volume18
Issue number3
DOIs
StatePublished - 2024
Externally publishedYes

Keywords

  • Anesthesiology
  • intra-operative awareness
  • meta-research

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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