Anaesthetic depth and complications after major surgery: an international, randomised controlled trial

Short, Timothy G.; Campbell, Douglas; Frampton, Christopher; Chan, Matthew T.V.; Myles, Paul S.; Corcoran, Tomás; Sessler, Daniel I.; Mills, Gary H.; Cata, Juan P.; Painter, Thomas; Han, Ruquan; Chu, Mandy H M; McAllister, Davina; Leslie, Kate; Shulman, Mark; Wallace, Sophie; Farrington, C.; Gallagher, William J.; Ditoro, A.; Peyton, Philip J; Baulch, S.; Dalyell, A; Sidiropoulos, Sofia; Reynolds, Jason; Rowley, J; Tan, Nicole; McCallum, Duncan; O’Loughlin, Edward; Wong, Selwyn; Owen, K; Сим, И А; Glazov, L; Coutts, Pauline; Pushpanathan, Mugialan; Findlay, V; Paech, Michael J.; Cavill, D; Chuan, Alwin; Pope, Laysan; Lucas, James; Robinson, Barbara L.; Millard, A.; Allen, Sam; Allen, ML; McKeown, Sandra; Sivalingam, P; Wilkes, T. Christopher; Jowett, Charlie; Kearney, Aaron M.; Bennett, Mike; Favero, J-P; Sawhney, Sadhan; Drummond, Kelsi; Osborn, Sarah C.; Wing, Andrew; Taylor, Jennifer; Edwards, Melannie; Reynolds, Hannah; Town, Cienwen; Terblanche, Nicolaas C.S.; Challis, Murray; Seale, Rebecca; Button, Kate; Cotter, R; Stewart, M. Kathleen; Zingerle, Nicolette; Hannon, Susan J.; Middleton, D. S.; Edgley, Carla; March, Sonja; McCulloch, Tim; Wong, Grace; Jeong, Sung Tae; Connell, Kathleen A.; Krämer, Kim; Henderson, Galen V.; Ward, V.; Buller, Y.; Hird, Nichola; Scott, David A.; Evered, Lisbeth; Snyder, Graham M; Silbert, Brendan; Corcoran, Philip C.; Fitzgerald, Emily; Said, Simone; Watson, Alison; Baby, Donna; Bolsin, Stephen; Marriott, Andrew; Ives, Kathryn; Wakefeld, B-J; Jeffreys, Amy S.; Bates, Samantha; Halliwell, Richard; Elliott, David; Cope, Leslie; Paranthoiene, R; Peng, Pei-Yu; Liu, X; Zhou, Xiao Hua; Jin, Xin; Liu, H; An, Li-Xin; Cui, Wan Shou; Zhang, L; Jia, Bo; Fang, Jonathan; Koo, Evonne; Lo, Elaine Ah-Gi; Fung, BrigitteKim-yook; Tsang, Mazie; Lam, Lucy; Pang, Ellie; Lau, Vivian Nga Man; Choi, Gordon; Kwok, Ricky; Yau, Kevin; Cheng, Benny P.; Lam, Chen-Fuh; Lee, E; Buggy, Donal J.; Keane, Helen; Byrne, Kelly; Connolly, Christopher N.; Ali, M. Ben; Cervantes, Alejandro; Kumar, K C Kiran; Dandy, S; Ritchie, Lewis D; Kennedy, R Ross; McKellow, Margie; Read, Charlotte; Truong, Ha-Nam; Chapman, Cary B; Walker, Simon; Olliff, Sue; Houston, Helen; Scott, M.; Minchin, I; Moniwa, A; McAlpine, John; Chaddock, M.; Gray, Lewis D; Czepanski, Carolyn; Vinish, S; Buehner, Ulrike; Williams, Evelyn; Zhou, Chengcheng; Goodman, Laurie S.; Bermaat, J; Mans, Gerbrand G; Garden, Adam S.; Franks, R; Deiterle, J; Barrett, Jane; Roubos, S.; Lier, Felix van; Verbrugge, Serge; Kalkman, Cor J.; Dieleman, Jan M.; Verdam-Veldkamp, J; Kampen, A. van; Pai, ArchanaJagdish; Sevillano, Annaliza; Yeung, Jason; Melody, Teresa; Atterbury, Katie; Hough, Matthew; Dukes, Suzie; Williams, Stephen; Milan, Zoka; Kunst, Gudrun; Bhatia, Kiren; Macnab, W. Ross; Weaver, Edward M.; Moulding, Ruairi; Doble, Patricia; Klepsch, Peter; Self, J. B.; Howes, T. E.; Rees, Bas P. van; Faulkner, Beverley; Blackburn, Jean; Crombie, Nick; Cooper, Lawton; Nair, Amit; Bell, George; Longfellow, R; Nicholas, Caroline; Garratt, T. Hardman; Pollard, Matthew; Brown, Gavin; Morrison, G. D.; Lang, A; Dawson, Henrietta; MacDonald, Madeline; Martin, Thomas; Niebrzegowska, Edyta; Dias, P L R; Baikady, Ravishankar Rao; Jhanji, Shaman; Siddaiah, Narendra; Bird, Lynne M.; Mittal, Rajat; Nalawaya, P; Sonksen, Julian; Gidda, R; Wrench, I.; Craw, Nicholas; Pippard, Lucy; Davies, Siân; Wright, Mary Cooter; Turan, Mustafa; Maheshwari, Kamal; Cohen, Barak; Saasouh, Wael; Singh, Puja; Govindarajan, Srinivasa; Cuko, Evis; Marcano, Francesc; Babazade, Rovnat; Leung, Steve; Raza, Syed; Reville, Eric M.; Hanline, Cecelia; Ayad, Sabry; Buttar, M; Akhtar, Zaki; Niazi, Azfar; Saha, Partha; Morris, Anne; Lokhande, Chetan; Hassan, M. El-Husseini; Honar, Hooman; Bairacharya, G; Saxon, John; Chelnick, David; Carlson, R V; Ruiz, Josefa; Wilks, Jonathan A.; Williams, W. Bradford; Dangler, Lori A.; Ifeanyi-Pillette, Ifeyinwa C.; Suárez, Jonnathan Fernández; Erfe, Rose; Pérez, Ana Luisa Hernández; Veselis, Robert A.; Yang, Guang; Mehta, Malini; Pryor, Kane O.; Rubin, Lee E.; Malhotra, Jyoti; Steinkamp, Michele; Cooke, Farrell E.; Friedlander, Robert M.

doi:10.1016/s0140-6736(19)32315-3

Cited by 120 publications

(70 citation statements)

References 26 publications

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“…Several early studies proposed statistical relationship between low BIS value (< 40 or 45) and postoperative mortality [ 4 – 6 ]. However, the cumulative duration of BIS value less than 40 or 20, and EEG suppression alone were not related to postoperative mortality in this study, consistent with previous further observational studies, randomized controlled trial, and meta-analysis [ 7 , 9 , 12 , 17 , 18 ]. In contrast, other previous studies showed the association between postoperative mortality and ‘double low’ of BIS and MAP, [ 9 , 12 – 14 ] similar to our results.…”

Section: Discussionsupporting

confidence: 91%

The cumulative duration of bispectral index less than 40 concurrent with hypotension is associated with 90-day postoperative mortality: a retrospective study

et al. 2020

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Background: The relationship between intraoperative low bispectral index (BIS) values and poor clinical outcomes has been controversial. Intraoperative hypotension is associated with postoperative complication. The purpose of this study was to investigate the influence of intraoperative low BIS values and hypotension on postoperative mortality in patients undergoing major abdominal surgery. Methods: This retrospective study analyzed 1862 cases of general anesthesia. We collected the cumulative time of BIS values below 20 and 40 as well as electroencephalographic suppression and documented the incidences in which these states were maintained for at least 5 min. Durations of intraoperative mean arterial pressures (MAP) less than 50 mmHg were also recorded. Multivariable logistic regression was used to evaluate the association between suspected risk factors and postoperative mortality. Results: Ninety-day mortality and 180-day mortality were 1.5 and 3.2% respectively. The cumulative time in minutes for BIS values falling below 40 coupled with MAP falling below 50 mmHg was associated with 90-day mortality (odds ratio, 1.26; 95% confidence interval, 1.04-1.53; P = .019). We found no association between BIS related values and 180-day mortality. Conclusions: The cumulative duration of BIS values less than 40 concurrent with MAP less than 50 mmHg was associated with 90-day postoperative mortality, not 180-day postoperative mortality.

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Section: Discussionsupporting

confidence: 91%

The cumulative duration of bispectral index less than 40 concurrent with hypotension is associated with 90-day postoperative mortality: a retrospective study

et al. 2020

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“…While in Readtke's report [39] , it was shown that the use of processed EEG had no influence on the 3-month mortality rate. Furthermore, a previous meta-analysis indicated that deep anesthesia had no effect on long-term mortality [57] , which is consistent with a recently published multicenter RCT [58] .…”

Section: Discussionsupporting

confidence: 87%

Effects of Electroencephalogram Guided Anesthesia on Postoperative Delirium: A Systematic Review and Meta-analysis

Ding

Chen

2020

Preprint

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Background: Postoperative delirium is a common complication characterized by confusion, inattentiveness and other mental symptoms. It is still unclear whether the use of electroencephalogram (EEG) monitoring during surgery can decrease the incidence of postoperative delirium. The purpose of this study was to evaluate the effectiveness of EEG guided anesthesia on postoperative delirium (POD) based on randomized controlled trials (RCTs).Methods: The electronic databases of Ovid MEDLINE, PubMed, EMBASE, Cochrane Library database, CNKI and other local databases were systematically searched for RCTs from their inception until October 2019. The odds ratios (ORs) and the mean differences (MDs) with a 95% confidence intervals (CIs) were calculated to evaluate the correlation between EEG and itemized categories and continuous variable, respectively.Results: Seven RCTs with 3859 patients were included in the final analysis. The summary OR indicated that patients receiving EEG monitoring had a lower incidence rate of postoperative delirium (OR: 0.65; 95% CI: 0.46-0.92; P = 0.01). In addition, no significant difference was found between the EEG monitoring group and the routine care group with respects to the length of hospitalization (MD: -0.59; 95%CI: -1.26 to 0.07; P=0.08).Conclusions: The findings of this study indicated that intraoperative use of electroencephalogram monitoring could decrease the risk of postoperative delirium. But for high risk patients, we should take a multi-component strategy to prevent delirium. Further large-scale, randomized controlled trials should be conducted to verify the treatment effect of intraoperative use of electroencephalogram monitoring on patients.

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“…All anesthesiologists were experienced in the interpretation and usage of BIS monitoring. In general, BIS values of 40-60 are indicative of a state of general anesthesia [10].…”

Section: Methodsmentioning

confidence: 99%

“…The mean BIS score in the BIS visible group was 43.7 (SD 7.59), and 42.2 (SD 7.84) in the BIS blinded group, with a p-value of 0.4935, indicating no significant difference between the groups. Furthermore, the consumption of anesthetic agents may change according to age, so the BIS score by age group [2][3][4][5][6], [7][8][9][10][11][12][13] was summarized and is shown in Table 5. The area under the curve was compared between the two groups, with the BIS visible group having a mean AUC of 6079.5 (SD 4989.49), and the BIS blind group having a mean AUC of 3556.6 (SD 1554.43).…”

Section: Baseline Characteristicsmentioning

confidence: 99%

The Use of Bispectral Index Monitoring Does Not Change Intraoperative Exposure to Volatile Anesthetics in Children

Sullivan

Egbuta

Park

et al. 2020

JCM

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The exposure of infants and children to volatile anesthetics, such as sevoflurane, has been a topic of concern with respect to the potential risk for long term neurocognitive effects. The primary objective of this study was to determine whether the perioperative utilization of Bispectral Index (BIS) monitoring alters the sevoflurane delivery and exposure to children. This is a prospective randomized trial of two groups of healthy ambulatory day surgery patients (2 to 12 years). The patients in both groups had the BIS applied soon after the induction of general anesthesia, but only the anesthesiologists in the group randomized to BIS visible were able to see the BIS values. All of the patients received general anesthesia with sevoflurane. This study found no difference in the overall exposure to sevoflurane between both groups (mean end-tidal sevoflurane level of 1.8 in both groups, P = 084). The duration of time in the recovery room, the time to meet discharge criteria, the Pediatric Agitation Emergence Delirium (PAED) scores and the Face, Legs, Activity, Cry, Consolability (FLACC) scores were not statistically different between the groups. The application and utilization of intraoperative BIS monitoring does not alter the sevoflurane administration nor the discharge readiness nor the recovery profile in healthy ambulatory children.

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Anaesthetic depth and complications after major surgery: an international, randomised controlled trial

Cited by 120 publications

References 26 publications

The cumulative duration of bispectral index less than 40 concurrent with hypotension is associated with 90-day postoperative mortality: a retrospective study

The cumulative duration of bispectral index less than 40 concurrent with hypotension is associated with 90-day postoperative mortality: a retrospective study

Effects of Electroencephalogram Guided Anesthesia on Postoperative Delirium: A Systematic Review and Meta-analysis

The Use of Bispectral Index Monitoring Does Not Change Intraoperative Exposure to Volatile Anesthetics in Children

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