Depth of anesthesia measured by bispectral index and postoperative mortality: A meta-analysis of observational studies

Liu, Yuhua; Qiu, Dongjie; Li, Jia; Tan, Juntao; Kang, Jin-Meng; Xie, Tian; Xu, Hongmeng

doi:10.1016/j.jclinane.2019.01.046

Cited by 22 publications

(20 citation statements)

References 37 publications

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“…Two meta-analyses proposed relationship between low BIS value alone and 90-day or 1-year postoperative mortality, not 30-day postoperative mortality [19,20]. On the other hand, other previous studies reported that double low was associated with 30-day postoperative mortality [9,13] or 90-day postoperative mortality [12,14].…”

Section: Discussionmentioning

confidence: 96%

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: Discussionmentioning

confidence: 96%

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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“…The BIS is a complex parameter composed of a combination of time domain, frequency domain and high order spectral subparameters. It is a unique quantitative electroencephalogram parameter (QEEG) which integrates several disparate descriptors of the EEG into a single variable based on a large volume of clinical data, to synthesize a combination that correlates behavioral assessments of sedation and hypnosis yet insensitive to the specific anesthetic agents chosen [2]. During the surgery, crystalloid and colloid fluids were infused according to the following protocol: continuous infusion of crystalloid at a rate of [10 9 body weight (kg)] ml/h, interventional colloid infusion to preserve normovolemia (stroke volume variation (SVV) \ 12) compensatory to the volume of blood loss.…”

Section: Patientsmentioning

confidence: 99%

“…Providing an adequate level of anaesthesia is challenging and requires careful monitoring and dose titration. Especially in the light of recent studies which have suggested that ''too deep'' anesthesia may increase long-term postoperative mortality in cardiac surgery patients [1,2]. Therefore understanding the pharmacokinetics and pharmacodynamics (PK/PD) of drugs used in anesthesia is crucial, especially for rarely studied groups of patients or conditions.…”

Section: Introductionmentioning

confidence: 99%

The influence of cardiac output on propofol and fentanyl pharmacokinetics and pharmacodynamics in patients undergoing abdominal aortic surgery

Bienert

Sobczyński

Młodawska

et al. 2020

J Pharmacokinet Pharmacodyn

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Cardiac output (CO) is expected to affect elimination and distribution of highly extracted and perfusion rate-limited drugs. This work was undertaken to quantify the effect of CO measured by the pulse pressure method on pharmacokinetics and pharmacodynamics of propofol and fentanyl administrated during total intravenous anesthesia (TIVA). The data were obtained from 22 ASA III patients undergoing abdominal aortic surgery. Propofol was administered via target-controlled infusion system (Diprifusor) and fentanyl was administered at a dose of 2-3 lg/kg each time analgesia appeared to be inadequate. Hemodynamic measurements as well as bispectral index were monitored and recorded throughout the surgery. Data analysis was performed by using a non-linear mixed-effect population modeling (NONMEM 7.4 software). Three compartment models that incorporated blood flows as parameters were used to describe propofol and fentanyl pharmacokinetics. The delay of the anesthetic effect, with respect to plasma concentrations, was described using a biophase (effect) compartment. The bispectral index was linked to the propofol and fentanyl effect site concentrations through a synergistic E max model. An empirical linear model was used to describe CO changes observed during the surgery. Cardiac output was identified as an important predictor of propofol and fentanyl pharmacokinetics. Consequently, it affected the depth of anesthesia and the recovery time after propofol-fentanyl TIVA infusion cessation. The model predicted (not observed) CO values correlated best with measured responses. Patients' age was identified as a covariate affecting the rate of CO changes during the anesthesia leading to age-related difference in individual patient's responses to both drugs.

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“…The bispectral index mainly reflects the excited or inhibited state of the cerebral cortex and the information of sedation and hypnosis, which is not only closely related to healthy physiological sleep but also can well monitor the sedative components in the depth of anesthesia. [ 1 – 3 ] The appropriate depth of anesthesia is beneficial to the perioperative period's safety and the reduction of postoperative complications. [ 4 ] Target - controlled infusion (TCI) is divided into open - loop systems and closed-loop systems.…”

Section: Introductionmentioning

confidence: 99%

Bispectral index monitoring of the clinical effects of propofol closed-loop target-controlled infusion

et al. 2021

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Background: To investigate whether closed-loop systems under bispectral index anesthesia depth monitoring can reduce the intraoperative propofol dosage. Methods: All randomized controlled trials (RCTs) on reducing propofol dosage under closed-loop systems were collected, and the literature was screened out, the abstracts and full texts were carefully read, and the references were tracked, data extraction and quality evaluation were conducted on the included research, and the RevMan5.3 software was used for meta-analysis. The main results were propofol and the incidence of adverse reactions such as hypertensive hypotension and postoperative cognitive dysfunction. A total of 879 cases were included in 8 articles, including 450 occurrences in the closed-loop system group and 429 cases in the open-loop system group. Results: Compared with manual control, closed-loop systems under bispectral index anesthesia depth monitoring reduced the dose of propofol (MD: −0.62, 95% CI: −1.08–−0.16, P = .008), with heterogeneity ( I 2 = 80%). Closed-loop systems significantly reduced the incidence of abnormal blood pressure (MD: −0.02, 95%CI: −0.05–0.01, P = .15, I 2 = 74%) and postoperative cognitive dysfunction (MD: −0.08, 95% CI: −0.14 −0.01, P = .02, I 2 = 94%). Conclusion: Bispectral index monitoring of propofol closed-loop target-controlled infusion system can reduce the amount of propofol, reduce the incidence of adverse reactions such as hypertensive or hypotension and postoperative cognitive dysfunction.

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Depth of anesthesia measured by bispectral index and postoperative mortality: A meta-analysis of observational studies

Cited by 22 publications

References 37 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

The influence of cardiac output on propofol and fentanyl pharmacokinetics and pharmacodynamics in patients undergoing abdominal aortic surgery

Bispectral index monitoring of the clinical effects of propofol closed-loop target-controlled infusion

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