Optimal Anesthetic Depth for Pediatric Dental Surgery: A Randomized Trial Confirming BIS 60 Efficacy via Closed-Loop TCI.

OBJECTIVE

This study evaluated the optimal depth of anesthesia guided by closed-loop target-controlled infusion (TCI) in preschool-aged children undergoing dental surgery. Dental procedures in this population are frequently associated with heightened anxiety and procedural distress, often necessitating general anesthesia; however, the appropriate depth of anesthesia remains insufficiently defined.

METHODS

A randomized, double-blind, controlled trial was conducted involving 60 children aged 3 to 6 years scheduled for dental surgery. Participants were allocated to 3 groups (A, B, and C), with bispectral index (BIS) values maintained at 50, 55, and 60, respectively, using a closed-loop TCI system. The primary outcomes were heart rate (HR) and mean arterial pressure (MAP), recorded at 7 intraoperative time points. Secondary outcomes included surgical duration, time to first eye opening (defined as eyelid movement in response to verbal command without implying full orientation), extubation time, discharge time, and total propofol dose.

RESULTS

No statistically significant differences were observed among groups in HR or MAP at any intraoperative time point (between-subject effect: HR, F=2.73, P =0.074; MAP, F=1.54, P =0.222). Surgical duration (F=0.521, P =0.596) and total propofol dosage ( P =0.165) also did not differ significantly. Recovery parameters demonstrated significant group differences. Time to first eye opening was 37.75±8.81 minutes in group A, 28.35±2.45 minutes in group B, and 20.70±5.21 minutes in group C ( P <0.001). Extubation time was 39.40±8.08 minutes, 29.60±2.58 minutes, and 22.70±5.63 minutes in groups A, B, and C, respectively ( P <0.001). Discharge time was shortest in group C (135.6±30.9 min), followed by group B (160.5±25.3 min), and longest in group A (202.5±26.5 min) (F=29.77, P <0.001). The incidence of adverse events was comparable across groups, and no serious adverse events occurred.

CONCLUSIONS

Maintaining a BIS value of 60 (±5) with a closed-loop infusion system provided adequate anesthetic depth for dental procedures in preschool-aged children, while significantly reducing recovery and discharge times. This anesthetic strategy may support enhanced recovery and improve perioperative efficiency in pediatric populations.