Anaesthesia, critical care & pain medicine · 2025
Bispectral index-guided anesthesia in children: A systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
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de Oliveira Dora Alexandra Carreira, Dos Santos Monteiro Júlia, de Macêdo Nickolas Ricardo, Tavares Costa Santos Arthur Henrique, Rosa Neves Sílvia Maria
Аннотация
INTRODUCTION: The bispectral index (BIS) parameter is used to guide the titration of general anesthesia; however, many studies have shown conflicting results regarding its benefits in children. We aimed to perform a systematic review and meta-analysis to determine whether BIS is advantageous for pediatric patients undergoing general anesthesia.
METHODS: PubMed, Embase, and Cochrane Library were systematically searched for randomized controlled trials (RCTs) comparing BIS-guided anesthesia vs. general anesthesia guided only by clinical parameters in children undergoing surgeries. We computed mean difference (MD) for continuous outcomes and risk ratio (RR) for binary outcomes, with 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics. Statistical analyses were performed using R Software, version 4.2.3.
RESULTS: We included 10 RCTs, comprising 1028 participants, of whom 536 (52%) underwent BIS-guided general anesthesia. Compared with general anesthesia guided solely by clinical parameters, BIS was associated with a lower time for airway device removal (MD -1.32 min; 95% CI -2.26 to -0.37; p < 0.01), recovery time (MD -2.67 min ; 95% CI -3.70 to -1.65; p < 0.01), PACU stay duration (MD -5.51 min; 95% CI -10.64 to -0.38; p = 0.04), and ET sevoflurane concentration (MD -0.49%; 95% CI -0.67 to -0.32; p < 0.01). The BIS guided group also showed a significantly longer time with an adequate BIS compared with the standard care group (MD 22.49%; 95% CI 17.80-27.18; p < 0.01). There were no differences between groups in anesthetic consumption, mean BIS during anesthesia, Pediatric Anesthesia Emergence Delirium (PAED) score at 10 min, and at 30 min.
CONCLUSIONS: In children, BIS monitoring during general anesthesia limited the exposure to volatile anesthetics and is associated with better recovery outcomes.
REGISTRATION: PROSPERO database under protocol number CRD42024607202 (https://www.crd.york.ac.uk/PROSPERO/view/CRD42024607202).
METHODS: PubMed, Embase, and Cochrane Library were systematically searched for randomized controlled trials (RCTs) comparing BIS-guided anesthesia vs. general anesthesia guided only by clinical parameters in children undergoing surgeries. We computed mean difference (MD) for continuous outcomes and risk ratio (RR) for binary outcomes, with 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics. Statistical analyses were performed using R Software, version 4.2.3.
RESULTS: We included 10 RCTs, comprising 1028 participants, of whom 536 (52%) underwent BIS-guided general anesthesia. Compared with general anesthesia guided solely by clinical parameters, BIS was associated with a lower time for airway device removal (MD -1.32 min; 95% CI -2.26 to -0.37; p < 0.01), recovery time (MD -2.67 min ; 95% CI -3.70 to -1.65; p < 0.01), PACU stay duration (MD -5.51 min; 95% CI -10.64 to -0.38; p = 0.04), and ET sevoflurane concentration (MD -0.49%; 95% CI -0.67 to -0.32; p < 0.01). The BIS guided group also showed a significantly longer time with an adequate BIS compared with the standard care group (MD 22.49%; 95% CI 17.80-27.18; p < 0.01). There were no differences between groups in anesthetic consumption, mean BIS during anesthesia, Pediatric Anesthesia Emergence Delirium (PAED) score at 10 min, and at 30 min.
CONCLUSIONS: In children, BIS monitoring during general anesthesia limited the exposure to volatile anesthetics and is associated with better recovery outcomes.
REGISTRATION: PROSPERO database under protocol number CRD42024607202 (https://www.crd.york.ac.uk/PROSPERO/view/CRD42024607202).