Bispectral index monitoring prevent awareness during total intravenous anesthesia: a prospective, randomized, double-blinded, multi-center controlled trial |
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Authors: | Zhang Chen Xu Liang Ma Ya-Qun Sun Yan-Xia Li Yan-Hong Zhang Liang Feng Chun-Sheng Luo Bing Zhao Zhen-Long Guo Jian-Rong Jin Yao-Jun Wu Gang Yuan Wei Yuan Zhi-Guo Yue Yun |
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Institution: | 1. Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China 2. Department of Anesthesiology, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu 225001, China 3. Department of Anesthesiology, Military General Hospital of Beijing People's Liberation Army, Beijing 100700, China 4. Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China 5. Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China 6. Department of Anesthesiology, Peking University Third Hospital,Beijing 100193, China 7. Department of Anesthesiology, First Hospital of Jilin University,Changchun, Jilin 130021, China 8. Department of Anesthesiology, Guangzhou First Municipal People's Hospital, Guangzhou, Guangdong 510180, China 9. Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China 10. Department of Anesthesiology, Lihuili Hospital, Medical College of Ningbo University, Ningbo, Zhejiang 315041, China 11. Department of Anesthesiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China 12. Department of Anesthesiology, Second Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China 13. Department of Anesthesiology, First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061,China 14. Department of Anesthesiology, First Hospital of China Medical University, Shenyang, Liaoning 110001, China |
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Abstract: | Background Awareness is a serious complication of general anesthesia.In China,the incidence of intraoperative awareness was 1% in patients undergoing total intravenous anesthesia (TIVA).In this study,we compared the incidence of awareness between Bispectral index (BIS)-guided and routine TIVA protocol and evaluated the effect of BIS on preventing awareness.Methods A prospective,randomized,double-blinded,multicenter controlled trial was performed.Patients (≥18 years of age) undergoing TIVA were randomly divided into BIS-guided group (Group A,BIS was monitored and recommended to maintain between 40-60) and control group (Group B,BIS was monitored but the screen was covered).The intraoperative BIS values were downloaded and the BIS trends of confirmed awareness cases were analyzed to determine whether light anesthesia existed.Results Of the total 5228 patients,2919 patients were assigned to Group A and 2309 to Group B.Four cases of confirmed awareness (0.14%) were reported in the BIS-guided group and 15 (0.65%) in the control group (P=0.002,OR=0.21,95% confidence intervals:0.07-0.63).The incidence of possible awareness (0.14% vs.0.26%,P=0.485) and dreaming (3.1% vs.3.1%,P=0.986) was comparable between BIS-guided group and the control group.Among the 19 confirmed awareness cases,intraoperative BIS trends of six cases were downloaded and identified.Five of them showed signs of light anesthesia as BIS >60 and lasted 19-106 minutes,whereas one case had a stable BIS trend and the values were within 60 during the operation.Another five awareness cases were reviewed for anesthesia procedures,of which improper light anesthesia were confirmed.Conclusions BIS-guided TIVA (BIS was recommended to maintain between 40-60) decreased the risk of awareness compared with routine TIVA.The main reason for awareness was light anesthesia. |
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Keywords: | awareness complications general anesthesia monitoring bispectral index |
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