Key result
Bispectral index-guided total intravenous anesthesia in high-risk children did not significantly reduce the time to extubation (median 15 vs 14 minutes, p=0.995) compared to standard clinical practice.
Why the study?
Total intravenous anesthesia is widely used in children, but few studies have evaluated the effect of bispectral index (BIS)-guided propofol infusion compared with conventional methods on recovery outcomes in children with higher risk factors.
Does BIS-guided total intravenous anesthesia reduce extubation time and PACU stay in high-risk children undergoing surgery?
RCT (n=414)
Single-blind
Stratified block randomization
No
Does BIS-guided total intravenous anesthesia reduce extubation time and PACU stay in high-risk children undergoing surgery?
Absolute Event Rate: 15% vs 14%
p-value: p=0.995
BIS-guided total intravenous anesthesia in high-risk children maintains appropriate anesthesia depth without prolonging extubation time, though it increases total propofol consumption compared to standard clinical practice.
BIS guidance offers no recovery benefit over conventional TIVA in high-risk children; challenges routine use assumptions in this population.
BACKGROUND TIVA is widely used in children, but few studies have attempted to evaluation of the effect of BIS-guided propofol infusion than that on conventional methods on recovery outcomes in children with higher risk factors. OBJECTIVE To evaluate the effect of bispectral index (BIS) guidance during total intravenous anesthesia on post-anesthetic recovery outcomes in children at higher risk during anesthesia. DESIGN A prospective, randomized, controlled trial. SETTING University medical centre. PATIENTS This study enrolled 472 children (aged 1-14 years) who met the higher-risk scoring criteria and were scheduled for surgery under total intravenous anesthesia. INTERVENTION The children were randomly assigned to the BIS group (group B) and standard clinical practice group (group S). The BIS values in group B were maintained at 45–60. The anesthesiologist controlled the depth of anesthesia in group S according to the variation in the clinical signs of the children. MAIN OUTCOME MEASURES BIS values, heart rate (HR), mean arterial pressure (MAP), and pulse oxygen saturation at each time points, as well as the time between drug withdrawal to extubation, duration of stay in the post-anesthesia care unit (PACU), the total amount of propofol used, and postoperative adverse reactions were recorded. RESULTS There was no significant difference in time from stopping propofol infusion to extubation and duration of PACU between the groups . There was no significant difference in BIS values between the groups at T2, T3, and T8. BIS values at T1, T4, T5, T6, and T7 in group B were lower than those in group S. There was no statistically significant difference in the HR between the groups. MAP in group B was lower than in group S at T5, T6, T7, and T8. The total amount of propofol administered in group B was higher than in group S. CONCLUSION The use of BIS-guided total intravenous anesthesia in higher-risk children can maintain the proper depth of anesthesia but does not prolong the time of extubation and the duration of stay in the PACU. TRIAL REGISTRATION Chictr.org.cn identifier: 24/11/2017 , ChiCTR-IOR-17013530
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Liu et al. (2021) conducted an RCT in High-risk children undergoing elective surgery (n=414). Bispectral index (BIS)-guided total intravenous anesthesia vs. Standard clinical practice (TIVA guided by clinical signs) was evaluated on Time of extubation (minutes) (p=0.995). Bispectral index-guided total intravenous anesthesia in high-risk children did not significantly reduce the time to extubation (median 15 vs 14 minutes, p=0.995) compared to standard clinical practice.
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