PRISMA: accuracy of response entropy and bispectral index to predict the transition of consciousness during sevoflurane anesthesia

Background: Bispectral index (BIS) and response entropy (RE) are used to monitor the depth of anesthesia. Objectives: To collect published data and compare the accuracy of BIS and RE in detecting the transition of consciousness during sevoflurane anesthesia. Data sources: Studies indexed in the PubMed, Embase, or Cochrane databases. Study eligibility criteria: Participants: Patients who need to use BIS and RE to monitor sevoflurane anesthesia depth simultaneously. Interventions: A random-effects model was fitted using RevMan 5.3. Subgroup analyses were performed on patient age. The Cochrane I 2 methodology was used to determine the heterogeneity of the statistical results, while GRADE Pro served to assess the quality of evidence. Results: Overall, 195 articles were identified, of which 7 were finally included. The meta-analysis results showed that BIS is more accurate than RE in predicting loss of consciousness (LOC) during sevoflurane anesthesia (MD, .06; 95% confidence interval [CI], .02–.09; P = .009; I 2 = 92%). In contrast, there was no significant difference between BIS and RE for recovery of consciousness (ROC; MD, .01; 95% CI, .00–.02; P = .79; I 2 = 83%). Subgroup analyses revealed no significant differences in LOC (MD, .02; 95% CI, .01–.05; P = .13; I 2 = 60%) and ROC (MD, −.01; 95% CI, −.06–.04; P = .58; I 2 = 95%) in children. However, the results in adults demonstrated that BIS is more accurate than RE in predicting LOC (MD, −.07; 95% CI, .05–.10; P = .002; I 2 = 76%). Limitations: First, this meta-analysis was affected by a large study heterogeneity. Second, this analysis only included publications in English, therefore, some studies may have been omitted. Conclusion: BIS is more accurate than RE in predicting LOC during sevoflurane anesthesia in adults. However, no significant differences were identified in children. Registration number (PROSPERO): CRD42020163119