Frelich M, Lečbychová K, Vodička V, Ekrtová T, Sklienka P, Jor O, Straková H, Bílená M, Formánek M, Burša F. Effect of BIS-guided anesthesia on emergence delirium following general anesthesia in children: A prospective randomized controlled trial.
Anaesth Crit Care Pain Med 2024;
43:101318. [PMID:
37918790 DOI:
10.1016/j.accpm.2023.101318]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE
Emergence delirium (ED) is a postoperative complication in pediatric anesthesia characterized by a perception and psychomotor disorder, with a negative impact on postoperative recovery. As the use of inhalation anesthesia is associated with a higher incidence of ED, we investigated whether titrating the depth of general anesthesia with BIS monitor can reduce the incidence of ED.
DESIGN
Randomized, prospective, and double-blind.
SETTING
Patients undergoing endoscopic adenoidectomy under general anesthesia according to a uniform protocol.
PATIENTS
A total of 163 patients of both sexes aged 3-8 years were enrolled over 18 months.
INTERVENTIONS
Immediately after the induction of general anesthesia, a bispectral index (BIS) electrode was placed on the patient's forehead. In the study group, the depth of general anesthesia was monitored with the aim of achieving BIS values of 40-60. In the control group, the dose of sevoflurane was determined by the anaesthesiologist based on MAC (minimum alveolar concentration) and the end-tidal concentration.
MEASUREMENTS
The primary objective was to compare the occurrence of ED during the PACU (post-anesthesia care unit) stay in both arms of the study. The secondary objective was to determine the PAED score at 10 and 30 min in the PACU and the need for rescue treatment of ED.
MAIN RESULTS
86 children were randomized in the intervention group and 77 children in the control group. During the entire PACU stay, 23.3% (38/163) of patients developed ED with PAED score >10: 35.1% (27/77) in the control group and 12.8% (11/86) in the intervention group (p = 0.001). Lower PAED scores were also found in the intervention group at 10 (p < 0.001) and 30 (p < 0.001) minutes compared to the control group. The need for rescue treatment did not differ between groups (p = 0.067).
CONCLUSION
Individualization of the depth of general anesthesia with BIS monitoring is an effective method of preventing ED in children.
CLINICAL TRIAL REGISTRATION
NCT04466579.
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