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Effect of BIS-guided anesthesia on emergence delirium following general anesthesia in children: A prospective
Michal Frelich1, Karolína Lečbychová2, Vojtěch Vodička2
1Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Ostrava, Czechia; Department of Intensive Medicine, Emergency Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Czechia.
Insights
Monitoring anesthesia depth with BIS effectively reduced emergence delirium in children undergoing adenoidectomy. This method lowered the incidence and severity of emergence delirium (ED) during PACU stay, improving postoperative recovery.
Area of Science:
- Pediatric Anesthesia
- Neuroanesthesia
- Postoperative Complications
Background:
- Emergence delirium (ED) is a common postoperative complication in pediatric anesthesia, impacting recovery.
- Inhalation anesthesia is linked to a higher incidence of ED.
- Clinical Trial Registration: NCT04466579.
Purpose of the Study:
- To investigate if titrating general anesthesia depth using a BIS monitor can reduce the incidence of ED in pediatric patients.
- To compare ED occurrence and severity between BIS-guided anesthesia and standard MAC-based anesthesia.
Main Methods:
- Randomized, prospective, double-blind study involving 163 children aged 3-8 years undergoing endoscopic adenoidectomy.
- Intervention group: Anesthesia depth guided by BIS values (40-60). Control group: Anesthesia guided by MAC and end-tidal concentration.
- Primary outcome: ED occurrence during PACU stay. Secondary outcomes: PAED scores at 10 and 30 minutes, need for rescue treatment.
Main Results:
- ED incidence was significantly lower in the BIS-guided group (12.8%) compared to the control group (35.1%) (p=0.001).
- BIS monitoring resulted in lower PAED scores at 10 and 30 minutes post-anesthesia (p<0.001).
- No significant difference was observed in the need for rescue treatment between the groups (p=0.067).
Conclusions:
- Individualizing anesthesia depth with BIS monitoring is an effective strategy for preventing emergence delirium in pediatric patients.
- BIS monitoring offers a valuable tool for optimizing anesthetic management and improving postoperative outcomes in children.
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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