Bispectral Index-guided Anesthesia for Older Patients Having Noncardiac Surgery: A Randomized Multicenter Trial.

Area of Science:

• Anesthesiology
• Geriatric Surgery
• Clinical Trials

Background:

• Older surgical patients face increased risks due to age-related physiological changes and comorbidities.
• Guidelines suggest Bispectral Index (BIS) monitoring to optimize anesthetic depth, but evidence for improved outcomes is limited.

Purpose of the Study:

• To evaluate the impact of Bispectral Index (BIS)-guided anesthetic management on 1-year all-cause mortality in older adults undergoing elective noncardiac surgery.

Main Methods:

• A randomized, multicenter, double-blind trial involved 6,982 patients aged 65+ years.
• Patients were assigned to either BIS-guided (target BIS 40-60) or routine anesthetic management.
• Primary outcome was 1-year all-cause mortality; secondary outcomes included 30-day complications, functional independence, and quality of life.

Main Results:

• One-year mortality rates were similar: 10.2% in the BIS-guided group and 10.0% in the routine group (P=0.812).
• 30-day complication rates were also comparable (10.4% vs. 10.6%, P=0.938).
• No significant differences were found in functional independence or quality of life between the groups.

Conclusions:

• Anesthesiologists appear to manage hypnotic depth effectively without BIS guidance, maintaining similar levels in both groups.
• BIS monitoring did not lead to improved postoperative outcomes, including mortality and complications, in this patient population.