Impact of Bispectral Index for monitoring propofol remifentanil anaesthesia. A randomised clinical trial

Background: Previous research has shown that the use of the bispectral index (BIS) monitor to measure the depth of anaesthesia reduces the amount of anaesthetics administered and the recovery time from general anaesthesia. The effect of BIS on recovery from anaesthesia and consumption of anaesthetics in a paediatric population receiving total intravenous anaesthesia (TIVA) with propofol and remifentanil has not been studied. Methods: A single-blind, single-centre clinical trial. One hundred fifty-seven patients were enrolled. They were scheduled for ear, nose, and throat surgery and stratified according to age groups (1-3 years, 4-11 years, 12-17 years, 18-65 years) and type of operation, yielding a total of nine subgroups. Patients were randomly allocated to receive either a TIVA with propofol and remifentanil according to conventional clinical practice (control) or guided by BIS. Normalised propofol (g/kg/min) and remifentanil (g/kg/min) consumption and time to extubation (s) were the outcome measures. Results: Children aged 1-3 years in the BIS group had a longer time to extubation compared with controls (P: 0.04). Patients aged 12-17 years in the BIS group received higher maintenance infusion rates of propofol compared with controls (P=0.02). No significant difference for the outcome variables was evidenced in the other age groups. Conclusion: BIS monitoring for guidance of propofol-remifentanil anaesthesia does not result in reduced consumption of anaesthetics and does not reduce time to extubation in adult and children compared with conventional practice. (Clinicaltrials.gov identifier: NCT01043952; http://clinicaltrials.gov/ct2/show/NCT01043952)