Titration of volatile anesthetics using bispectral index facilitates recovery after ambulatory anesthesia

Dajun Song, Girish P. Joshi, Paul F. White

Research output: Contribution to journalArticle

335 Citations (Scopus)

Abstract

Background: The bispectral (BIS) index has previously been shown to be a quantifiable measure of the sedative and hypnotic effects of anesthetic drugs. This study was designed to assess the effect of BIS monitoring on the utilization of volatile anesthetics and their recovery profiles after ambulatory surgery. Methods: Sixty consenting women undergoing outpatient laparoscopic tubal ligation procedures were randomly as-signed to one of four treatment groups. After a standardized induction, anesthesia was maintained with either desflurane (Groups I and II) or sevoflurane (Groups III and IV) in combination with nitrous oxide, 65%, and fentanyl. In the control groups (Groups I and III), the anesthesiologists were blinded to the BIS value, and the volatile anesthetics were administered according to standard clinical practice. In Groups II and IV, the volatile anesthetics were titrated to maintain the BIS value at 60. The volatile anesthetic usage and the times from discontinuation of anesthesia to verbal response, orientation, and home- readiness were recorded. Results: During the maintenance period, the BIS values were significantly lower in the control groups (mean, 42) compared with the BIS-titrated groups (mean, 60). The volatile anesthetic usage in the BIS-titrated groups was 30-38% lower (P < 0.05) compared with the control groups. Similarly, the times to verbal responsiveness were 30-55% shorter in the BIS-titrated (vs. control) groups. Conclusions: Titrating desflurane and sevoflurane using the BIS monitor decreased their utilization and contributed to a faster emergence from anesthesia in outpatients undergoing laparoscopic tubal ligation procedures.

Original languageEnglish (US)
Pages (from-to)842-848
Number of pages7
JournalAnesthesiology
Volume87
Issue number4
DOIs
StatePublished - Oct 1997

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Anesthetics
Anesthesia
Tubal Sterilization
Control Groups
Hypnotics and Sedatives
Outpatients
Nitrous Oxide
Fentanyl
Ambulatory Surgical Procedures
Maintenance
desflurane
sevoflurane
Therapeutics

Keywords

  • Anesthesia, general
  • Anesthetic outcome, recovery
  • Anesthetics, inhalation; desflurane
  • Bispectral analysis
  • Monitoring, electroencephalography
  • Sevoflurane

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Titration of volatile anesthetics using bispectral index facilitates recovery after ambulatory anesthesia. / Song, Dajun; Joshi, Girish P.; White, Paul F.

In: Anesthesiology, Vol. 87, No. 4, 10.1997, p. 842-848.

Research output: Contribution to journalArticle

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abstract = "Background: The bispectral (BIS) index has previously been shown to be a quantifiable measure of the sedative and hypnotic effects of anesthetic drugs. This study was designed to assess the effect of BIS monitoring on the utilization of volatile anesthetics and their recovery profiles after ambulatory surgery. Methods: Sixty consenting women undergoing outpatient laparoscopic tubal ligation procedures were randomly as-signed to one of four treatment groups. After a standardized induction, anesthesia was maintained with either desflurane (Groups I and II) or sevoflurane (Groups III and IV) in combination with nitrous oxide, 65{\%}, and fentanyl. In the control groups (Groups I and III), the anesthesiologists were blinded to the BIS value, and the volatile anesthetics were administered according to standard clinical practice. In Groups II and IV, the volatile anesthetics were titrated to maintain the BIS value at 60. The volatile anesthetic usage and the times from discontinuation of anesthesia to verbal response, orientation, and home- readiness were recorded. Results: During the maintenance period, the BIS values were significantly lower in the control groups (mean, 42) compared with the BIS-titrated groups (mean, 60). The volatile anesthetic usage in the BIS-titrated groups was 30-38{\%} lower (P < 0.05) compared with the control groups. Similarly, the times to verbal responsiveness were 30-55{\%} shorter in the BIS-titrated (vs. control) groups. Conclusions: Titrating desflurane and sevoflurane using the BIS monitor decreased their utilization and contributed to a faster emergence from anesthesia in outpatients undergoing laparoscopic tubal ligation procedures.",
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