Bispectral index (BIS) monitoring and postoperative delirium in elderly patients undergoing surgery: A systematic review and meta-analysis with trial sequential analysis
Document Type
Article
Publication Date
12-1-2022
Abstract
Objective: To examine the effect of bispectral index (BIS)-guided anesthesia on the incidence of postoperative delirium (POD) in elderly patients undergoing surgery. Design: A systematic review, meta-analysis, and trial sequential analysis (TSA). Setting: In the operating room, postoperative anesthesia care units (PACU), and ward. Participants: Elderly patients (>60 years old) undergoing surgery. Interventions: The EMBASE, MEDLINE, and CENTRAL databases were searched systematically from their inception until December 2020 for randomized controlled trials comparing BIS and usual care or blinded BIS. Measurements and Main Results: Ten trials (N = 3,891) were included for quantitative meta-analysis. In comparison to the control group, there was no significant difference in the incidence of POD in elderly patients randomized to BIS-guided anesthesia (odds ratio OR] 0.71, 95% CI 0.47-1.08, I2 = 76%, p = 0.11, level of evidence = very low, TSA = inconclusive). The authors' review demonstrated that elderly patients with BIS-guided anesthesia were significantly associated with a lower incidence of postoperative cognitive dysfunction (POCD) (OR 0.64, 95% CI 0.46-0.88, p = 0.006), extubation time (mean difference MD] -3.38 minutes, 95% CI -4.38 to -2.39, p < 0.00001), time to eye opening (MD -2.17 minutes, 95% CI -4.21 to -0.14, p = 0.04), and time to discharge from the PACU (MD -10.77 minutes, 95% CI -11.31 to - 10.23, p < 0.00001). Conclusion: The authors' meta-analysis demonstrated that BIS-guided anesthesia was not associated with a reduced incidence of POD, but it was associated with a reduced incidence of POCD and improved recovery parameters.
Keywords
BIS, Meta-analysis, Postoperative delirium, Postoperative cognitive dysfunction, Elderly, Systematic review
Divisions
anaesthesiology
Funders
None
Publication Title
Journal of Cardiothoracic and Vascular Anesthesia
Volume
36
Issue
12
Publisher
Elsevier
Publisher Location
1600 JOHN F KENNEDY BOULEVARD, STE 1800, PHILADELPHIA, PA 19103-2899 USA