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TECHNOLOGY, COMPUTING, AND SIMULATION

Is Depth of Anesthesia, as Assessed by the Bispectral Index, Related to Postoperative Cognitive Dysfunction and Recovery?

Ehab Farag, MD, FRCA^*, Gordon J. Chelune, PhD, Armin Schubert, MD, MBA^*, and Edward J. Mascha, PhD

From the *Department of General Anesthesiology and Outcomes Research, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, Ohio; Department of Neurology, Center for Alzheimer’s Care, Imaging, and Research, University of Utah, Salt Lake City, Utah; and Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.

Address correspondence and reprint requests to Armin Schubert, MD, MBA, Department of General Anesthesiology, Cleveland Clinic, 9500 Euclid Avenue, E31, Cleveland, Ohio 44195. Address e-mail to schubea{at}ccf.org.

We randomized 74 patients to either a lower Bispectral Index (BIS) regimen (median BIS, 38.9) or a higher BIS regimen (mean BIS, 50.7) during the surgical procedure. Preoperatively and 4–6 wk after surgery, the patients’ cognitive status was assessed with a cognitive test battery consisting of processing speed index, working memory index, and verbal memory index. Processing speed index was 113.7 ± 1.5 (mean ± se) in the lower BIS group versus 107.9 ± 1.4 in the higher BIS group (P = 0.006). No difference was observed in the other two test battery components. Somewhat deeper levels of anesthesia were therefore associated with better cognitive function 4–6 wk postoperatively, particularly with respect to the ability to process information.

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