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TECHNOLOGY, COMPUTING, AND SIMULATION

Bispectral Index-Guided General Anesthesia in Combination with Thoracic Epidural Analgesia Reduces Recovery Time in Fast-Track Colon Surgery

Jochen Mayer, MD^*, Joachim Boldt, MD, PhD^*, Alexander Schellhaaß, MD^*, Björn Hiller, MD, and Stefan W. Suttner, MD^*

From the *Department of Anesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Germany and Department of General Surgery, Klinikum Ludwigshafen, Germany.

Address correspondence to: Dr. Jochen Mayer, Department of Anesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Bremserstr. 79, 67063 Ludwigshafen, Germany. Address e-mail to j-mayer{at}gmx.de.

BACKGROUND: The impact of bispectral index (BIS)-guided general anesthesia on recovery from general anesthesia has been evaluated in different patient populations. The benefit of using BIS has been inconsistent. We designed this study to examine the value of BIS-guided anesthesia in a fast-track setting where the goal is rapid recovery.

METHODS: Forty-four patients undergoing open colon resection were randomly assigned to receive either BIS-guided (BIS group, n = 22) or clinically guided (standard care group, n = 22) total IV anesthesia with propofol after placing a thoracic epidural catheter. Duration of postanesthesia care unit stay, time to tracheal extubation, direct drug cost, the incidence of hemodynamic abnormalities, ability of ambulation on the day of surgery, and patient satisfaction with anesthetic management were assessed.

RESULTS: In the BIS-guided group, tracheal extubation was achieved significantly earlier (7.6 vs. 15.4 min, P < 0.01) and the postanesthesia care unit stay was significantly shorter (51 vs. 85 min, P < 0.01). Total anesthetic drug cost was reduced by 23% and the incidence of hypotension requiring treatment was significantly lower in the BIS group. Early ambulation, patient satisfaction, and incidence of adverse events were not significantly different between the groups.

CONCLUSIONS: BIS-guided IV anesthesia in combination with thoracic epidural analgesia facilitates rapid recovery and reduces the overall cost of care in patients undergoing fast-track colon surgery.